The Case Against Artificial Sweeteners as Sugar Substitutes

"I think a lot of people consuming them kind of assume they’re harmless because they contain zero calories. But what the evidence is suggesting is maybe there’s more to the story than that."
"The message is there isn’t strong evidence for a benefit from these products – and there’s potential evidence for harm."
"I’m going to say that you should drink water."
"The results [of the new review] showed a statistically significant association between consumption of artificial sweeteners and higher risks of diabetes, heart disease and increased weight gain."
"Given the widespread and increasing use of artificial sweeteners, and the current epidemic of obesity and related diseases, more research is needed to determine the long-term risks and benefits of these products." 
Dr.Meghan Azad, assistant professor of pediatrics and child health, University of Manitoba

Nonnutritive sweeteners such as those used in diet pop were associated with weight gain, a higher risk of Type 2 diabetes and other health problems, according to researchers from the University of Manitoba’s George and Fay Yee Centre for Healthcare Innovation.  (Getty Images/iStockphoto)

A new study published in the Canadian Medical Association Journal carried out by University of Manitoba researchers reviewing the effects of sugar substitutes in an effort to avoid using sugars in diet-conscious consumers' food choices has concluded that these artificial sweeteners may be responsible for making people gain weight, and increasing as well the onset risks inherent in high blood pressure, diabetes and cardiovascular events such as heart attack and stroke.

While hard-and-fast evidence is as yet elusive, and the study's lead author calls for ongoing research, a leading theory is that the use of sweeteners changes the body's metabolic processes, leading to functional anomalies which confuse the brain and the body's capacity to respond to, and process sugar.

Artificial sweeteners like aspartame represent the most widely used food additives globally. They're found in over six thousand products worldwide as substitutes for sugar in "no sugar added" foods such as ice cream, yogurt and granola bars.

The presence of artificial sweeteners in foods is so ubiquitous that when urine and blood samples are taken from people who state they never use such additives, trace amounts nonetheless show up. "People are consuming them without knowing it", stated Dr. Azad, study lead author.
 

Diet Coke is poured on a Big Gulp cup at a 7-Eleven store     Joe Raedle / Getty Images

A study published in the journal Nature two years earlier had discovered that sugar substitutes act on gut bacteria. Mice fed saccharin for 11 weeks showed alterations in their gut microbiome, and became pre-diabetic, leading Dr. Azad to wonder whether evidence could be found for similar effects in people. This led her and her colleagues to perform a systematic review and meta-analysis (study of earlier studies) to assess the effects of long-term, regular consumption of sweeteners on cardio-metabolic health conditions.

Of 37 studies reviewed which reflected the involvement of over 400,000 people, seven of the studies represented randomized controlled trials involving approximately a thousand people followed for an average of six months. The studies concluded that sweeteners did not demonstrate a consistent effect of weight loss.

Another thirty longer and larger observational studies which had people responding with information relating to their use of artificial sweeteners and who were then followed for an average of ten years, showed a 14 percent rise in diabetes in "high" consumers (people having a diet soft drink at least once or more daily).
 

Artificial sweeteners are synthetic food additives that provide a sweet taste to mimic sugar, while containing significantly fewer calories. / Mario Tama/Getty Images

Compared to those reporting never or rarely consuming sugar substitutes, a 32 percent increased risk of coronary heart disease, heart failure and other cardiovascular problems assailed the artificial sweetener users who also evidenced a 31 percent increase in risk of metabolic syndrome, representing a group of conditions which include hypertension and abnormal cholesterol raising the risk of heart disease and stroke.