Artificial sweeteners

Artificial sweeteners are a hotly debated topic. On the one hand, it is claimed that they can increase the risk of cancer, as well as affect blood sugar and gut health. On the other hand, most health experts consider them safe and harmless and many people use these sweeteners to eat less sugar and lose weight. This article will take a closer look at the scientific evidence on artificial sweeteners and their effects on health.

What are artificial sweeteners?

Artificial sweeteners - also known as sugar substitutes - are chemicals that are added to drinks and food to give them a sweet taste. These sweeteners are often referred to as 'concentrated sweeteners' as they provide a taste similar to table sugar, while having up to a thousand times the sweetening power of sugar. Although some sweeteners provide calories, the amount of these sweeteners needed is usually so small that they provide minimal amounts of calories (1)

How do artificial sweeteners work?

The surface of the tongue is covered by a large number of taste buds. Each taste bud contains several taste receptors that perceive different flavors (2). When you eat something, the different food molecules come into contact with your taste receptors. When a food molecule matches a receptor, it sends a signal to the brain that allows it to identify the taste (2). For example, a sugar molecule fits perfectly like a key to a lock to the sweet taste receptor, allowing the brain to identify a sweet taste. The molecules of artificial sweeteners resemble sugar molecules closely enough to fit the sweet taste receptors. However, they are generally so different from sugar that the body cannot break them down and use them for energy. This is the reason why they have a sweet taste without providing extra calories. Only a few artificial sweeteners have a structure that the body can break down into calories. However, since only very small amounts of artificial sweeteners are needed to give foods a sweet taste, these sweeteners also provide virtually no calories (1).

Summary: Artificial sweeteners taste sweet because they are recognized by the sweet receptors of the tongue. Since only very small amounts of artificial sweeteners are needed to give food a sweet taste, sweeteners provide virtually no calories.

What are the most widely used artificial sweeteners?

The following sweeteners are approved in Europe and the USA (3, 4):

Aspartame: Aspartame is 200 times sweeter than table sugar.
Acesulfame potassium: Acesulfame potassium is 200 times sweeter than table sugar. Acesulfame potassium is suitable for baking and cooking.
Advantam: Advantam is 20,000 times sweeter than table sugar and is suitable for baking and cooking.
Aspartame-acesulfame salt: Aspartame-acesulfame salt is sweeter than table sugar by a factor of 350.
Cyclamate: Cyclamate is 50 times sweeter than table sugar and is suitable for baking and cooking. Cyclamate has not been permitted in the USA since 1970.
Neotame: Neotame is sweeter than table sugar by a factor of 13,000. Neotame is suitable for cooking and baking and is known under the brand name Newtame.
Neohesperidin: Neohesperidin is sweeter than table sugar by a factor of 340 and is suitable for cooking and baking. Neohesperidin can be mixed with acidic foods, but is not approved in the USA.
Saccharin: Saccharin is sweeter than table sugar by a factor of 700.
Sucralose: Sucralose is sweeter than table sugar by a factor of 600 and is suitable for cooking and baking. Sucralose can be mixed with acidic foods and is known under the brand name Splenda.
Summary: There are many different types of sweeteners, but not all of them are approved everywhere in the world.

Artificial sweeteners, appetite and weight

Artificial sweeteners are very popular with people who want to lose weight. However, their effects on appetite and weight vary from study to study.

The effects of artificial sweeteners on appetite

Some people believe that artificial sweeteners stimulate appetite and promote weight gain (5). They think that artificial sweeteners are not able to activate the "reward pathway" in response to food intake, which is necessary to give you a feeling of satisfaction after eating (6). Because they taste sweet but lack the calories found in other sweet-tasting foods, they are believed to confuse the brain into continuing to feel hungry (7, 8). In addition to this, some scientists believe that you need to eat more artificial sweetener-sweetened foods than sugar-sweetened foods to feel full. It has even been suggested that sweeteners can cause cravings for sugary foods (5). However, while these theories may sound plausible, many recent studies do not support the idea that artificial sweeteners increase hunger or calorie intake (9, 10, 11, 12, 13). In fact, several studies have found that subjects report less hunger and consume fewer calories when replacing sugary foods and beverages with artificial sweetener-sweetened alternatives (14, 15, 16, 17, 18).

