Overall, there are few risks associated with
using artificial sweeteners, and may even be beneficial For weight loss, blood
sugar control, and dental health.
Artificial sweeteners
are often the subject of heated debate.
On the one hand, they
claim to increase your risk of cancer and damage your blood sugar and gut
health.
On the other hand,
most health authorities consider them safe, and many people use them to reduce
sugar intake and lose weight.
This article reviews
the evidence for artificial sweeteners and their health effects.
What is an artificial sweetener?
Artificial sweeteners
or sugar substitutes are chemicals that are added to certain foods and
beverages to make them taste sweet.
People often refer to
them as "strong sweeteners" because they provide a taste similar to
table sugar, but up to thousands of times sweeter.
While some sweeteners
contain calories, the amount needed to sweeten a product is so small that you
end up consuming almost no calories (1).
Summary: artificial sweeteners are chemicals used to
sweeten food and beverages. They provide almost zero calories.
How do artificial sweeteners work?
The surface of your
tongue is covered with many taste buds, each with several taste receptors that
can detect different tastes (2).
Your taste receptors come into contact with food molecules as you eat.
A perfect match between receptors and molecules sends signals to your brain that allow you to recognize flavors.
For example, sugar
molecules fit perfectly into your sweet taste receptors, allowing your brain to
recognize sweetness.
Artificial sweetener molecules
are very similar to sugar molecules and adapt to sweet taste receptors.
However, they are
often too different from sugar for your body to break them down into calories.
This is how they provide sweetness without adding calories.
Only a few artificial
sweeteners have structures that allow your body to break down into calories. Given
that only a very small amount of artificial sweeteners is needed to sweeten
food, you hardly burn calories (1).
Summary: artificial sweeteners taste sweet because they
are recognized by the sweet receptors on the tongue. They provide almost zero
calories because your body can't break them down.
Common artificial sweeteners
The following
artificial sweeteners are permitted in the United States and/or the European
Union (3, 4):
- Aspartame. Aspartame is sold under NutraSweet,
Equal, or Sugar Twin brands and is 200 times sweeter than table sugar.
- Acesulfame potassium. Also known as acesulfame
potassium, it is 200 times sweeter than table sugar. It is suitable for
cooking and baking and is sold under the Sunnet or Sweet One brand.
- Advantage. This sweetener is 20,000 times sweeter
than table sugar and is suitable for cooking and baking.
- Aspartame-acesulfame salt. Sold under the Twinsweet
brand, it's 350 times sweeter than table sugar.
- Cyclamate. Cyclamate is 50 times sweeter than table sugar and is used in cooking and baking. But since 1970, it has been prohibited in the US.
- New sweet. Sold under the Newtame brand, this sweetener
is 13,000 times sweeter than table sugar and is suitable for cooking and
baking.
- Neohesperidin. it's 340 times sweeter than sugar
and is suitable for cooking, baking, and mixing with acidic foods. Please
note that it is not approved for use in the United States.
- Sachari. Sold under the Sweet'N Low, Sweet Twin, or
Necta Sweet brands, saccharin is 700 times sweeter than table sugar.
- Sucralose. Sucralose is 600 times sweeter than
table sugar and is suitable for cooking, baking, and mixing with acidic foods.
It is sold under the Splenda brand.
Summary: there are many types of artificial sweeteners,
but not all countries approve of their use. The most common include aspartame,
sucralose, saccharin, neostens, and acesulfame potassium.
Artificial sweeteners, appetite, and weight
People on weight loss diets are fond of artificial sweeteners.
However, their effects on appetite and weight vary from study to study.
Effects on appetite
Some people think that
artificial sweeteners may increase appetite and promote weight gain (5).
The idea is that
artificial sweeteners may not activate the food reward pathways you need to be
satisfied after eating (6).
Given that they taste
sweet but lack calories in other sweet foods, it is thought that they confuse
the brain and make it still feel hungry (7, 8).
In addition, some
scientists believe that you need to eat more artificially sweetened foods to
feel full compared to sugar-sweetened foods.
It has even been
suggested that sweeteners may cause cravings for sugary foods (5, 9, 10, 11).
That said, many recent
studies do not support the idea that artificial sweeteners increase hunger or
calorie intake. （12, 13）。
In fact, several
studies have found that when participants replaced sugary foods and beverages
with artificially sweetened substitutes, they reported feelings of hunger and
burned fewer calories. （14, 15, 16, 17, 18）。
Summary: recent studies have found that replacing
sugary foods or beverages with artificially sweetened foods or drinks can
reduce hunger and calorie intake.
