Artificial Sweeteners
Tell me about
Artificial Sweeteners / Non-nutritive Sweeteners (NNS)
Brief description
These are low/zero calorie substances used to sweeten foods and drinks. Typically they are present in drinks, desserts, ready meals, cakes, gum and toothpaste(1). They produce a sweet taste using the same taste receptors as sugar, however they are not similar enough for the body to process them as energy(2).
Examples of sweeteners approved in the UK include:
acesulfame K (E950)
aspartame (E951)
erythritol (E968)
saccharin (E954)
sorbitol (E420)
steviol glycosides (E960)
sucralose (E955)
xylitol (E967)
Artificial sweeteners are often much sweeter than sugar, and in some cases up to 20,000 times sweeter (see link).
Evidence base
Effect on blood glucose and/or insulin levels: Findings from a systematic review of 36 trials (n=472 healthy participants, examining: acesulfame potassium, aspartame, cyclamate, saccharin, stevia, and sucralose + various blends); found that NNS beverages had no effect on postprandial glucose, insulin, GLP-1, GIP PYY or ghrelin (other hormones responsible for sugar regulation and appetite) when compared to sugar sweetened beverages (SSB). Authors likened the response of NNS to water(3).These findings were reinforced by similar older trials(4).
Effect on BMI and Body weight: When comparing individuals on an unrestricted energy diet, those who consumed more NNS had lower body weight/BMIs than SSB(5).
In some studies high intakes of NNS is associated with higher BMI(6) – the authors suggested this could be due to changes in digestive hormones (however in the above, more recent studies refute this argument). Furthermore, these conclusions were drawn from only three cross-sectional studies, two of which were statistically significant.
Sugar substitutes may prevent cavity formation among children and adolescents. Findings from 6325 participants (aged 6-18), found xylitol, sorbitol and erythritol (sugar alcohols/ low-intensity NNS) had a significant effect in prevent dental caries(7).
Recommended serving & duration.
All NNS should be consumed in moderation.
Safety & tolerability
According to the European Food Safety Authority (EFSA) , NNS are generally considered safe. As with all nutritional research, reviews of food additives should occur regularly and you can track the status of all NNS on the EFSA website: https://www.efsa.europa.eu/en/topics/topic/sweeteners
Furthermore, the FDA recommend consuming no less than 50mg/kg/day of aspartame (in Europe this is 40mg/kg/day). One can of diet soda typically contains 200-300mg in total. Please bear in mind many foods may contain NNS and other sweeteners have different recommended limits making calculations on intake challenging(8):
Acesulfame K: 15 mg/kg/d
Sucralose: 5 mg/kg/d
Saccharine: 15 mg/kg/d
Steviol glycosides: 4 mg/kg/d
Author opinion (revised: 2024)
Currently, there is limited long term research suggesting significant harm of NNS consumption. Multiple studies which may link NNS consumption to cancer or cardiovascular risk appear conflicting or with evidence of bias - this also extends to conclusions about body weight changes(9).
Ultimately, NNS contain zero or little calories and no sugar content making them especially useful for calorie restricted diets (with respect to weight loss) or risk reduction of diabetes.
Furthermore, NNS may satisfy sweet craving (given they tend to be much sweeter than sugar); therefore, prevent over-snacking.
However, NNS have little effect on satiety (the feeling of fullness), and so arguments can be made to suggest individuals may still consume the same amount of food regardless of NNS beverage intake (in-particular).
This may be especially problematic in young adults/children, where their brains are developing to cravings of sweet foods/drinks. Overconsumption of NNS in this population may lead to cravings that are not fulfilled by sugar containing foods. E.g. in a child used to consuming multiple NNS beverages, a SSB may not now satisfy the sweet craving anymore – leading to overconsumption of SSB.
Despite this possibility, studies to date have found NNS in children and adolescents are associated with less BMI gain, versus sugar containing drinks – therefore are currently still a superior choice(10).
References:
UK N. The truth about sweeteners 2023 [Available from: https://www.nhs.uk/live-well/eat-well/food-types/are-sweeteners-safe/.Ford HE, Peters V, Martin NM, Sleeth ML, Ghatei MA, Frost GS, et al. Effects of oral ingestion of sucralose on gut hormone response and appetite in healthy normal-weight subjects. Eur J Clin Nutr. 2011;65(4):508-13.Zhang R, Noronha JC, Khan TA, McGlynn N, Back S, Grant SM, et al. The Effect of Non-Nutritive Sweetened Beverages on Postprandial Glycemic and Endocrine Responses: A Systematic Review and Network Meta-Analysis. Nutrients. 2023;15(4).Greyling A, Appleton KM, Raben A, Mela DJ. Acute glycemic and insulinemic effects of low-energy sweeteners: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2020;112(4):1002-14.Laviada-Molina H, Molina-Segui F, Pérez-Gaxiola G, Cuello-García C, Arjona-Villicaña R, Espinosa-Marrón A, et al. Effects of nonnutritive sweeteners on body weight and BMI in diverse clinical contexts: Systematic review and meta-analysis. Obes Rev. 2020;21(7):e13020.Ruanpeng D, Thongprayoon C, Cheungpasitporn W, Harindhanavudhi T. Sugar and artificially sweetened beverages linked to obesity: a systematic review and meta-analysis. QJM: An International Journal of Medicine. 2017;110(8):513-20.Luo BW, Liang NL, Townsend JA, Lo ECM, Chu CH, Duangthip D. Sugar substitutes on caries prevention in permanent teeth among children and adolescents: a systematic review and meta-analysis. J Dent. 2024;146:105069.FDA. Aspartame and Other Sweeteners in Food 2023 [Available from: https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food.de Lima RC, Silva GBE, Mendonça VS, Malhão TA, Diogenes MEL, Huguenin GVB. Evaluation of Conflicts of Financial Interest in Publications on the Consumption of High-Intensity Sweeteners and Body-Weight Changes: A Systematic Review. Nutr Rev. 2024.Espinosa A, Mendoza K, Laviada-Molina H, Rangel-Méndez JA, Molina-Segui F, Sun Q, et al. Effects of non-nutritive sweeteners on the BMI of children and adolescents: a systematic review and meta-analysis of randomised controlled trials and prospective cohort studies. Lancet Glob Health. 2023;11 Suppl 1:S8.