Summary: Recent studies conclude that replacing sugary foods and beverages with artificial sweetener-sweetened alternatives may reduce hunger and calorie intake.

The effects of artificial sweeteners on weight

In terms of weight control, some observational studies have reported an association between the consumption of artificially sweetened beverages and obesity (19, 20). However, randomized controlled trials - the gold standard of scientific research - report that artificial sweeteners can reduce body weight, fat mass and waist circumference (21, 22). These studies also show that replacing regular soft drinks with sugar-free versions can reduce body mass index (BMI) by up to 1.3 to 1.7 points (23, 24). In addition, choosing foods sweetened with artificial sweeteners instead of foods with added sugar can reduce the amount of calories consumed daily. Different studies, ranging from 4 to 40 weeks, show that this can lead to a weight loss of up to 1.3 kilograms (13, 25, 26). Drinks sweetened with artificial sweeteners can be an easy alternative for people who regularly consume regular soft drinks and want to reduce their sugar intake. However, opting for light drinks will not lead to weight loss if this is compensated for by consuming larger portions or additional sweets. If light drinks increase your cravings for sweets, then water may be a better alternative (27).

Summary: Replacing sugary foods and drinks with sweetener-sweetened alternatives can help with weight loss.

Artificial sweeteners and diabetes

Diabetics may benefit from choosing artificial sweeteners, which can provide the pleasure of a sweet taste without the accompanying rise in blood glucose levels (18, 28, 29). However, some studies report that the consumption of light drinks may increase the risk of diabetes by 6 to 121% (30, 31, 32). This may seem contradictory, but it is important to note that all of these studies were observational. They cannot prove that artificial sweeteners cause diabetes, but merely show that people who are more likely to develop diabetes also like to drink light drinks. On the other hand, many controlled studies show that artificial sweeteners do not affect blood glucose levels or insulin levels (33, 34, 35, 36, 37, 38). To date, only one small study conducted with Hispanic women has observed a negative effect. Women who drank a beverage sweetened with artificial sweetener before a sugary drink had 14% higher blood glucose levels and 20% higher insulin levels than women who drank only water before the sugary drink (39). However, the subjects were not used to drinks sweetened with artificial sweeteners, which could at least partially explain these results. In addition, artificial sweeteners could have different effects based on age or genetic background (39). For example, researchers have shown that replacing sugar-sweetened beverages with artificial sweetener-sweetened beverages had a stronger effect in Spanish adolescents (40). This could be linked to the unexpected effects in the Spanish women mentioned above. Although not all experts agree, the data currently available support the use of artificial sweeteners by diabetics. However, further research is needed to assess the long-term effects in different populations. Summary: Artificial sweeteners can help diabetics reduce the amount of sugar in their diet. However, further research is needed to assess the effects in different populations.

Artificial sweeteners and metabolic syndrome

Metabolic syndrome is a collection of medical conditions that includes high blood pressure, high blood sugar levels, excessive abdominal fat and abnormal cholesterol levels. These conditions increase the risk of chronic diseases such as stroke, heart disease and type 2 diabetes. Some studies suggest that light drink consumers may be at up to 36% higher risk of metabolic syndrome (41). However, higher quality studies report that light drinks have either no effect or even protective effects (42, 43, 44). A recent study had overweight or obese subjects drink either one liter of sugary soft drinks, light drinks, water or skim milk per day. At the end of the six-month study, there were clear differences between the subjects who drank light drinks and the subjects who drank sugary soft drinks. The former weighed 17 to 21% less, had 24 to 31% less abdominal fat, 32% lower cholesterol levels and 10 to 15% lower blood pressure (44). Water had the same benefits as light drinks.

Summary: It is unlikely that artificial sweeteners promote metabolic syndrome. Replacing sugary drinks with light drinks may even reduce the risk of several serious diseases.

Artificial sweeteners and gut health

Gut bacteria play an important role in health and poor gut health is associated with numerous problems. These include weight gain, poorer blood sugar control, metabolic syndrome, a weakened immune system and disturbed sleep (45, 46, 47, 48, 49, 50). The composition and function of gut bacteria vary from person to person and appear to affect what people eat - and this includes artificial sweeteners (51, 52). In one study, the artificial sweetener saccharin disrupted the balance of gut bacteria in 4 out of 7 subjects who were unaccustomed to consuming this sweetener. These four subjects also showed poorer blood glucose control five days after consuming the sweetener (53). When the gut bacteria from these four subjects were implanted into mice, these animals also developed poorer blood glucose control (53). In contrast, when mice were implanted with gut bacteria from the subjects that had not responded to saccharin, no change in glycemic control was observed (53).

