Does sucralose cause headaches

Is Sucralose a Dangerous Sugar Substitute?

Sugar, the ingredient that is on everyone’s mind. In the United States more than one-third of adults are obese and dietary guidelines are cracking down on added sugar. Sugar substitutes have become an increasingly popular option for people who want sweets without the additional calories. In 2015 the sugar substitute business was valued at over 13 billion dollars and continues to grow.1 Sucralose is a widely used sugar substitute that is considered safe by the U.S Food & Drug Administration (FDA) but recent research is challenging the safety of sucralose.

Like many artificial sweeteners sucralose was discovered by accident in a laboratory. In 1976 Tate & Lyle and the Queen Elizabeth College in London were conducting a joint research project that involved chemically modifying sugar. One of the researchers misunderstood “test” for “taste” and by accident sucralose was discovered.1

Sucralose is marketed under the brand name “Splenda” and is commonly seen on tables in little yellow packets. Beyond those packets sucralose is used in thousands of food and beverage products, from baked goods to beverages, and the number of products is steadily climbing. If you were to check your pantry or refrigerator it wouldn’t be surprising to find “sucralose” or “Splenda” in the ingredient list of food and beverage items.

Although sucralose is made from sugar it is not a natural product. Sucralose is produced by a multi-step patented chemical process that replaces three hydrogen-oxygen groups with three chlorine atoms. The replacement with chlorine atoms intensifies the sweetness to 600 times more than table sugar and contain zero calories.3

In 1999 The U.S. Food and Drug Administration (FDA) approved sucralose as safe for human consumption as a general sweetener.4 However, there is conflicting research on the safety of sucralose. Some of the potential negative effects of sucralose include:

Sucralose may increase blood glucose and insulin levels: Sucralose may negatively affect the very people who are using it to decrease sugar consumption and stabilize blood glucose levels. A study found that sucralose increased blood glucose levels and insulin levels while decreasing insulin sensitivity.5 This could negatively affect people, especially those with diabetes, who consume sucralose to try to manage their blood glucose levels.

Sucralose and gut health: Gastrointestinal health, gut health, has become a topic of great interest. It’s no surprise that our bodies and gastrointestinal (GI) tract are home to more bacteria than we have cells in our body. We tend to think of bacteria as something to avoid but bacteria also play a beneficial role in our health. A large portion of our immune system is located in the GI tract and beneficial bacteria play a major role in a healthy immune system. A study on sucralose and the GI microbiome found that sucralose altered the gut microbiome by decreasing beneficial bacteria by up to 50%. Additionally, they found that 12 weeks after the study the beneficial bacteria in the GI tract had not recovered. Which means that even after sucralose was no longer being consumed the GI tract was still negatively affected. The study also found that sucralose may limit the bioavailability of certain orally administered medications which may make medications less effective.6

Cooking and chloropropanols: One of the proposed uses of Splenda is to reduce calories when cooking and baking. Splenda was considered to be heat resistant but research is finding otherwise. When heated, Splenda was found to degrade and release harmful chloropropanols at high temperatures.7/8 Chloropropanols are toxic and may lead to cancer and infertility in men.

Benjamin Franklin once said “when in doubt, don’t”. If you are uncertain about the health effects of sucralose it is best just to avoid this product. As an alternative to consuming sucralose limit the amount of added sugar in your diet to less than 100 calories or 25 grams for most women and 150 calories or 36 grams for most men.9

On April Fool’s Day, 1998, the Food and Drug Administration approved the artificial sweetener sucralose, aka 1,6-dichloro-1,6-dideoxy-beta-D-fructofuranosyl-4- chloro-4-deoxy-alpha-D-galactopyranoside. But, despite its scary name, the worst it seemed to do was just be a rare migraine trigger in susceptible individuals, to which the manufacturer of sucralose replied that you have to weigh whatever risk there may be against its broader health benefits, “helping to mitigate the health risks associated with the national epidemic of obesity.”

As I discuss in my video Effect of Sucralose (Splenda) on the Microbiome, the hope was to offer a harmless sugar substitute to provide a sweet taste without the calories or spikes in blood sugar. However, that’s not how it appears to have turned out: Population studies have tied consumption of artificial sweeteners, mainly in diet sodas, with increased risk of developing obesity, metabolic syndrome, and type 2 diabetes. But, an association is not causation. You’ve got to put it to the test.

