While there’s no singular best diet for Crohn’s disease, it’s common knowledge among Crohn’s patients that certain foods can trigger or worsen Crohn’s disease symptoms. This list of foods to avoid with Crohn’s disease include fatty foods, alcohol, high-fibre foods, dairy, oily foods, carbonated drinks—and now, probably Splenda.
A recent study from Case Western University found that, over a six-week period, the artificial sweetener Splenda worsens gut inflammation. They conducted their study on groups of mice both with and without Crohn's disease, finding that the sweetener worsened inflammation in mice with Crohn’s, while having no substantive effect on mice without the condition.
What is Splenda?
Splenda is a zero-calorie sweetener that quickly gained popularity after being introduced in the U.S. in the late 90s. Because it tastes similar to sugar and has remains stable at high temperatures, it is used widely as a sugar substitute in baking and industrial food processing.The Splenda formula combines a small amount of sucralose (a version of sucrose, only 600 times sweeter) with a large amount of dextrose and maltodextrin, which make up about 95% of the sweetener content by volume.
Although studies are still being conducted on the health effects of sucralose, dextrose, and maltodextrin, researchers generally observe that sucralose is not metabolized by the human body, while dextrose and maltodextrin are readily metabolized.
Why should I leave Splenda out of my Crohn’s disease diet?
The 2018 study published in Inflammatory Bowel Diseases mentioned found that the mice fed Splenda had increased numbers of Proteobacteria microbes in their intestines. Specifically, the Splenda-fed mice who had Crohn’s disease shows overgrowth of E. coli and increased penetration into the intestinal lining. This overgrowth of microbes can trigger the body’s immune response, causing inflammation in the gut.
The study showed that Splenda can induce biological changes in the gut bacteria and intestinal wall that may cause inflammation in the gut and, over time, exacerbate the symptoms of Crohn’s disease. The authors of the study caution Crohn’s patients against the consumption of Splenda:
"Patients with Crohn's disease should think carefully about consuming Splenda or similar products containing sucralose and maltodextrin."
-Alex Rodriguez-Palacios, assistant professor of medicine at Case Western Reserve School of Medicine.
What is Proteobacteria?
Proteobacteria includes pathogens such as E. coli and Salmonella. While a certain amount is healthy, overgrowth of these microbes in the body can cause harm and have been linked to various intestinal-tract diseases. When the overgrowth of Proteobacteria persists, people can develop chronic inflammation as is the case with Inflammatory Bowel Disease (IBD).
What about other artificial sweeteners for Crohn’s?
While the Splenda study examined the effects of just one food product, there’s evidence that other additives may have similar effects on the gut. Splenda is just one artificial sweetener—what about the effects of Equal and Crohn’s, or natural sweeteners like Stevia and Crohn’s?
For example, a 2012 ex vivo study of artificial sweeteners Stevia, Splenda, and Equal (containing aspartame, dextrose, and maltodextrin) showed a thicker E coli biofilm in both the Splenda and Equal petri dishes, but not in the the Stevia dish. Because Stevia contains no maltodextrin and the other artificial sweeteners do, these findings suggest that maltodextrin may be at the root of bacteria overgrowth and penetration in the gut. Other studies support the assessment that maltodextrin may worsen inflammation caused by bacteria in the gut; in additional studies, maltodextrin has been shown to suppress intestinal cells’ anti-bacterial and anti-microbial defense mechanisms.
What’s the best sweetener for Crohn’s?
Crohn’s patients find themselves between a rock and a hard place: while sugar is known to cause inflammation, it appears that many of food additives that serve as sugar alternatives contribute to inflammation as well.
There’s no 'best sweetener' for Crohn’s. However, the findings from the studies above suggest that it’s best to avoid sweeteners containing maltodextrin.
Rodriguez-Palacios, A., Harding, A., Menghini, P., Himmelman, C., Retuerto, M., Nickerson, K., Lam, M., Croniger, C., McLean, M., Durum, S., Pizarro, T., Ghannoum, M., Ilic, S., McDonald, C., Cominelli, F. (2018) The Artificial Sweetener Splenda Promotes Gut Proteobacteria, Dysbiosis, and Myeloperoxidase Reactivity in Crohn’s Disease–Like Ileitis. Inflammatory Bowel Diseases. DOI: 10.1093/ibd/izy060
Sham, C. W. (2005). Splenda - A Safe and Sweet Alternative to Sugar. Nutrition Bytes, 10(2). Retrieved from https://escholarship.org/uc/item/6nn545qf
Swan, Kaiulani. (2016) Evaluation of Select Food Additive Exposures in Children with Crohn’s Disease. Retrieved from https://digital.lib.washington.edu/researchworks/bitstream/handle/1773/37207/Swanwashington0250O_16416.pdf?sequence=1