Although interesting, this is currently the only study that has observed these effects in humans. Further studies are therefore needed before meaningful conclusions can be drawn.

Summary: Artificial sweeteners may disrupt the balance of gut bacteria in some people, which could increase the risk of disease. However, further studies are needed to confirm these effects.

Artificial sweeteners and cancer

This debate about whether there is a link between artificial sweeteners and cancer dates back to the 1970s, initiated by animal studies showing an increased risk of bladder cancer in mice fed extremely high levels of saccharin and cyclamate (54). Fortunately, saccharin is metabolized differently in mice and humans. Since then, over 30 human studies have been conducted that have failed to find a link between artificial sweeteners and an increased risk of cancer (1, 55, 56, 57). One such study observed 9,000 participants over a period of 13 years and analyzed their sweetener consumption. After taking all factors into account, the scientists were unable to find a link between artificial sweeteners and the development of different types of cancer (55). A recent study review analyzed studies published over a period of 11 years. This review also found no link between cancer risk and the consumption of artificial sweeteners (58). This issue was also assessed by official bodies in the USA and Europe. Both agreed that artificial sweeteners in the recommended amounts do not increase the risk of cancer (1, 59). One exception is cyclamate, which was banned in the USA after the publication of the bladder cancer study on mice in 1970. Since then, extensive studies conducted on animals have failed to show an increased risk of cancer. Nevertheless, cyclamate has not been re-approved in the USA since then (1).

Summary: Based on the currently available scientific data, it is unlikely that artificial sweeteners increase the risk of cancer in humans.

Artificial sweeteners and dental health

Tooth decay occurs when bacteria in the mouth ferment sugar. This produces acids that can damage tooth enamel. Unlike sugar, artificial sweeteners do not react with the bacteria in the mouth, which means that they do not produce acid and do not cause tooth decay (60). Scientific research shows that sucralose is less likely to cause tooth decay than sugar. For this reason, products containing sucralose may be advertised with the claim that they can reduce tooth decay (28, 60, 61).

Summary: Artificial sweeteners can reduce tooth decay when consumed instead of sugar.

Aspartame, headaches, depression and seizures

Some artificial sweeteners can cause unpleasant side effects such as headaches, depression and seizures in some people. Although most studies have not found a link, two studies note that some people are more sensitive than others in this regard (62, 63, 64, 65, 66).

This individual variability could also apply to the effect of aspartame on depression. For example, people who suffer from mood disorders may be more likely to experience symptoms in response to aspartame consumption (67). Finally, it should be noted that artificial sweeteners do not increase the risk of seizures in most people. However, one study reported increased brain activity in children suffering from a certain form of epilepsy (68, 69, 70).

Summary: For most people, artificial sweeteners will not cause headaches, depression or seizures. However, some people may be more sensitive to them than others.

Safety and side effects

Artificial sweeteners are generally considered safe for human consumption (1). They are carefully tested and regulated by health authorities to ensure that they do not pose a risk to health. However, some people should avoid certain sweeteners. Aspartame, for example, contains the amino acid phenylalanine. People who suffer from the rare metabolic disorder called phenylketonuria cannot metabolize this amino acid and should therefore avoid aspartame. In addition, some people are allergic to the class of compounds called sulfonamides, which includes saccharin. In these people, saccharin can cause breathing difficulties, skin rashes and diarrhea.

Summary: Artificial sweeteners are generally considered safe, but should be avoided by people who suffer from phenylketonuria or are allergic to sulfonamides.

Conclusion

All in all, the use of sweeteners poses little risk and sweeteners may even have benefits when it comes to weight loss, blood sugar control and dental health. These sweeteners are particularly beneficial when used to reduce the sugar content of the diet. The likelihood of negative effects occurring can vary from person to person. Some people may feel bad or experience negative side effects after consuming artificial sweeteners, while the same sweeteners are well tolerated by most people.

References

https://www.healthline.com/nutrition/artificial-sweeteners-good-or-bad#section12