Indeed, if you give obese individuals the amount of sucralose found in a can of diet soda, for example, they get a significantly higher blood sugar spike in response to a sugar challenge, requiring significantly more insulin—20 percent higher insulin levels in the blood—suggesting sucralose causes insulin resistance. This may help explain the links between artificial sweetener consumption and the development of diabetes, heart disease, and stroke. So, sucralose is not some inert substance. It affects the blood sugar response. But how?

The Splenda company emphasizes that sucralose is hardly even absorbed into the body and, as such, stays in the digestive tract to be quickly eliminated from the body. But the fact that it’s not absorbed in the small intestine means it makes it down to the large intestine and may affect our gut flora. Studies have been done on artificial sweeteners and the gut bacteria of rats going back years, but there hadn’t been any human studies until fairly recently. Researchers tested saccharin, sucralose, and aspartame, the artificial sweeteners in Sweet & Low, Splenda, and NutraSweet, respectively, and found that non-caloric artificial sweeteners induce glucose intolerance by altering the microbes in our gut. The human studies were limited, but, after a few days on saccharin, for example, some people got exaggerated blood sugar responses tied to changes over just one week to the type of bacteria they had in their gut.

Acesulfame K, another common artificial sweetener, also was found subsequently to be associated with changes in gut bacteria. So, all this time, artificial sweeteners were meant to stave off chronic diseases but may actually be contributing to the problem due to microbial alterations. Some in the scientific community were surprised that “even minor concentrations of a sweetener are sufficient to cause substantial changes in gut inhabitants…” Others were less surprised. Each molecule of aspartame is, after all, metabolized into formaldehyde. That may explain why some people who are allergic to formaldehyde have such bad reactions to the stuff. “Therefore, it is not unexpected that very small amounts of the sweetener can modify bacterial communities…” However, the reports about the safety of aspartame are mixed. “All of the studies funded by the industry vouch for its safety, whereas 92% of independently funded studies report that aspartame can cause adverse health effects.”

That should tell you something.

“Undoubtedly, consumers of these food additives, which are otherwise perceived as safe, are unaware that these substances may influence their gut bacteria. This may be of particular importance to patients with diseases correlated with modifications of the gut , such as irritable bowel syndrome and inflammatory bowel diseases” (IBDs) like ulcerative colitis and Crohn’s disease. People may not realize artificial sweeteners may be affecting their gut.

Might the effect be large enough to be actually see changes in the incidence of inflammatory bowel disease? Let’s look at Canada, the first country to approve the use of sucralose. Their rates of IBD did seem to double after the approval of sucralose. What about in the United States? After decades of relatively stable rates of ulcerative colitis and Crohn’s disease, rates did appear to start going up. In China, after the approval of sucralose, IBD rates rose 12-fold. Again, these could just be total flukes, but such correlations were also found on two other continents as well. Indeed, the more graphs you see showing this rise in rates of IBD after sucralose’s approval in different countries, the harder it is to dismiss a possible connection.

The good news, though, is that after stopping artificial sweeteners, the original balance of gut bacteria may be restored within weeks. Now, of course, the negative consequences of artificial sweeteners should not be interpreted to suggest that we should all go back to sugar and high fructose corn syrup. For optimal health, it is recommended that we all try to cut down on both.

Can’t get enough of artificial sweeteners? Check out:

  • Diet Soda and Preterm Birth
  • Aspartame-Induced Fibromyalgia
  • Aspartame and the Brain
  • Does Aspartame Cause Cancer?
  • Does Diet Soda Increase Stroke Risk as Much as Regular Soda?

Erythritol May Be a Sweet Antioxidant, but there are some caveats for it and other nontoxic, low-calorie sweeteners. See:

  • How Diet Soda Could Make Us Gain Weight
  • Neurobiology of Artificial Sweeteners
  • Unsweetening the Diet

Does it really matter if our gut flora get disrupted? You’re in for a surprise. See:

  • Microbiome: The Inside Story
  • Microbiome: We Are What They Eat
  • Prebiotics: Tending Our Inner Garden
  • How to Reduce Carcinogenic Bile Acid Production
  • Putrefying Protein and “Toxifying” Enzymes
  • What’s Your Gut Microbiome Enterotype?
  • How to Change Your Enterotype
  • Paleopoo: What We Can Learn from Fossilized Feces

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

  • 2012: Uprooting the Leading Causes of Death
  • 2013: More Than an Apple a Day
  • 2014: From Table to Able: Combating Disabling Diseases with Food
  • 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet
  • 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers

