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Chronic use of artificial sweeteners: pros and cons 

Research Roundup

Chronic use of artificial sweeteners: pros and cons 

17 October 2024

With increasing concern about the obesity epidemic, there is rising use of non-nutritive sweeteners (NNS) for weight control, diabetes management and dental caries prevention.  

This recent review (1) outlined benefits and potential risks associated with the long-term consumption of artificial sweeteners (ASs), particularly focusing on their impact on children and adolescent health. Children due to their smaller size, consume the highest quantity of NNS relative to their body weight per day. 

Sweeteners were classified into artificial sweeteners (chemically produced) and natural sweeteners (extracted from plants). Common artificial sweeteners include aspartame, saccharin, sucralose, neotame, acesulfame-k, and advantame, while natural sweeteners include stevia, agave, and Luo Han Guo Monk fruit extracts. 

The review of over 100 studies indicated mixed results of NNS consumption on different health outcomes.  

Health benefits: Artificial sweeteners were found to be associated several health benefits: 

  • Tooth decay prevention: ASs were found to have preventive effect on dental caries, possibly due to their antimicrobial activity against dental bacteria.  
  • Weight management: Substituting sugar-sweetened beverages with low-calorie alternatives was linked with reduced body mass index (BMI) and body weight, particularly in children and adolescents.  
  • Diabetes management: ASs aided glycemic control by reducing sugar intake, although their impact on insulin and incretin* secretion was less pronounced than that of natural sugars.  (* incretin hormones stimulate insulin secretion)
  • Flavour enhancement: ASs enhance the sweet taste of foods without adding kilojoules, although some, like saccharin and acesulfame-k, may have a bitter aftertaste.  

Health risks: Despite their benefits, artificial sweeteners were linked to health risks: 

  • Insulin resistance and diabetes: Prolonged use of ASs may be associated with the development of insulin resistance and type 2 diabetes (T2DM) in healthy individuals and worsened glycemic control in people with diabetes. 
  • Gut microbiota disruption: ASs are linked to altered gut microbiota, potentially leading to prediabetes and other metabolic issues.  
  • Cancer risk: Studies on the link between ASs and cancer were inconsistent, with some indicating a potential risk and others finding no significant association.  
  • Non-alcoholic fatty liver disease (NAFLD): ASs, particularly sucralose, were associated with the development of NAFLD through mechanisms like hepatic inflammation and lipogenesis.  
  • Other side effects: ASs may have caused hepatotoxicity, gastrointestinal symptoms, headaches, mood disorders and dizziness. Their consumption during pregnancy potentially was linked to preterm birth.  

Based on the present literature and the recommendations by different paediatric societies and the European Union regulations, the authors proposed the recommendations for NNS use by children:  

  • Infants under 2 years should avoid sweeteners.  
  • Children with phenylketonuria should avoid aspartame and neotame.  
  • Children with diabetes or obesity may benefit from non-nutritive sweeteners as part of a balanced diet and healthy lifestyle.  
  • ASs can reduce dental caries development.  
  • Paediatricians and healthcare professionals should be trained to advise on appropriate sweetener selection.  

The authors concluded that the study underscores the importance of understanding both the benefits and risks of ASs. While offering advantages in weight management, diabetes control, and dental health, their association with potential adverse effects warrant cautious use, especially in children. The authors stated further research is essential to establish safe consumption guidelines and fully understand the long-term implications of ASs on health.  

Limitations of the review include the consideration of many studies that had short durations and heterogeneous populations, which can lead to inconsistent findings. The presence of confounding factors, such as increased food intake to compensate for low-calorie beverages, further complicated the results. There is limited research on children, specifically a lack of high-quality, long-term studies focusing on the effects of ASs. This includes research on the appropriate age of exposure, taste preferences, neurodevelopment, and the impact on the microbiome. Additionally, different types of artificial and natural sweeteners may have varying effects on health, making it challenging to generalise findings across all sweeteners. 

Reference  

  1. Kossiva L, Kakleas K, Christodouli F, Soldatou A, Karanasios S, Karavanaki K. Chronic Use of Artificial Sweeteners: Pros and Cons.Nutrients. 2024; 16(18):3162. https://doi.org/10.3390/nu16183162