Zuckerersatzstoffe – sichere Alternativen oder mögliche Risikoträger?

Zusammenfassung

Hoher Zuckerkonsum trägt nicht nur zur Karies, sondern über metabolische Folgen wie Adipositas und Typ-2-Diabetes auch zum kardiovaskulären Risiko bei. Alternative Zucker und Zuckerersatzstoffe wie Süßstoffe und Zuckeraustauschstoffe sollen diese Risiken reduzieren. Unter den Zuckervarianten ist bislang kein wirklich gesunder Kandidat ermittelbar. Süßstoffe sind heterogene, intensiv süß schmeckende Substanzen, die vor allem in kalorienreduzierten Getränken verwendet werden. Zuckeraustauschstoffe – also Zuckeralkohole – sind etwa halb bis ebenso süß wie normaler Zucker und stecken überwiegend in festen Lebensmitteln.
Epidemiologisch ist der Verzehr von Zucker, aber auch von Zuckerersatzstoffen, mit Adipositas, Typ-2-Diabetes, kardiovaskulären Erkrankungen und Krebs assoziiert. Diese Beobachtungsdaten sind jedoch durch starke Confounder (andere Lebensstilfaktoren) und „Reverse Causality“ massiv verzerrt.
In methodisch gut kontrollierten (verblindeten) Studien (RCT) bewirken Süßstoffe und Zuckeraustauschstoffe gegenüber Zucker eine signifikante Reduktion von anthropometrischen und einigen glykämischen Markern, gegenüber Wasser gibt es keinen Vorteil. Tauscht man Zucker durch Zuckerersatz aus, so ist der Gewichtsverlust geringer, als anhand der Kalorienersparnis zu erwarten ist. Süßstoffe und Zuckeraustauschstoffe bieten noch offene Forschungsfragen zu Verhaltenseffekten, Veränderungen des Darmmikrobioms oder der hormonellen Stoffwechselregulation und zu möglichen rheologischen Phänomenen.
Was ist wichtig
Unter allen Süßungsmitteln sind die verschiedenen, haushaltsüblichen Zucker eindeutig die schlechtere Wahl. Süßstoffe und Zuckeraustauschstoffe sind durch methodisch unzureichende Beobachtungsstudien stark in Verruf geraten, schneiden aber in randomisiert-kontrollierten Studien besser ab als Zucker. Gerade mechanistische Fragen zu Stoffwechsel und Hormonsystem, Darmmikrobiom und Gerinnungskaskaden müssen endlich in naher Zukunft durch hochwertige Testreihen geklärt werden.

Abstract

High sugar intake contributes to tooth decay, but also (via metabolic sequelae such as obesity and type 2 diabetes) to cardiovascular risk. Alternative sugars, sweeteners and sugar alcohols are used in order to reduce these risks. Among widely investigated non-sucrose sugars, up to now no clearly recommendable candidate has arisen. Sweeteners are chemically, taste-wise and biologically heterogeneous compounds with intensive sweetness, usually found in low-calorie beverages. Sugar alcohols are half as or just as sweet as sugar; they are often used in solid food stuffs.
In epidemiological studies, the intake of non-caloric sweeteners and sugar alcohols is consistently associated with obesity, type 2 diabetes, cardiovascular disease and cancer. Strong confounders (unhealthy lifestyle in every aspect) or “reverse causality” reduce the level of evidence from these kinds of studies.
In blinded randomised-controlled trials (RCT), sugar alternatives lead to a significant reduction of anthropometric outcomes and some glycemic parameters. When compared to water, sugar replacements provide no relevant benefit. When replacing sugar with low-calorie alternatives, weight loss effect is way smaller than expected on the basis of reduced energy intake. Sweeteners and sugar alcohols require further research with respect to behavioral effects, changes in the gut microbiome, the hormonal metabolic regulation and rheologic phenomena.
What is important
Among all kinds of sweetening agents, the variety of conventional sugars is clearly the worst option. Sugar replacements such as sweeteners and sugar alcohols were deemed dangerous on the basis of methodologically limited observational studies. However, in randomised controlled trials their cardiometabolic impact is better compared to sugars. Mechanistic questions regarding metabolism and hormone system, gut microbiom and coagulation need to be answered finally and quickly with high-quality clinical trials.

Schlüsselwörter

Süßstoffe - Zuckeraustauschstoffe - Adipositas - KHK - Epidemiologie - RCT

Keywords

CVD - epidemiology - RCT - sweeteners - sugar alcohols - obesity

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