Download the Sucralose Factsheet

There’s no mistaking it: Americans love to eat. Enjoying good food with good company is one of life’s great pleasures. And yet, frequent over-indulgences can have a detrimental impact on conditions like obesity and type 2 diabetes, which take a substantial toll on individuals, communities and our healthcare system. Replacing foods and beverages high in calories and added sugars with ones that are lower in sugar is one option to help reduce intake of excess calories. In turn, this may help reduce the risk of obesity and related chronic diseases. One type of low-calorie sweetener, sucralose, has been used in foods and beverages for decades as a way to lower intake of added sugars, while still providing satisfaction from enjoying something sweet. This fact sheet will examine the evidence for many topics of interest around sucralose and health so that you can make informed decisions about its place in your diet.

What is sucralose?

Sucralose is a no-calorie sweetener that contributes sweetness to foods and beverages without adding calories or carbohydrates. It is made from a process that begins with regular table sugar (sucrose); however, sucralose is not sugar. Three select hydrogenoxygen groups on a sucrose molecule are replaced with three chlorine atoms, resulting in a no-calorie sweetener that is about 600 times sweeter than sugar. Although sucralose provides sweetness, its structure prevents enzymes in the digestive tract from breaking it down. Most consumed sucralose (about 85 percent) is not absorbed. Of the small amount absorbed (about 15 percent), none is broken down for energy, so sucralose does not provide any calories. All absorbed sucralose is excreted quickly in the urine (Roberts 2000, Magnuson 2016).

Sucralose is the no-calorie sweetener in regular SPLENDA® retail sweeteners and it is also used in other retail sweeteners, such as those sold under store brand names. Sucralose is found in beverages and foods like chewing gum, dairy products, canned fruits, syrups and condiments. Because it is stable at high temperatures, sucralose can be used in baked goods. However, a food containing sucralose may be slightly different than the same food made with sugar, because sugar also plays a role in the structure, texture and flavor of foods. Like all no and low-calorie sweeteners, only very small amounts of sucralose are needed to achieve the sweetness of sugar. To make measuring and pouring easier, low-calorie sweeteners like sucralose are typically blended with approved food ingredients. This is why a packet of sucralose sweetener seems equal in quantity to a packet of table sugar, for example.

Is sucralose safe to consume?

Yes. More than 100 safety studies representing over 20 years of research have shown sucralose to be safe. The Food and Drug Administration (FDA) approved its use in specific food categories in 1998 and expanded the approval to all food and beverage categories in 1999. Leading global health authorities such as the European Food Safety Authority (EFSA), the FAO/WHO Joint Expert Committee on Food Additives (JECFA), Japan’s Ministry of Health, Labor and Welfare, Food Standards Australia New Zealand and Health Canada have also found sucralose to be safe. The FDA established an acceptable daily intake (ADI) for sucralose of 5 milligrams per kilogram of body weight (mg/kg) per day. The ADI represents an amount 100 times less than the quantity of sucralose found to be safe in research studies. For a person weighing 150 pounds (68 kg), this equates to 340 mg of sucralose—the amount found in nine cans of diet soda or more than 28 individual packets of sucralose— consumed, on average, every day over a lifetime. While estimates of dietary exposure to sucralose are limited in the United States, predictions of daily intake are below the ADI (1.3 mg/kg per day for the average adult and maximal intakes of up to 2.4 mg/kg per day, FDA 1998, FDA 1999). Sucralose has been found safe at levels hundreds of times this amount. Globally, sucralose intake also remains well below the ADI established by JECFA, which is 0-15 mg/kg per day. A 2018 scientific review found that studies conducted since 2008 raise no concerns for exceeding the ADI of the major low- and no-calorie sweeteners, including sucralose, in the general population (Martyn 2018).

What is an ADI?

The acceptable daily intake, or ADI, is the average daily intake over a lifetime that is expected to be safe based on significant research (WHO 2009). It is usually derived by determining the highest intake level found to have no adverse effects in lifetime studies in animal models. These studies are required by FDA and other regulatory agencies around the world before permitting any new food ingredient. That amount is then divided by 100 to determine the ADI (Renwick 1991). The ADI is a conservative number that the vast majority of people will not reach.

Is sucralose safe for children?

Yes. Foods sweetened with sucralose can add sweetness to a child’s diet without contributing to increased calorie intake, sugar intake or risk of cavities. As with adults, current intake of low-calorie sweeteners in children is considered to be well within acceptable levels. Due to limited studies in children, the American Academy of Pediatrics does not have official recommendations on low-calorie sweetener intake.

