Are artificial sweeteners good for you?

By Naveed Saleh, MD, MS
Published July 7, 2021

Key Takeaways

For better or worse, sugar is a major part of the human diet, and humans have been sweetening food for centuries. Natural sweeteners—such as sucrose, honey, and sugars from fruits and vegetables—boast at least some nutritional value. On the other hand, artificial sweeteners such as aspartame, saccharin, and sucralose offer no nutritional value.

Non-caloric artificial sweeteners arrived on the scene more than a century ago, and American diets were forever changed as people sought to decrease sugar intake and lose weight. 

But according to the authors of one recent review, artificial sweeteners, from a metabolic standpoint, cannot simply replace natural sugars. “The physical characteristics of a natural sweetener in terms of sweetness intensity, quality, degradability and abundance in nature are much superior to that of artificial sweeteners,” they wrote. “Moreover, they are easily metabolized in humans. In contrast, the artificial sugars provide low calories because they are not metabolised completely in the human body.”

 Artificial sweeteners and their effects on health are the subject of ongoing scientific research. Let’s take a look at recent studies on the topic.


Some experts opine that the main reason people develop type 2 diabetes is artificial sweeteners. Although this statement may be hyperbole, artificial sweeteners may play a role in the pathogenesis of diabetes, according to research.

In a cross-sectional study published in the Journal of Family Medicine and Primary Care, researchers compared insulin resistance levels in diabetic patients who either consumed artificial sweeteners or didn’t. Those who consumed artificial sweeteners had higher insulin resistance levels.

According to the authors, “Ingestion of these artificial sweeteners (AS) results in the release of insulin from pancreas which is mistaken for glucose (due to their sweet taste). This increases the levels of insulin in blood eventually leading to decreased receptor activity due to insulin resistance.”

The authors also cited a study in which participants received either sucralose or water and then underwent a glucose tolerance test. Those who received sucralose demonstrated increased insulin levels. Another study cited by the authors demonstrated a dose-dependent relationship between artificially sweetened soft drinks and type 2 diabetes risk.

Read more about the health effects of artificial sweeteners in soft drinks and other beverages at MDLinx.

Neurocognitive effects

The artificial sweetener aspartame has been tied to behavioral and cognitive problems, including learning issues, seizure, headache, irritable mood, anxiety, migraines, insomnia, and depression. These effects could be due to elevated levels of phenylalanine and aspartic acid. 

According to the authors of a study published in Nutritional Neuroscience, “These compounds can inhibit the synthesis and release of neurotransmitters, dopamine, norepinephrine, and serotonin, which are known regulators of neurophysiological activity. Aspartame acts as a chemical stressor by elevating plasma cortisol levels and causing the production of excess free radicals.”

They added, “High cortisol levels and excess free radicals may increase the brain's vulnerability to oxidative stress, which may have adverse effects on neurobehavioral health. We reviewed studies linking neurophysiological symptoms to aspartame usage and concluded that aspartame may be responsible for adverse neurobehavioral health outcomes. Aspartame consumption needs to be approached with caution due to the possible effects on neurobehavioral health.”

Nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease, or NAFLD, occurs in those who drink little or no alcohol and manifests as the accumulation of excess fat in the liver.

In a recent review published in the EXCLI Journal, authors noted that consuming artificial sweeteners may disrupt the gut microbiome, leading to NAFLD. The gut microbiome is a complex system that contributes to diverse physiologic processes, including bone mineralization, immune system regulation, xenobiotics metabolism, proliferation of intestinal cells, and protection against pathogens. A disruption in the gut microbiome is referred to as gut dysbiosis.

Based on previous research, the authors suggested that artificial sweeteners may induce gut dysbiosis by killing aerobic and anaerobic gut bacteria. For instance, sucralose may decrease populations of bifidobacterialactobacilliBacteroides, and Clostridiales. On the other hand, saccharin could inhibit lactobacilli and E. Coli strains.

“Dysbiosis is one of the factors with demonstrated contribution to the pathogenesis of NAFLD. Increasing evidence shows that (artificial sweeteners) have a potential role in microbiota alteration and dysbiosis. We speculate that increased consumption of (artificial sweeteners) can further raise the prevalence of NAFLD. However, further human studies are needed to determine this relationship definitively,” the authors concluded.

Bottom line

Artificial sweeteners have been approved for use in food by the FDA. Furthermore, the American Heart Association offers this guidance: “Foods and beverages that contain NNSs [non-nutritive substances] can be included in a healthy diet, as long as the calories they save you are not added back by adding more foods as a reward later in the day, adding back calories that take you over your daily limit.”

Nevertheless, artificial sweeteners may carry risks, according to the most recent research. Thus, it’s a good idea to partake of artificially sweetened products judiciously and not over-consume. The exact pathophysiologic effects of artificial sweeteners have yet to be elucidated, and when compared with excess consumption of sugar, might represent the lesser of two evils.

Read more here about what natural sugar does to the brain, at MDLinx

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