Experts weigh in on the safety of Splenda, Stevia, and other similar sugar substitutes.
Since the first artificial sweetener was accidentally invented about 144 years ago, many of us have become attached to the intoxicating fantasy that these fake sugars provide: Eating what we want without dealing with the consequences. But do sugar substitutes really come risk-free?
If you’ve ever done a cursory Google search about these miracle products, you know that the alleged negative effects are enough to make your head spin. We added yet another health concern to the list after a study published in Nature Medicine this week found that consumption of one artificial sweetener was linked to a seriously increased risk of heart attack and stroke. Despite the validity of available research, the sheer amount of data can be so overwhelming that it’s not always clear if these health risks are substantiated and worth sacrificing your daily Diet Coke.
So, is it better to enjoy the short-term bliss of reduced-calorie sweet treats or should we focus on the potential long-term health issues associated with consuming these chemicals? Plus, how real are the so-called “dangers” — and are these hazards worth the risk for groups struggling with other health issues like diabetes? And speaking of serious concerns, have we ever nailed down whether these substances actually cause cancer?
We’re breaking down the pros and cons of artificial sweeteners — with some surprising news about how these sweeteners may impact your health.
What are artificial sweeteners?
Artificial sweeteners are chemicals added to food and drinks to make them taste sweet; typically, the artificial stuff is hundreds to thousands of times as sweet as table sugar. Artificial sweeteners can go by brand names (like Splenda) but they’re also commonly called low-calorie sweeteners, non-nutritive sweeteners, artificial sweeteners, sugar substitutes, and high-intensity sweeteners.
The FDA has currently approved the following sweeteners as food additives: aspartame, acesulfame-K, saccharin, sucralose, neotame, and advantame. Some steviol glycosides and monk fruit are permitted safe as well.
Sugar alcohols like erythritol, lactitol, maltitol, mannitol, sorbitol, and xylitol are technically not artificial sweeteners, though they do have fewer calories per gram than sugar.
Which artificial sweetener is linked to an increased risk of heart attack and stroke?
According to the Nature Medicine study, the sugar alcohol erythritol was linked to an increased risk of heart attack and stroke. Erythritol is often used to bulk up Stevia, monk fruit-sweetened products, and even reduced-sugar products, all of which are often branded as healthy alternative sweeteners. Despite the nutritious branding, the study’s lead author Stanley Hazen, MD, Ph.D., said that “the degree of risk was not modest.”
The lab and animal research performed in the study reveal that erythritol seemingly makes blood platelets clot particularly easily. This clotting risk is significant since the clots can detach and travel to the brain or heart, where they can cause a heart attack or stroke.
Researchers stumbled upon the link while evaluating chemicals in 1,157 blood samples of people at risk for heart disease; these samples were collected between 2004 and 2011. When researchers discovered the correlation, they tested a few thousand additional samples from 2,100 people in the United States and 833 in Europe. When the research team directed a group of eight healthy volunteers to drink a beverage with 30 grams of erythritol in it, these volunteers had “heightened” risks of blood clotting. Keep in mind that the Food and Drug Administration currently does not have an acceptable daily intake (ADI) for erythritol so 30 grams is neither above or below an advised level.
Additionally, research shows that those with the highest amount of erythritol in their blood are at twice the risk for heart attack and stroke: “If your blood level of erythritol was in the top 25 percent compared to the bottom 25 percent, there was about a two-fold higher risk for heart attack and stroke. It’s on par with the strongest of cardiac risk factors, like diabetes,” Dr. Hazen added.
Can artificial sweeteners cause cancer?
For decades, experts have tried to confirm or deny the hypothesized link between artificial sweeteners and cancer — and the public has experienced whiplash from this tug-of-war. At the moment, there’s a sort of firm answer to the question that is unfortunately subject to change.