Can pregnant and breastfeeding women consume sucralose?

Yes. Pregnant and lactating women are frequently concerned about the influence of foods, beverages and medications on their babies’ health. Research has shown that sucralose has no adverse effects on expecting or nursing mothers or on the fetus, and there are no known side effects of sucralose consumption (Grotz and Munro 2009, Magnuson 2017). Because only small amounts of sucralose are absorbed into the bloodstream, the amount of sucralose present in breast milk is very low (Sylvetsky 2015). All women should try to consume the necessary nutrients and calories for their baby’s growth during pregnancy and breastfeeding, while taking care not to exceed their needs. This may include being mindful of all sources of sweeteners, whether they be from sugar or low-calorie sweeteners.

Can people with diabetes consume sucralose?

Yes. Products containing sucralose provide a sweet taste and are often low or lower in carbohydrates, which is important for people who must monitor their carbohydrate intake. Sucralose does not raise blood sugar levels or otherwise affect blood glucose control. The 2018 American Diabetes Association Standards of Medical Care in Diabetes state that, “The use of nonnutritive sweeteners may have the potential to reduce overall calorie and carbohydrate intake if substituted for caloric (sugar) sweeteners and without compensation by intake of additional calories from other food sources. Nonnutritive sweeteners are generally safe to use within the defined acceptable daily intake levels.” This statement is supported by the Academy of Nutrition and Dietetics, Diabetes UK, and Diabetes Canada. People with diabetes should talk with a registered dietitian, healthcare professional or a certified diabetes educator for advice on healthy eating to improve blood sugar control.

Will sucralose help me lose or maintain my weight?

Substituting foods and beverages sweetened with sucralose for their full sugar counterparts can play a role in weight loss or weight management. In a survey of members of the National Weight Control Registry, the largest study of successful weight-loss maintainers, over 50 percent of all respondents stated that they regularly consume low-calorie beverages, 78 percent of whom felt that doing so helped control their calorie intake (Catenacci 2014). Data from randomized controlled trials, considered to be the gold standard for assessing causal effects, support that substituting low-calorie sweetener options for regular-calorie versions leads to modest weight loss (Miller 2014, Rogers 2016). For example, in one study, more than 300 participants were assigned to consume either water or low-calorie sweetened beverages for one year as part of a weight-loss program. Those who were assigned to the low-calorie sweetener group lost 6.21 kg on average, compared to those in the water group, who lost 2.45 kg (Peters 2016). Some observational studies have demonstrated an association between low-calorie sweeteners and increased weight and waist circumference (Fowler 2016). Observational studies, which examine the relationship between an exposure (such as sucralose intake) and an outcome (such as body weight or a health condition), are not able to provide direct evidence of cause and effect. Additionally, observational studies are not randomized, so they cannot control for all of the other exposures or factors that may be causing or influencing the results. For example, one hypothesis is that people may compensate for “calorie-free” choices by eating or drinking more calories in other food choices or future meals (Mattes 2009). Think of a person who may justify ordering dessert at a restaurant because they had a diet soda with their meal: The extra calories from the dessert may be greater than the calories saved by ordering the diet beverage.

These additional calories may contribute to weight gain or prevent further weight loss. It has also been suggested that people who are already overweight or obese may begin to choose low-calorie sweetened foods and beverages as one method for losing weight (Drewnowski 2016). This makes it difficult to assume that the use of a low-calorie sweetener can be the cause of weight gain. Recent systematic reviews and meta-analyses (a scientific approach that combines findings from many studies into one powerful analysis) have concluded that, overall, findings from observational studies showed no association between low-calorie sweetener intake and body weight, and a small positive association with body mass index (BMI) (Miller 2014, Rogers 2016). It is important to note that losing and maintaining one’s weight often require multiple simultaneous approaches. Making a single change, such as substituting low-calorie sweeteners for full-calorie, sugar-containing products, is just one component. Lifestyle and behavioral practices like eating a healthful diet, exercising regularly, getting enough sleep, and maintaining social support networks are all important factors in achieving weight-loss and weight-maintenance goals.

Does sucralose affect blood sugar control?