Effect on weight
For weight control,
some observational studies have reported a time-consuming link between
artificial sweetened beverages and obesity (19, 20).
However, randomized
controlled studies — the gold standard for scientific research — report that
artificial sweeteners can reduce weight, fat mass, and waist circumference. （21, 22）。
These studies also
show that replacing regular soft drinks with sugar-free versions can lower body
mass index (BMI) by as much as 1.3-1.7 percentage points. （23, 24）。
What's more, choosing
foods that are artificially sweetened instead of foods with added sugar may
reduce the number of calories you burn each day.
Various studies
ranging from 4 weeks to 40 months have shown that this can lead to weight loss
of up to 2.9 pounds (1.3 kg) ( 25, 26).
Artificial
sugar-sweetened drinks are a simple substitute for those who regularly drink
soft drinks and want to reduce their sugar intake.
However, if you make
up for it by eating more food or extra sweets, choosing sugar-free soda won't
lead to any weight loss. If sugar-free soda increases your cravings for sweets,
sticking to water may be best (27).
Summary: replacing sugary foods and drinks with
artificially sweetened foods and drinks may help with weight loss.
Artificial sweeteners with diabetes
Those with diabetes
may benefit from opting for artificial sweeteners because they provide
sweetness without accompanying elevated blood sugar levels (18, 28, 29).
However, some studies
have reported that drinking sugar-free soda increases the risk of diabetes by 6
to 121%. （30, 31, 32）。
This may seem
paradoxical, but it is important to note that all studies are observational. They
didn't prove that artificial sweeteners cause diabetes, only that people who
may have type 2 diabetes also like to drink sugar-free soda.
on the other hand,
many control studies have shown that artificial sweeteners do not affect blood
sugar or insulin levels (33, 34, 35, 36, 37, 38).
To date, only one
small study of Hispanic women has found negative effects.
Women who drank
artificially sweetened beverages before drinking sugary drinks had 14% higher
blood glucose levels and 20% higher insulin levels than women who drank water
before drinking sugary drinks. （39）。
However, participants
were not accustomed to drinking artificially sweetened beverages, which may
partly explain the results. What's more, artificial sweeteners may have
different effects depending on a person's age or genetic background (39).
For example, studies
have shown that replacing sugary drinks with artificially sweetened drinks has
a stronger impact on Hispanic youth. （40）。
This may be related to
the unintended effects of the Hispanic women mentioned above.
Although the findings
are not consistent, the current evidence generally supports the use of
artificial sweeteners in people with diabetes. Still, more research is needed
to assess their long-term effects in different populations.
Summary: artificial sweeteners can help people with
diabetes reduce their intake of added sugars. However, more research is needed
on the effects of artificial sweeteners on different populations.
Artificial sweeteners and metabolic syndrome
Metabolic syndrome
refers to a group of disorders that include high blood pressure, hyperglycemia,
excessive abdominal fat, and abnormal cholesterol levels.
These conditions
increase your risk of chronic diseases such as stroke, heart disease, and type
2 diabetes.
Some studies suggest
that drinkers of sugar-free soda may have a 36% risk of metabolic syndrome. （41）。
However,
higher-quality studies have reported that sugar-free soda is either ineffective
or protective (42, 43, 44).
A recent study asked
obese and overweight people to drink a quarter gallon (1 liter) of regular
soda, sugar-free soda, water, or semi-skim milk a day.
at the end of the
six-month study, people who drank sugar-free soda lost 17 to 21 percent, had 24
to 31 percent less belly fat, 32 percent less cholesterol levels, and 10 to 15
percent less blood pressure than those who drank sugar-free sodas (44).
In fact, drinking
water has the same benefits as drinking sugar-free soda (44).
Summary: there is little chance that artificial sweeteners will raise your risk of metabolic syndrome. Switching from sugar-filled beverages to ones with artificial sweeteners may lower your chance of developing several illnesses.
Artificial sweeteners with intestinal health
Your health is greatly influenced by the microorganisms in your stomach, and numerous issues are associated with poor gut health.
these include weight
gain, poor glycemic control, metabolic syndrome, weakened immune system,
destruction, and sleep (45, 46, 47, 48, 49, 50).
The composition and
function of gut bacteria vary from person to person and are influenced by the
foods you eat, including certain artificial sweeteners (51, 52).
In one study, the
artificial sweetener saccharin disrupted the gut bacterial balance of
four-sevenths of healthy participants who were not accustomed to eating them.
These four
"responders" also showed poor glycemic control just 5 days after
consuming artificial sweeteners (53).
