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artificial sweetener

Pharmacokinetics: - not absorbed - eliminated in feces Adverse effects: - carbohydrate malabsorption when used in excess - artificial sweeteners can alter the gut microbiome leading to absorption of more calories & glucose intolerance [3] - may increase risk of metabolic syndrome & type 2 diabetes [5] - diet soda consumption associated with in increased risk of stroke, myocardial infarction, cardiovascular mortality, all-cause dementia & Alzheimer's disease [4,9] - sucralose may increase glucose uptake, inflammation, & adipogenesis, most notable in persons with obesity [6] - artificially-sweetened beverages like diet soda associated with risk for cardiovascular disease: - ischemic stroke (RR=1.31), coronary artery disease (RR=1.29), all-cause mortality (RR=1.16) [8]; cerebrovascular disease (RR=1.2-1.3) [12] - MKSAP19 says no association of artificial sweeteners & cardiovascular risk [2] - artificial sweeteners (especially aspartame & acesulfame-K) are associated with increased cancer risk (RR=1.15 for aspartame) [11] Notes: 1) Artificial sweeteners are regulated by the FDA. 2) no scientific evidence that artificial sweeteners are a health risk for most people - not sure this is true (see adverse effects above) - no evidence that the regulated artificial sweeteners on the US market are related to cancer risk in humans - in contrast, health risks of excessive calorie consumption are well substantiated 3) no clinically-relevant benefits for most health care outcomes [7] - benefits of reduced calories in artificial sweeteners only realized if total calorie intake is reduced [1] 4) use of artificial sweeteners may facilitate reduction in sugar intake & thus in total calorie intake [1] 5) potential benefit in glycemic control [1] 6) artificial sweetners are not associated with reduced BMI [5] 7) artificially-sweetened beverages are aviable alternative to water as a replacement strategy in overweight or obese adults at risk for or with diabetes mellitus [10]

Related

artificially-sweetened beverage diet soda

Specific

acesulfame-K advantame aspartame erythritol saccharin sucralose

General

food additive

References

  1. Gardner C, Wylie-Rosett J, Gidding SS et al Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2012 Jul 24;126(4):509-19. [58 references] PMID: 22777177 http://circ.ahajournals.org/content/early/2012/07/09/CIR.0b013e31825c42ee (corresponding NGC guideline withdrawn Dec 2017)
  2. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2023
  3. Suez J et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature 2014 Oct 9; 514:181 PMID: 25231862
  4. Wersching H, Gardener H, Sacco RL Sugar-Sweetened and Artificially Sweetened Beverages in Relation to Stroke and Dementia. Are Soft Drinks Hard on the Brain? Stroke April 20, 2017 PMID: 28428347 http://stroke.ahajournals.org/content/early/2017/04/20/STROKEAHA.117.017198
  5. Azad MB, Abou-Setta AM, Chauhan BF et al Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies. CMAJ July 17, 2017 vol. 189 no. 28 E929-E939 PMID: 28716847 http://www.cmaj.ca/content/189/28/E929
  6. Monaco K Artificial Sweeteners Impact Metabolic Health Even on Cellular Level. Not as healthy as consumers may think, researcher says. MedPage Today. March 20, 2018 https://www.medpagetoday.com/meetingcoverage/endo/71882 - Kundu N, et al Sucralose promotes metabolic dysregulation and intracellular ROS accumulation. The Endocrine Society Annual Meeting (ENDO) 2018; Abstract SUN-071.
  7. Toews I, Lohner S, de Gaudry DK et al Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies. BMJ 2019;364:k4718 PMID: 30602577 Free full text https://www.bmj.com/content/364/bmj.k4718 - Malik VS Non-sugar sweeteners and health BMJ 2019;364:k5005 PMID: 30606710 https://www.bmj.com/content/364/bmj.k5005
  8. Mossavar-Rahmani Y, Kamensky V, Manson JE et al Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women's Health Initiative. Stroke. 2019 Mar;50(3):555-562. Published online: Feb 14, 2019 PMID: 30802187 https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023100 - Gardener H, Elkind MSV Artificial Sweeteners, Real Risks Stroke. Mar;50(3):549-551. Published online: Feb 14, 2019 PMID: 30760171 https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.024456
  9. Chazelas E et al. Sugary drinks, artificially-sweetened beverages, and cardiovascular disease in the NutriNet-Sante cohort. J Am Coll Cardiol 2020 Nov 3; 76:2175. PMID: 33121725 https://www.sciencedirect.com/science/article/abs/pii/S0735109720365967
  10. McGlynn ND, Khan KA, Wang L et al Association of Low- and No-Calorie Sweetened Beverages as a Replacement for Sugar-Sweetened Beverages With Body Weight and Cardiometabolic Risk. A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(3):e222092. PMID: 35285920 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790045
  11. Debras C, Chazelas E, Srour B et al Artificial sweeteners and cancer risk: Results from the NutriNet-Sante population-based cohort study. PLOS Medicine. 2022. Mar 24;19(3):e1003950 PMID: 35324894 PMCID: PMC8946744 Free PMC article https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003950
  12. Debras C, Chazelas E, Sellem L et al Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Sante cohort. BMJ 2022;378:e071204 Sept 7 Not indexed in PubMed https://www.bmj.com/content/378/bmj-2022-071204
  13. Artificial Sweeteners http://cis.nci.nih.gov/fact/3_19.htm