Foods and beverages made with sucralose are frequently recommended to people with diabetes as an alternative to sugar-sweetened foods and beverages. Extensive research shows that sucralose does not raise blood sugar levels or otherwise affect blood glucose control in humans (Nichol 2018, Romo-Romo 2017, Grotz 2017), and a recent consensus statement by experts in nutrition, medicine, physical activity and public health concluded that the use of low-calorie sweeteners in diabetes management may contribute to better glycemic control (Serra-Majem 2018). Despite these conclusions, some studies have periodically raised questions about sucralose and blood glucose control. One randomized trial proposed that sucralose may “prime the pump” to increase blood glucose and insulin concentrations if dietary sugars are eaten with or soon after low-calorie sweeteners (Pepino 2013). Results of many other randomized clinical trials do not support this hypothesis (Temizkan 2015, Grotz 2017). A few observational studies have demonstrated an association between low-calorie sweetener consumption and risk for type 2 diabetes (Sakurai 2014, Imamura 2015) but are not able to directly link cause and effect, and as with the studies on body weight and obesity, they are at risk of confounding. For instance, many studies do not adjust for obesity status, a direct contributor to developing type 2 diabetes. Given that overweight and obese individuals tend to consume more low-calorie sweetened beverages as compared to lean individuals (Bleich 2014), this is a critical omission. Many medical, nutrition and public health organizations around the world, backed by a large body of evidence, support the consumption of low-calorie sweeteners in people with diabetes. These individuals, or those who are at risk for developing diabetes, should be mindful of food and beverage intake from all sources, including those containing low-calorie sweeteners and sugars. It is important to discuss nutrition with a doctor or registered dietitian and to eat a healthful, balanced diet to keep blood sugar levels under control.

Emerging Research: Can sucralose make me hungrier?

Highly palatable foods activate brain regions of reward and pleasure. This positive association can enhance appetite and, if left unchecked, the resulting increase in food intake can lead to overweight and obesity (Singh 2014). Substituting full-calorie and sugar-containing foods with their counterparts made with low-calorie sweeteners has exhibited a similar effect on reward pathways, but without contributing additional calories. Some have expressed concern that activating reward pathways without delivering sugar to the body may have unintended consequences, and the role that low-calorie sweeteners play in appetite and food cravings is a developing area of research. As noted in recent reviews (Fowler 2016, Sylvetsky & Rother 2018), some research in animal models has demonstrated changes in food intake and appetite-related hormones after consuming low-calorie sweeteners. And yet, similar effects have not been seen in humans. To date there is no strong evidence that low-calorie sweeteners, including sucralose, enhance appetite or cravings in humans (Rogers 2017), and some randomized trials have demonstrated the opposite effect—including a decrease in hunger (Peters 2016) and reduced dessert intake compared to those who drank water (Piernas 2013). Others have shown no effect of sucralose on hormones that regulate hunger and fullness (Steinert 2011, Ford 2011) or on total energy intake and selection of sweet foods (Bellisle 2015, Fantino 2018). These discrepancies underscore an area in which animals and humans are inherently different as research subjects. In humans, the link between physiology, psychology, personal experiences and food is unmistakably complex, and the translation of animal research to this area of study should be viewed with caution.

Emerging Research: What about the microbiome?

The microbes living in our intestinal tract have become recognized as potentially significant contributors to our health, though research on the gut microbiome is still in its infancy. In rodents, exposure to sucralose has resulted in wide-ranging, inconsistent effects (Bian 2017, Uebanso 2017). To date there are few studies on sucralose’s effect on the human gut microbiome, though it is known that it is not metabolized by the gut microbiota (Magnuson 2017). There are significant differences between the microbiome profiles from one person to another, and research has shown that the gut microbiome changes in response to normal changes in the diet (David 2014). A great deal of research is still needed to identify a microbiome profile and degree of diversity considered to be “optimal” in populations and in individuals.

What is the bottom line?

All types of foods and beverages can have a place in our diets, including those made with sucralose. Sucralose has been FDA-approved for two decades and its safety has been acknowledged by many international health agencies. Sucralose’s impact on and association with chronic conditions like obesity and diabetes have been extensively studied. Observational studies linking low-calorie sweeteners to weight gain inherently cannot demonstrate a causal relationship, while randomized clinical trials consistently support that low-calorie sweeteners like sucralose can be useful in nutritional strategies to assist with weight-loss and weight-maintenance goals. Sucralose has no impact on blood sugar or insulin levels in randomized trials and no effect on appetite. Adopting a healthful, active lifestyle that is tailored to personal goals and priorities is vital to supporting one’s well-being. Choosing foods and beverages sweetened with low-calorie sweeteners such as sucralose is one way to control sugar intake and keep calories in check, which are important components of maintaining health and reducing risk for diet-related disease.

Which Artificial Sweeteners are Safest for Migraine?

