Non-Nutritive Sweeteners: The Good, The Bad, The Unknown
Author: Mark Gold, MD
The plethora of non-nutritive sweeteners on the market, including aspartame, sucralose and stevioside, are widely consumed and have grown in popularity in tandem with the growing waistlines of over half the population of the U.S. Yet their impact on health, especially long-term health, remains unclear. Conflicting research surrounding the impact and purported health benefits of artificial sweeteners is also not settled in the minds of most Americans, including scientists.
What We Know About Non-Nutritive Sweeteners
Long-term studies have shown that regular consumption of artificially sweetened beverages, for instance, reduces the intake of calories and thus promotes weight loss or maintenance of a healthy weight. Yet other research shows no effect, and some studies have demonstrated weight gain from using artificial sweeteners. It’s hard to tell. Nearly everyone has witnessed an obese person in the grocery store with a cart that is half-filled with diet soda and the other half with highly processed carbohydrates and sugary snacks. So, purchasing artificial sweeteners does not necessarily mean that the consumer is eating a low caloric diet.
But what about the cardio and metabolic impact?
To shed light on the impact of artificial sweeteners, Azad, et al (2017) synthesized data from both randomized controlled trials (RCT) and numerous prospective studies to determine whether the routine use of non-nutritive sweeteners was associated with adverse, long-term cardiometabolic effects.
Searching MEDLINE, Embase and Cochrane Library for these data, the team found seven clinical trials (1003 participants) and 30 cohort studies (405, 907 participants) that met inclusion criteria. The investigators were able to determine changes in body mass index (BMI), obesity and several important cardiometabolic end points.
The outcomes revealed that among the RCT groups, non-nutritive sweeteners had no significant effect on BMI, body weight, waist line, nor any cardiometabolic disease or cardiac events.
In the cohort studies with 4 to 9 years of follow-up, investigators showed that higher intake of non-nutritive sweeteners was associated with higher BMI, increasing waist circumference, higher incidence of abdominal obesity and overweight, plus increased hypertension, obesity, type 2 diabetes, metabolic syndrome
and cardiovascular events.
Why Does This Matter?
The observational cohort data suggest that intake of non-nutritive sweeteners may be associated with cardiometabolic risk. More details on baseline host behavior would have helped investigators to more clearly specify confounding variables and risk factors. Further research is warranted to fully understand the long-term risks and benefits of non-nutritive sweeteners as modifiable risk factors for obesity and cardiometabolic disease. But it is likely that sugar substitutes trigger the brain and cause more eating and obesity than we would like to imagine.