Artificial Sweeteners: Benefits, Myths and Safety

Artificial Sweeteners or non-nutritive sweeteners are sugar substitutes that provide sweetness with low or zero calories. These sweeteners may be derived from naturally-occurring substances such as sucralose (Splenda) coming from sugar. They are regulated by the Food and Drug Administration (FDA) as food additives and have an Acceptable Daily Intake (ADI) which is the maximum amount considered to be safe to consume each day throughout a lifetime. The ADI is usually set 100 times lower than the amount found to have no adverse health effects in toxicology studies.

Throughout studies and experience, artificial sweeteners have been considered to be a useful method for weight control and diabetes because of their low or non-caloric value. Since artificial sweeteners are not carbohydrates, they do not raise blood sugar levels and so, they can benefit those with diabetes. The position of the American Dietetic Association provides information on the safety of non-nutritive sweeteners and stands by incorporating these sweeteners into a diet, consumers can enjoy the taste of sweetness without the added sugar or calories. As a result, consumers may benefit by managing weight, controlling blood glucose, and even dental caries (Journal of the Academy of Nutrition and Dietetics, 2004).

Despite the benefits artificial sweeteners can provide, they still cause some concern regarding health including cancer. Plus, the name “artificial” can cause some confusion even though they are derived from naturally occurring substances.

Artificial Sweeteners and Obesity

Obesity is a complex problem, health-wise and cost-wise. According to the CDC, the US obesity prevalence was 42.4% between 2017-2018, increasing from 30.5% between the years of 1999-2000. Related conditions to obesity include stroke, type 2 diabetes, and types of cancers. It is a serious disease but also expensive. The medical costs for those struggling with obesity were $1,429 more than those with a healthy weight.

Excess body fat is a result of consuming more energy than expending. Sugary foods have been a top concern associated with the rise of obesity and weight gain, especially in children (American Dietetic Association, 2004). These sugary foods tend to be high calorie and increase palatability, therefore, high consumption of these foods is most likely to occur and result in gaining weight. However, it is important to note that although high sugar intake has been associated with weight gain, there is no evidence supporting the theory that sugar alone is linked to gaining weight without a calorie surplus.

Since high sugar foods tend to be calorically dense, artificial sweeteners have the potential to manage weight by replacing the sugar content in the food because of their low or zero-calorie content. According to the American Dietetic Association, non-nutritive sweeteners can save 380cal/day or 1 pound of weight loss in 9 to 10 days, considering intakes of 95g daily. Evidence supports the benefit of adding these sweeteners to promote weight loss considering they add palatability to low-calorie foods and reduce overall, total calorie intake.

Artificial Sweeteners and Diabetes

Diabetes is a result of how your body uses glucose and an excess amount of sugar in the blood. Current evidence does not support the notion that sugar intakes directly cause diabetes. A prospective study of over 39,000 women aged 45 years and older found that intake of sugar does not play a significant role in preventing type 2 diabetes which supports the stance of the American Diabetes Association’s guideline of being able to include a moderate amount of sugar into a healthy diet (Janket et al., 2003).

With the concerns of artificial sweeteners and insulin or causing weight gain, since the body does not recognize artificial sweeteners as carbohydrates, blood glucose metabolism or secretion of insulin does not occur. The American Diabetes Association recommends focusing on total carbohydrate and calorie intake rather than the glycemic response of their consumption to return blood glucose levels to a normal range.

Artificial Sweeteners and the Gut Microbiome

The gut microbiome has become a popular topic to discuss and so, it is no surprise that it has been questioned regarding artificial sweeteners. The gut microbiome plays a crucial role in food digestion and energy homeostasis and can be interrupted by diet and other environmental factors (Bian et al., 2017). Concerns about these sweeteners altering the human microbiome are still being investigated and merit more studies in the form of prospective blinded clinical trials (Suez et al., 2015). There seem to be inter-individual differences in the response to artificial sweeteners which brings the notion of focusing on a more personalized approach to diet catered to the individual’s glycemic response and microbiome.

However, the current evidence shows no effects on the gut microbiota composition when consuming pure aspartame or sucralose daily in high doses (Ahmad et al., 2020). In this study, 17 healthy participants ages 18-45 years old with a BMI of 20-25, consumed 14% of the ADI of aspartame and 20% of the ADI of sucralose during two 14-day treatment periods. Results did not indicate any differences in the microbiota community structure or in short-chain fatty-acids (SCFAs).

Safety

The safety of using artificial sweeteners has been in question for years, despite the benefits found through studies.

Questions surrounding insulin spikes when consuming artificial sweeteners have occurred, however, there are several studies debunking this myth. Randomized crossover studies of healthy individuals have shown no insulin response after consumption of sucralose or aspartame compared to tasting glucose, however, there has been a response in insulin found from artificial sweeteners when combined with natural sugars (Pang et al., 2021). Also, majority of acute and short-term randomized controlled trials show no signs of sucralose consumption or intravenous infusion on circulating insulin levels when compared to water, glucose, or sucrose. Longer-term studies have also shown zero effects of saccharin, steviol glycoside, and aspartame consumption on insulin levels in healthy, diabetic, obese, or overweight individuals (Higgins & Mattes, 2019; Steinert et al., 2011; Maersk et al., 212).

The most common concern is the association between sweeteners and cancer. However, studies that have claimed artificial sweeteners cause cancer have been reviewed and concluded as low-quality studies with limitations. Common limitations include the dose that subjects were given were very high, unrealistic doses, and these studies were done in rats and so, these findings are not applicable in real life. The purpose of these studies was to find a carcinogenic effect and so, doses were continued to be given until an effect occurred which was at very high doses (Sigma Nutrition, 2022). In contrast, epidemiological studies in humans showed different findings where no bladder-cancer-inducing effects of saccharin and cyclamate were detected (Weihrauch & Diehl, 2004). To this date, high-quality studies don’t show an association between artificial sweeteners and cancer or an increase in developing cancer (Food Insight, 2022). According to the National Cancer Society, there is no current evidence of quality that supports the concern of FDA-approved artificial sweeteners causing cancer or other serious illnesses.