Overwhelmed by all of the artificial sweeteners available? Understand the pros and cons to make an informed choice.

Medical review by Margert Slavin, PhD, RD

Many of us reach for comfort foods like cookies or even a Diet Coke during a Migraine attack. Could your choice of sweetener actually be contributing to your attack days? How do you know which artificial sweetener is best for you to consume?

Artificial sweeteners are sugar substitutes often used in an effort to cut calories or even follow a ketogenic diet. Stevia, aspartame, sucralose, and sugar alcohols are popular examples. Not all sugar substitutes are created equally.

Artificial Sweeteners 101

The FDA has approved 6 artificial sweeteners.

The FDA has approved the following six artificial sweeteners (1) :

  1. Acesulfame potassium
  2. Advantame
  3. Aspartame
  4. Neotame
  5. Saccharin
  6. Sucralose

Artificial sweeteners are often found in processed foods marketed as “diet” or “light” because they contain fewer calories than white sugar. It makes sense – who wouldn’t want to save 150 calories by drinking a diet soda versus a regular?

Artificial sweeteners are often found in sodas, water, yogurt, prepackaged snacks, and more. However, they continue to be clouded in controversy.

Controversies with Artifical Sweeteners

Perhaps the most famous was a 1970s study that linked saccharin to the development of bladder cancer in lab rats (2). This led Congress to place a warning label on any product with the artificial sweetener. Consecutive studies have since proven that this was only an issue with rats and does not affect human beings, which is why it was removed as a potential carcinogen back in 2000.

The six FDA approved artificial sweeteners have been studied multiple times and have come back as safe for consumption at the levels found in foods…but this doesn’t necessarily mean they’re good choices for someone with Migraine.

Do Artificial Sweeteners Cause Migraines? What the Research Says

Artificial sweeteners can be found in many packaged foods and drinks.

Sucralose headaches are occasionally reported, making it an addition to some Migraine diet lists. Aspartame is the more commonly reported food trigger for people with Migraine.

Clinical evidence linking aspartame to Migraine or headache, however, is unclear.

One double-blind study conducted by the UK Food Standards Agency in 2015 found no link between aspartame consumption. and adverse health effects (3).

A more recent – but controversial – review article hypothesizes that aspartame raises the levels of phenylalanine and aspartic acid in the brain, which might have implications for release of important regulators in our brain like serotonin, dopamine, and norepinephrine (4). Although this link could potentially create an issue for those with Migraine, more research on aspartame and its link to neurobehavioral health is needed to draw a fair conclusion.

No other artificial sweeteners have been linked to Migraine attacks and the evidence on aspartame is weak. Still, people have reported headaches, dizziness, and nausea as a side effect of consumption.

Migraine food triggers are a personal thing. If you suspect you are sensitive to aspartame or other artificial sweeteners, it is best to avoid them.

Sugar Alcohols

Although not always naturally derived, sugar alcohols are naturally present in certain fruits and vegetables. These carbohydrates have a chemical structure that resembles aspects of both sugar and alcohol but doesn’t contain ethanol like alcoholic beverages.

Sugar alcohols contribute fewer calories because they are only partially absorbed and metabolized by the body. They can be useful for diabetic, low carb, or reduced-calorie diets.

Unlike artificial sweeteners which can range from 200-600 times sweeter than table sugar, sugar alcohols are often less sweet. In other words, for a similar level of sweetness, sugar alcohols typically provide fewer calories than sugars but more calories than artificial sweeteners.

These include:

  • Erythritol
  • Hydrogenated starch hydrolysate
  • Isomalt
  • Lactitol
  • Maltitol
  • Sorbitol
  • Xylitol

Because not all of the sugar alcohols are absorbed into the blood after eating, they can pass through the small intestine and into the large intestine (colon) where they are fermented by bacteria. Unfortunately, this can also contribute to gas and abdominal discomfort, as well as laxative effects in individuals who are sensitive.

The laxative effect of sugar alcohols is the reason why reviews for sugar-free gummy bears on Amazon went viral. (One reviewer simply wrote: ‘help me.’)

For these reasons, individuals may want to eat small doses of sugar alcohols first, to test your personal tolerance. No connection to Migraine attacks is noted.

Stevia and Migraines: Any Evidence?

Stevia is made from a plant and is many times sweeter than table sugar.

Stevia, which is perhaps the most popular of sugar alcohols, is derived from the leaves of a stevia plant and became more commonly used in Japan during the 1970s. It is not metabolized which is how it contains zero calories (5).

