It is expected that in 2024, 144 million people in the US will be using artificial sweeteners daily. The rationale for using non caloric or low caloric artificial sweeteners is of course to be able “to have your cake and eat it too.” That is, the sweet tooth can be satisfied without the known ill effects of sugar consumption. You can reduce your calories and therefore lose weight while still getting all the sweetness you crave. Is this true? Are artificial sweeteners safe? Do they help people lose weight? Are there ill effects from consuming artificial sweeteners over a long time? The answers to some of these questions are far from clear, but there is evidence to answer some of them.

There are six different sweetener compounds approved as food additives by the FDA. The FDA also approves the use of three plant and fruit based sweeteners as safe. To complicate things further, there are six FDA approved sugar alcohols (which have slightly less calories than sugar, but are metabolized differently). Below is a table listing all these sweeteners and their brand names. Scroll to the right to see the nutritive sweeteners in the table. Here is a link to the article containing the table

Non-nutritive sweeteners								Nutritive Sweeteners
Names	Aspartame	Acesulfame-K	Saccharin	Sucralose	Neotame	Advantame	Steviosides	Mannitol	Xylitol	Sorbitol	Erythritol
Brand names	NutraSweet®, Equal®, others	Sunett®, Sweet One®	Sweet’N Low®, Sweet Twin, Sugar Twin®, Necta Sweet®	Splenda®	Used as ingredient in food products.	Used as an ingredient in food and beverage products	Stevia®, Truvia™, Sun Crystals®, PureVia™, Sweetleaf Sweetener™	Used as ingredient in food products.	XyloSweet	Used as ingredient in food products.	Zerose

The only thing all these compounds have in common is that they stimulate the human sweet taste receptor. Some are absorbed in the small intestine and some are not absorbed. They have (or may have) different effects on metabolism. Some of them are 2000 times as sweet as sugar and some (the sugar alcohols) are as sweet or half as sweet as sugar.

In this post I’m going to write about the pro and con evidence for each of these different classes of sweeteners. I’m also going to write about the effects of using honey, maple syrup and agave as sweeteners.

Human Taste

Humans have only five kinds of taste buds, mostly on the tongue, but some on the roof of the mouth and the throat. They are sweet, sour, bitter, salt and umami (spicy). All tastes are combinations of activity of these five kinds of receptors. Artificial sweeteners stimulate primarily the sweet taste buds. A few of them in larger quantities stimulate the bitter taste buds as well.

Do artificial sweeteners increase the risk of cancer?

The answer to this question is almost certainly no. There were some early studies of aspartame in rats that showed an increased incidence of bladder cancer. This turned out to be related to physiology specific to rats and not humans. There is no evidence at present to suggest that any artificial sweeteners increase the risk of cancer in humans. Obesity does increase the risk of cancer and many overweight people use artificial sweeteners. There is no evidence that the sweeteners themselves increase the risk of cancer.

Do artificial sweeteners help with weight loss?

The answer to this question is no. Almost all human and animal studies to date show no effect on weight loss or weight gain for any of the artificial sweeteners.

Do artificial sweeteners increase the risk of cardiovascular disease?

The answer to this question is probably yes. A large study in France showed that consumption of artificial sweeteners was associated with cardiovascular disease. The main ones consumed were aspartame, acesulfime potassium and sucralose. Apartame was associated with increased risk of stroke. Consumption of  acesulfame potassium and sucralose was associated with an increased risk of coronary disease. Here is a link to that study in the British Medical Journal.

Do artificial sweeteners increase the risk of type 2 diabetes?

The answer to this question is complicated. The large study in France did show some increase in type 2 diabetes in the group that took the largest amount of artificial sweeteners. Some studies suggest that this effect may be due to the artificial sweeteners’ effect on the microbiome. Only sucralose, saccharine, and the sugar alcohols seem to affect the composition of the gut microbiome. It appears that people with certain kinds of composition of their microbiome are at risk of developing diabetes.

Other side effects of artificial sweeteners

People with irritable bowel syndrome may have increased symptoms from artificial sweeteners. People with inflammatory bowel disease (such as ulcerative colitis or crohn’s disease may have exacerbation of their symptoms from artificial sweeteners.

What about using honey, maple syrup, or agave as sweeteners?

Honey and maple syrup have some antioxidants that may be good for you, but they also have as much sugar as regular table sugar. Agave has mostly fructose as opposed to glucose, so it tends to make your blood sugar higher for longer. It also is only metabolized in the liver, and too much fructose can lead to fatty liver. Any of these in small amounts not too frequently is fine. The same is true for sugar.

Bottom Line

There are no health benefits to using any of the artificial sweeteners, including the ones derived from plants and fruits, and including the sugar alcohols. Evidence is accumulating that many of them may cause harm by increasing the risk of cardiovascular disease and adversely affecting the microbiome. You are much better off to use small amounts of sugar, honey, or maple syrup no more than a few times a week. You should avoid foods advertised as sugar free if any of the artificial sweeteners are listed on the label. Refer to the table at the beginning of this post to see what they are called.