In particular, the safety of sucralose has been extensively studied including over 100 studies and evaluations over 20 years to assure there is no legitimate concern when consuming it. These studies have consistently shown that it does not cause cancer, birth defects, genetic changes, or tooth decay (Calorie Control Center, 2009). Studies in healthy humans haven’t found any evidence of toxicity or potential for carcinogenic effects even at doses more than the range of anticipated daily ingestion levels but instead, that non-nutritive sucralose was well-tolerated (Berry et al., 2016).

The key points are that artificial sweeteners have been consistently studied for their safety after a few studies pointing out their associations with certain illnesses including cancer. However, those studies are low quality and have limitations. Higher-quality studies show otherwise where not only are non-nutritive sweeteners safe to consume but they provide health benefits such as weight management, obesity, and type 2 diabetes.

Below is a podcast episode (#431) by Sigma Nutrition where they discuss the current evidence and myths around artificial sweeteners and address concerns regarding the association between these sweeteners and illnesses such as the ones mentioned above.

References:

Adult Obesity Causes and Consequences. (2021, March 22). CDC. https://www.cdc.gov/obesity/adult/causes.html

American Dietetic Association (2004). Position of the American Dietetic Association: use of nutritive and nonnutritive sweeteners. Journal of the American Dietetic Association, 104(2), 255–275. https://doi.org/10.1016/j.jada.2003.12.001

Ahmad, S. Y., Friel, J., & Mackay, D. (2020). The Effects of Non-Nutritive Artificial Sweeteners, Aspartame and Sucralose, on the Gut Microbiome in Healthy Adults: Secondary Outcomes of a Randomized Double-Blinded Crossover Clinical Trial. Nutrients, 12(11), 3408. https://doi.org/10.3390/nu12113408

Are Low-Calorie Sweeteners Safe? (2022, Jan. 27). Food Insight. https://foodinsight.org/facts-about-low-calorie-sweeteners/

Berry, C., Brusick, D., Cohen, S. M., Hardisty, J. F., Grotz, V. L., & Williams, G. M. (2016). Sucralose Non-Carcinogenicity: A Review of the Scientific and Regulatory Rationale. Nutrition and cancer, 68(8), 1247–1261. https://doi.org/10.1080/01635581.2016.1224366

Bian, X., Chi, L., Gao, B., Tu, P., Ru, H., & Lu, K. (2017). The artificial sweetener acesulfame potassium affects the gut microbiome and body weight gain in CD-1 mice. PloS one, 12(6), e0178426. https://doi.org/10.1371/journal.pone.0178426

Does Aspartame Cause Cancer? (2019, Feb. 11). American Cancer Society. https://www.cancer.org/cancer/cancer-causes/aspartame.html

Higgins, K. A., & Mattes, R. D. (2019). A randomized controlled trial contrasting the effects of 4 low-calorie sweeteners and sucrose on body weight in adults with overweight or obesity. The American journal of clinical nutrition, 109(5), 1288–1301. https://doi.org/10.1093/ajcn/nqy381

Janket, S. J., Manson, J. E., Sesso, H., Buring, J. E., & Liu, S. (2003). A prospective study of sugar intake and risk of type 2 diabetes in women. Diabetes care, 26(4), 1008–1015. https://doi.org/10.2337/diacare.26.4.1008

Maersk, M., Belza, A., Holst, J. J., Fenger-Grøn, M., Pedersen, S. B., Astrup, A., & Richelsen, B. (2012). Satiety scores and satiety hormone response after sucrose-sweetened soft drink compared with isocaloric semi-skimmed milk and with non-caloric soft drink: a controlled trial. European journal of clinical nutrition, 66(4), 523–529. https://doi.org/10.1038/ejcn.2011.223

Artificial Sweeteners and Cancer. (2016, Aug. 10) National Cancer Society. https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/artificial-sweeteners-fact-sheet#is-there-an-association-between-artificial-sweeteners-and-cancer

Pang, M. D., Goossens, G. H., & Blaak, E. E. (2021). The Impact of Artificial Sweeteners on Body Weight Control and Glucose Homeostasis. Frontiers in nutrition, 7, 598340. https://doi.org/10.3389/fnut.2020.598340

Steinert, R. E., Frey, F., Töpfer, A., Drewe, J., & Beglinger, C. (2011). Effects of carbohydrate sugars and artificial sweeteners on appetite and the secretion of gastrointestinal satiety peptides. The British journal of nutrition, 105(9), 1320–1328. https://doi.org/10.1017/S000711451000512X

Suez, J., Korem, T., Zilberman-Schapira, G., Segal, E., & Elinav, E. (2015). Non-caloric artificial sweeteners and the microbiome: findings and challenges. Gut microbes, 6(2), 149–155. https://doi.org/10.1080/19490976.2015.1017700

Weaknesses of “Artificial sweeteners and cancer risk: Results from the NutriNet-Sante’ ‎population-based cohort study.” (24, March 2022). Calorie Control Center. https://caloriecontrol.org/ccc-staff-summary-of-artificial-sweeteners-and-cancer-risk-results-from-the-nutrinet-sante-population-based-cohort-study/

Weihrauch, M. R., & Diehl, V. (2004). Artificial sweeteners--do they bear a carcinogenic risk?. Annals of oncology : official journal of the European Society for Medical Oncology, 15(10), 1460–1465. https://doi.org/10.1093/annonc/mdh256