Are you a longtime user of sugar substitutes? It may be time to change

On Nutrition

Sugar substitutes, artificial sweeteners, low-calorie sweeteners, nonnutritive sweeteners … no matter how you refer to them, they’re not without controversy. If sugar is “bad,” but artificial sweeteners are “chemicals,” what are you supposed to do when you want the taste of sweet, but a piece of fruit just isn’t going to cut it?

The World Health Organization asserted its opinion a few weeks ago when it released a guideline recommending against using nonsugar sweeteners for weight control — one of the main reasons people use them — because they don’t actually work for that purpose in the long term, and some research has found that long-term use could increase risk of Type 2 diabetes and cardiovascular disease.

“People need to consider other ways to reduce free sugars intake, such as consuming food with naturally occurring sugars, like fruit, or unsweetened food and beverages,” wrote Francesco Branca, WHO director for nutrition and food safety, in a news release. “NSS are not essential dietary factors and have no nutritional value. People should reduce the sweetness of the diet altogether, starting early in life, to improve their health.”

Artificial sweeteners have been around since the late 1800s, when a scientist accidentally discovered saccharine, although use didn’t really start exploding until about 25 years ago. That may be because next-generation sugar substitutes taste far better than saccharine. (I can vividly remember the taste of 1970s-era saccharine-sweetened Tab sodas, and it’s not a pleasant memory.)

While use of sugar substitutes is widespread in the U.S. among both children and adults, in general, people in higher-weight bodies are more likely to use them. After all, other than when saccharine was needed during World War I sugar rationing, artificial sweeteners’ main purpose is to reduce not just the sugar content of foods, but the calorie content.

I don’t put a lot of stock in the studies that found adverse effects in rats — one, because humans are not rats, and two, because often the amount of a substance fed to rats is greatly in excess of the adjusted-for-body-size amount a human would ever consume. However, there is human research that raises questions about the wisdom of freely using artificial sweeteners. In a nutshell, it appears that these sweeteners are not merely inert substances that help people avoid sugar or cut calories.

I’ve had a few clients who went cold turkey on artificial sweeteners after a heavily reported upon 2014 study published in the journal Nature, which found that, in both mice and humans, artificial sweeteners alter the function of bacteria in the gut microbiota, raising blood sugar levels and possibly leading to weight gain. A 2022 randomized-controlled trial by the same research group, published in the journal Cell, compared the effects of giving saccharin, sucralose, aspartame and stevia at doses lower than the acceptable daily intake to the effects of giving glucose or nothing at all. The participants were all healthy adults, yet each nonnutritive sweetener distinctly altered their microbiota, while saccharin and sucralose also raised blood sugar.

The WHO guideline name-checked common artificial sweeteners such as acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives. A study published in February in the journal Nature Medicine looked at levels of erythritol, a sugar alcohol used as a low-calorie sweetener (other types of sugar alcohols include xylitol, sorbitol and maltitol) in the blood of 4,000 people in the U.S. — mostly over the age of 60 — who were at elevated risk of cardiovascular disease. They found that higher use was associated with a higher likelihood of having a heart attack or stroke. While this type of observational study can’t prove cause and effect, the researchers did also find that erythritol promotes blood clots in mice and appears to do so in humans as well.

So if you’re wondering if it’s OK or even “healthy” to opt for sugar substitutes, it’s worth asking yourself what you would be eating or drinking if you avoided these sweeteners. Would you be eating and drinking more sugar? Or might you be drinking more water and eating more fruit? Artificial sweeteners are about 200 to 20,000 times sweeter than sucrose, aka table sugar. That fact has been a cause for some concern, as reflected in the WHO statement.

However, I don’t recommend a black-or-white approach with most things nutrition-related, and this is one of those things. Sometimes it comes down to what’s the better choice among your likely choices. Let’s say you drink six sugar-sweetened sodas each day, and you are not ready or willing to swap water for some or all of those sodas, or at least not yet. Switching to diet soda would have the benefit of greatly reducing the amount of easily absorbable sugar you are ingesting.

Eating or drinking sugar isn’t inherently bad — I think we’ve been trained to fear sugar more than we should — but there is a tipping point. It’s normal to like the taste of sweet. It’s also OK to enjoy a sweet taste that’s more heightened than what you would find naturally in nutritious foods like fruit or milk. Life would be sad without birthday cake or ice cream on a hot summer day. It may be simply that with both sugar and sugar substitutes added to foods and beverages, that the devil’s in the dose.

Just as it can be worthwhile to take a rough inventory of how much added sugar you consume, the same can be true for artificial sweeteners. If you are drinking a lot of “diet” soda and also eating yogurt, ice cream, cookies and sweet snack foods that use artificial sweeteners, perhaps it’s time to start training your taste buds to be satisfied with a little less sweet.