In the US, purified stevia extracts are considered as ‘generally recognized as safe’ by the FDA for use in food (6).

In studies, stevia has widely been shown to be a safe sugar substitute that can also facilitate weight loss and help those on a low carbohydrate diet still enjoy sweet snacks. Some long-term studies have also shown that it may actually lower blood sugar levels, but short term studies did not support these results (7).

Because it’s much sweeter than real sugar, you can substitute 1 teaspoon of stevia extract for each cup of sugar, but each product is a little different. There haven’t been any verifiable reports of stevia triggering attacks or stevia migraines.

Watch out for the calorie creep

Although artificial sweeteners are commonly used for weight management, one crossover study from 2017 compared the short-term effects of aspartame, monk fruit, stevia, and sucrose consumption among 30 healthy male subjects. The study found that those who consumed any of the artificial or low-calorie sugars in a mid-morning beverage ate more calories at lunch than those who consumed regular sugar in their beverage.

The energy they saved by consuming low-calorie sugar substitutes ended up being fully compensated for by the rest of the meal (8). In the end, they saved no calories.

Moderation is Key with Artificial Sweeteners

For those who are not following a low carb diet, consuming sugar, both processed and natural, is best done in moderation. Instead of reaching for a cookie, blending a quick sorbet with frozen fruit, like mango, would be a great alternative.

It’s important to remember that blood sugar fluctuations can occur due to a number of reasons like hormone fluctuations and stress. Food is just one factor. Rather than eating candy alone, enjoying a small amount after a healthy meal that contains protein can temper spikes in glucose levels and may help mitigate any sugar-related attacks.

Eating consistent, healthy meals filled with whole foods will be your best bet for managing Migraine.

Comments? Which natural or artificial sweetener do you trust to avoid Migraine attacks?

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By JulianF September 28, 2016 at 4:37 pm

I’ve only been suffering with migraines for the past 5 years. My migraines always have visual effects and rarely come with a headache, I start with flashes and then lose all vision in a central point which gets bigger.

In the last few years I’d been frustrated that I started having migraines after exercising. After reading about the effects of exercise on migraines I was concerned it was acting as a trigger. I stopped exercising, put on a lot of weight and became more and more miserable about the way I felt.

A year ago my 11 year old son started having headaches, they where diagnosed as being migraines. Doctors where also concerned he was diabetic as high levels of sugar where found in his urine. My son had started at a new school and we found out he was drinking two fizzy fruit drinks a day. They where marketed as one of your five a day fruit and “school friendly”. I found that one of the ingredients was sucralose.

I read up a lot about sucralose and immediately found it was known as a migraine trigger and also passed through your body undigested and would be passed out in your urine. The last part explained the high sugar level in my son’s urine. My son stopped drinking these fruit drinks and hasn’t had a migraine since.

I also realised that whenever I was exercising I would drink a sport drink and when I checked it also contained sucralose. I’ve now stopped drinking them and am exercising 6 days a week without any issues from migraines.

I just wanted to add this here in case it can help anyone else as these kinds of sweeteners are being hidden away in more and more foods which are then marketed as low calorie and good for you.

Here is the study which found sucralose to be a potential migraine trigger:


Artificial Sweeteners

This page is part of The 3-Day Migraine Diet. See the full diet for more details.

Migraine Triggers: Artificial Sweeteners

Twelve reasons why artificial sweeteners are a top migraine trigger:

1. Top Medical Authorities Say So…

Artificial sweeteners are listed as top migraine triggers by numerous medical authorities and migraine sufferers (1, 2, 3, 4, 5, 6, 7).

The best CBD products for migraines

Look inside

2. FDA Complaints

The most common artificial sweetener, aspartame, had over 10,000 complaints filed with the FDA.

Headaches, migraines, and memory loss are at the top of the list (FDA Docket)

3. Turns Migraines On and Off Like A Key

There are several case studies of patients experiencing migraines from chewing gum with aspartame.

In all cases, migraines stopped after the patients stopped chewing the gum.

Migraines were reproduced by reintroducing the gum (study ).

4. Splenda Triggers Migraine in Case Study

Sucralose (Splenda) is supposedly a migraine-safe food.

However, a case study found that sucralose produced migraines with aura in a female patient.

That patient had never experienced an aura before.

Withdrawal of sucralose resulted in complete elimination of migraines.

After her health was restored, blind exposure to sucralose triggered migraines once again (study ).