Officially, organizations like the FDA have reviewed existing research and concluded that there is no proof that these chemicals cause cancer. However, researchers continue to conduct comprehensive studies: The recent NutriNet-Santé study is an ongoing, long-term assessment of the health of 102,865 French adults. Since 2009, individuals have self-reported data about their medical histories and lifestyles. This research currently suggests a link between the consumption of artificial sweeteners and a slight risk of breast cancer and weight-related cancers. The methodology was incredibly detail-oriented: “24-hour dietary records allowed us to collect precise information on the consumption of industrial products, including their commercial brands/names.”
But still, this information is annoyingly new and certainly doesn’t prove low-calorie sweeteners cause cancer. As Mary-Jon Ludy, Ph.D., points out, it can be tough to pinpoint if the sweeteners caused the cancer or if the cancer is the result of broader lifestyle choices: “With an observational study design, it is not possible to determine whether high levels of artificial sweetener intake cause cancer, or whether individuals with cancer consume excessively high levels of artificial sweeteners.” In other words, more thorough research is needed.
If you’re tearing your hair out over the cancer issue, it might be time to switch focus. Amy Shapiro MS, RD, CDN, a dietitian and founder of the private practice Real Nutrition, says that the risk of cancer actually isn’t necessarily her concern. Instead, she focuses on the less publicized side effects that can also severely complicate her clients’ health. “There isn’t any research showing that using artificial sweeteners increases the risk of cancer in humans. However, they aren’t necessarily digestible by the human body, so consuming artificial sweeteners can lead to bloating, diarrhea, or discomfort of the gut,” she says.
While it’s always important to consider cancer risks, considering these other potential health issues may guide you toward a decision to abstain.
Are artificial sweeteners bad for you for other reasons?
Alongside the digestion issues, Shapiro mentions artificial sweeteners are linked to chronic health issues including diabetes, which is what some people are trying to avoid in their consumption of the stuff. “Potential health risks after long-term use include increased risks of stroke, chronic heart disease, chronic kidney disease, and type 2 diabetes.”
Kristen Carli, MS, RD, a dietician and founder of Camelback Nutrition & Wellness, concurs that artificial sweeteners can cause long-term illnesses and health issues.
“Research shows that artificial sweeteners may encourage fat production, lead to sugar cravings (though this is disputed), increase hunger, increase weight gain and obesity, increase risk of developing diabetes, damage gut bacteria, and even increase risk of early death,” she says.
That’s right — both Carli and Shapiro stated that fake sugar can actually cause type 2 diabetes and can adversely affect metabolism and stimulate weight gain, even though low-calorie sweeteners are branded as products designed to encourage or maintain weight loss. Shapiro says she understands using these products “allows for a calorie deficit” but points out that long-term changes certainly aren’t guaranteed.
If you’re already diabetic, Carli clarifies that you can manage your blood sugar with these products: “Sugar substitutes do not affect blood sugar or insulin levels, making them a good option for those with diabetes.”
Shapiro agrees that artificial sweeteners can be a useful tool for people with diabetes, though she’s cautious about framing them as a safe option: “There is insufficient evidence supporting safe consumption of artificial sweeteners for the diabetic population. However, for those with diabetes, they can be helpful as they do not trigger blood glucose or insulin levels.”
Are there ways to use artificial sweeteners safely?
Here’s the inevitable answer that you may be dreading: The best method for managing sugar intake is boring, frustrating, run-of-the-mill moderation. Carli says that while too much sugar can adversely affect your health, it’s better to use some sugar occasionally than consuming a ton of artificial sweeteners. “My best advice is to use real sugar, just less often,” she says. Shapiro recommends exploring alternative sweeteners like “honey, agave, maple syrup, dates, coconut sugar, and allulose.” In many cases, these are sweeter than sugar, so a little will go a long way. Some of these alternatives, like coconut sugar, even contain some vitamins and minerals — and who doesn’t need more of those? Still, quitting sugar or altering your sweetener intake is easier said than done. But if you’re in need of specific advice on how to refresh your relationship with sugar, it’s very possible, and we’ve even got some advice on deck.
The information provided on this site isn’t intended as medical advice, and shouldn’t replace professional medical treatment. Consult your doctor with any serious health concerns.