What's more, when the
gut bacteria of these people were transferred to mice, the animals also had
poor blood sugar control. （53）。
On the other hand,
there was no change in the ability of mice implanted with "unreactor"
gut bacteria to control blood sugar levels. （53）。
While interesting,
more research is needed before strong conclusions can be drawn.
Summary: artificial sweeteners may throw off the balance of bacteria in the digestive tracts of certain individuals, raising their risk of contracting the illness. To verify this effect, more study is necessary.
Artificial sweeteners and cancer
Since the 1970s, the
debate over whether there is a link between artificial sweeteners and cancer
risk has been intense.
It was ignited when
animal studies found that mice fed extremely high amounts of saccharin and
cyclamate had an increased risk of bladder cancer. (54）。
However, mice
metabolize saccharin differently than humans.
since then, more than
30 human studies have found no link between artificial sweeteners and the risk
of cancer (1, 55, 56, 57).
One study examined the use of artificial sweeteners by 9,000 participants over 13 years. After accounting for other factors, the researchers found no
link between artificial sweeteners and the risk of various cancers. (55）。
In addition, a recent
review of studies published over 11 years did not find a link between cancer
risk and artificial sweetener consumption. (58）。
Regulators in the United
States and Europe have also evaluated the topic. Both agree that artificial
sweeteners, when consumed in recommended amounts, do not increase cancer risk (1, 59).
One exception is
cyclamate, which was banned in the United States after the publication of the
original mouse bladder cancer study in 1970.
Since then, extensive
studies of animals have failed to show a link to cancer. However, cyclamate has
never been re-approved for use in the United States (1).
Summary: based on current evidence, artificial
sweeteners are unlikely to increase the risk of cancer in humans.
Artificial sweeteners with dental health
Tooth decay occurs
when bacteria in the mouth ferment sugar – also known as caries or tooth decay.
The resulting acid can damage tooth enamel.
Unlike sugar,
artificial sweeteners do not react with bacteria in the mouth. This means they
do not form acid or cause tooth decay (60).
Studies have also
shown that sucralose is less likely to cause tooth decay than sugar.
For this reason, the
Food and Drug Administration (FDA) allows products containing sucralose to
claim that they can reduce tooth decay (60, 61).
The European Food
Safety Authority (EFSA) states that all artificial sweeteners when eaten in place
of sugar, neutralize acids and help prevent tooth decay (28).
Summary: consuming artificial sweeteners instead of
sugar can reduce the likelihood of tooth decay.
Aspartame, headache, depression, and epilepsy
Some artificial
sweeteners can cause unpleasant symptoms in some people, such as headaches,
depression, and seizures.
while most studies
have found no link between aspartame and headache, two studies have noted that
some people are more sensitive than others (62, 63, 64, 65, 66).
This individual
difference may also apply to the effects of aspartame on depression.
For example, people
with mood disorders may be more likely to develop depressive symptoms from consuming
aspartame. (67）。
Finally, artificial
sweeteners do not increase the risk of seizures in most people. However, one
study reported increased brain activity in children with absence seizures (68, 69, 70).
Summary: artificial sweeteners are less likely to cause
headaches, depression, or seizures. However, some people may be more sensitive
to these effects than others.
Safety and side effects
Artificial sweeteners
are generally considered safe for human consumption (1).
They are carefully
tested and regulated by U.S. and international authorities to ensure they are
safe to eat and drink.
That said, some people
should avoid eating them.
For example,
individuals with a rare metabolic disorder of phenylketonuria (PKU) are unable
to metabolize the amino acid phenylalanine in aspartame. Therefore, people with
PKU should avoid aspartame.
What's more, some
people are allergic to sulfonamides (a class of compounds to which saccharin
belongs). For them, saccharin may cause difficulty breathing, rashes or
diarrhea.
, In addition, there is
growing evidence that certain artificial sweeteners such as sucralose reduce
insulin sensitivity and affect gut bacteria. (71, 72）。
Summary: artificial sweeteners are generally considered
safe, but people with phenylketonuria or allergies to sulfonamides should avoid
them.
Conclusion:
overall, there are few
risks associated with using artificial sweeteners, and may even be beneficial
for weight loss, blood sugar control, and dental health.
They are especially
beneficial if you use these sweeteners to reduce the amount of sugar added to
your diet.
That is, the
likelihood of negative effects varies from person to person and depends on the
type of artificial sweetener consumed.
Some people may feel
uncomfortable or negatively affected after consuming artificial sweeteners,
even if they are safe and accepted by most people.
If you want to avoid
artificial sweeteners, try using natural sweeteners.