5. Aspartame Triggers Acne and Migraines

A 2008 study found that diet soda with aspartame could trigger both dermatitis (acne) and migraines (study ).

All patients had reactions to formaldehyde patch testing, which may explain why aspartame triggers migraines.

Aspartame can produce toxic formaldehyde. Dermatitis is also linked to migraines.

The odds are seven times higher that a child with migraines will also have acne (study ).

6. Excitotoxin

Aspartame is considered an excitotoxin, similar to the migraine trigger glutamate (study ).

It excites brain cells to death.

This process is intimately involved in triggering migraines (study 1, 2, 3).

7. Oxidative Stress

Aspartame induces oxidative stress and memory impairment in lab rats (study 1, 2, 3).

Oxidative stress is associated with migraines and nearly all migraine triggers.

8. Poor Autonomic Function

Aspartame may decrease the function of the autonomic nervous system (study 1, 2).

Poor autonomic nervous system function is associated with migraines (article ).

9. Low Serotonin and Increased Depression

Diet soda increased the risk of depression in a study with over 260,000 participants (study ).

Aspartame decreases serotonin and low levels of serotonin are associated with depression and migraines (study 1, 2, 3).

Suicidal attempts are 2.5 times higher in migraine sufferers (study 1, 2).

Anti-depressants and medications that boost serotonin are the most popular migraine prevention medications.

10. Increased Obesity and Migraines

Numerous large studies reviewed by researchers at Yale University found that artificial sweeteners can increase the risk of obesity (study ).

Obesity increases migraine risk (study ).

A 2014 study of about 24,000 people by researchers at John Hopkins University found that obese individuals drink more diet soda than adults who have a healthy weight and they also consume significantly more calories from solid food.

Artificial sweeteners have the ability to stimulate hunger and that may explain the growing trend of increased obesity (study ).

The graph below shows that the rise in obesity parallels the use of artificial sweeteners.

Artificial Sweeteners obesity time line, migraines

Figure 1 Photo Credit Yale University

11. A Damaged Gut

A 2014 study published in the journal Nature found that artificial sweeteners may alter the gut biome and induce glucose intolerance (study , article ).

This is consistent with a 2008 study that found Splenda can damage healthy gut bacteria (study ).

A damaged gut will increase the risk of migraines (article ).

12. It’s Not Zero Calories

Contrary to what the package says, zero-calorie sweeteners actually do have calories from added dextrose (sugar) or maltodextrin (corn sugar).

Both maltodextrin and sugar can damage the gut and increase symptoms of irritable bowel syndrome (IBS) (study ).

IBS will increase migraine risk (article ).

Industry-Funded Studies Label Artificial Sweeteners as Safe

I must admit the research I’ve provided is controversial. For every negative study, there is a positive study for artificial sweeteners.

An industry-funded Coca-Cola study found that diet soda was better than water for weight loss (NPR ).

The FDA and most published studies (especially industry-funded studies) label artificial sweeteners as safe, but why risk it? It’s your health (study ).

Safe, Maybe, but Not Migraine Safe

As for migraines, there’s more than enough research to show that artificial sweeteners are a top migraine trigger and that we should avoid them.

Artificial sweeteners are associated with insulin problems, diabetes, obesity, inflammation, gut problems, depression, and migraines.

Reduce or Eliminate:

All artificial sweeteners, such as aspartame (NutraSweet), saccharin (Sweet’N Low), sucralose (Splenda), and many others.

An alternative to artificial sweeteners is pure stevia. (Truvia is not pure stevia. It contains fermented sugar and only a derivative of stevia.)

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THE FACTS Artificial sweeteners have been linked in anecdotal reports to a variety of health problems for more than 30 years. But one of the more mysterious reported side effects is also among the most commonly mentioned, headaches.

Migraine sufferers are often known to steer clear of sweeteners, if only to be on the safe side, and there is no shortage of medical Web sites spreading the claim. But according to various studies, the anecdotal evidence does not exactly hold up.

Since the 1980’s, about a half dozen studies have examined the link, and a majority have discounted it. Most of those studies looked specifically at aspartame, found in diet soda and consumed by millions.

Image Credit…Leif Parsons

One study, published in the journal Neurology in 1994, for several weeks followed 32 people who complained of regular headaches brought on by sweeteners. On some days, they were exposed to sweeteners and on others, to a placebo. At the end of the study, the researchers found that the subjects were slightly more likely to report headaches on days that they consumed artificial sweetener. But the study, while intriguing, was also small and did not include a control group.

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