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Are Artificial Sweeteners Bad for Your Health?

Here's what the research says on sugar substitutes.

frankieleon/CC by 2.0
Source: frankieleon/CC by 2.0

You will find artificial sweeteners in a broad range of foods: diet sodas, yogurts, canned fruits, chewing gum, and ice cream to name a few. You may remember that the federal government used to require a cancer warning label for the sweetener saccharine. However, research has found that saccharine does not cause cancer, so the government removed the label nearly 20 years ago.

Since then, food companies have developed many more artificial sweeteners. But what do we know about their safety?

Although there is an extensive body of evidence on artificial sweeteners, much of it is conflicting. Recently, an enormous review , published in 2017 in Nutrition Journal pulled together data from 372 studies including 15 smaller systematic reviews. The authors organized the review by looking at the evidence for individual health effects and medical problems. Here’s what they found:

Appetite and food intake in the short term: Results on whether artificial sweeteners increase hunger to lead people to eat more in the short-term were completely mixed. A total of 21 studies asked whether artificial sweeteners increased appetite: 10 studies described an increase in appetite and food intake and 11 studies described a decrease in appetite and food intake.

Cancer: The theory that artificial sweeteners caused cancer was the original concern about their use decades ago, but again the research is mixed. Originally, bladder cancer was the largest concern because saccharine was found to cause bladder cancer in some laboratory animals. Out of 32 studies looking at whether artificial sweeteners increase the risk of bladder or urinary tract cancer, eleven found a positive association and 20 reported no association. The authors also looked at evidence of whether artificial sweeteners increase the risk of six other types of cancer. They found one study published in 2014 that linked artificial sweeteners with colon cancer. The rest of the evidence found no association between consuming artificial sweeteners and developing cancer.

Kidney disease: The authors found one systematic review and four individual studies looking at whether consuming artificial sweeteners leads to kidney disease. The review found no association. Two of the individual studies found a positive association, but the others did not.

Dental health: There is some evidence that drinking artificially-sweetened beverages makes one’s saliva more acidic, which can lead to cavities. But other studies found that artificial sweeteners lead to fewer cavities and less plaque on teeth, most likely because the sweetener replaces sugar, which is significantly worse for teeth.

Diabetes: Some studies and two separate systematic reviews found links between consumption of artificial sweeteners and diabetes, although both reviews describe problems with the data used for the analyses.

Headaches: The data on headaches is split. Out of five studies, two concluded that artificial sweeteners can lead to headaches and three found no link.

Mental health: There is a limited amount of evidence that artificial sweeteners can increase symptoms of depression in people with mood disorders, but not among the general public.

Weight gain: There is evidence in a high-quality systematic review that finds replacing sugar with artificial sweeteners leads to weight loss and may be helpful for people who are dieting.

The review authors conclude that we really don’t know enough about artificial sweeteners. They write, “there is a need for both further primary research and high quality comprehensive systematic reviews” to inform public health recommendations.

In the meantime, there is solid evidence that consuming sugar leads to a variety of health problems. While artificial sweeteners may not be the best answer, based on the available evidence, they seem to be a better choice than consuming added sugar.

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Lohner, S., Toews, I., & Meerpohl, J. J. (2017). Health outcomes of non-nutritive sweeteners: Analysis of the research landscape. Nutrition Journal,16(1). doi:10.1186/s12937-017-0278-x