By Serena Gordon
"It's been widely accepted that nonnutritive sweeteners don't raise blood sugar, but there's never been a large-scale study to confirm that," said study co-author Maxwell Holle. He's a Ph.D. candidate in the department of food science and human nutrition at the University of Illinois at Urbana-Champaign.
Plus, he said, many past studies have only looked at the effects of artificial sweeteners when consumed with other foods.
"We wanted to see studies that used nonnutritive sweeteners by themselves, so we could create a reliable reference," Holle said.
Artificial sweeteners are extremely popular in the United States. They provide a sweet taste without adding a lot of calories or carbohydrates, which can be especially important if someone has diabetes.
From 1999-2000 to 2009-2012, the use of these sweeteners in the United States went up by 200 percent in children and 54 percent in adults, the researchers said. About 1 in 4 American children and about 2 in 5 American adults use them on a regular basis.
There are eight types of artificial sweeteners allowed in foods in the United States, which include saccharin (Sweet'N Low), aspartame (Equal), steviol glycosides (Stevia) and sucralose (Splenda), the researchers said.
Another group of sweeteners found in some foods labeled sugar-free are called sugar alcohols. These include sorbitol, mannitol, xylitol, isomalt, and hydrogenated starch hydrolysates, according to the Joslin Diabetes Center in Boston. These sugar alcohols were not included in the review.
The study authors looked at 29 randomized controlled trials. Those studies had a total of 741 participants. Most were healthy, 69 had type 2 diabetes, and the health status of 150 people was unknown.
The review only included studies where the artificial sweetener was consumed without other foods and drinks containing calories. The study authors concluded that artificial sweeteners don't affect blood sugar levels.
"If you're worried about a rise in blood sugar, it's safe to consume nonnutritive sweeteners alone," said study co-author Alexander Nichol, a master's student in the department of food science and human nutrition at UIUC.
However, that doesn't mean you "can consume as much as you want of food and drinks containing these sweeteners," Nichol said.
Certified diabetes educator Maudene Nelson said that misconceptions abound when it comes to sugar-free foods and drinks. She's a nutritionist with Columbia University's Student Health Services in New York City, and was not involved with the review.
The biggest misconception, Nelson said, is that you can eat these foods without consequence because they don't contain sugar.
"Sugar substitutes don't give sugar-free chocolates and candy a 'health halo,' " Nelson said, explaining that these foods still have carbohydrates and fats and protein, which can all affect blood sugar. They also all have calories, which can affect weight.
"This study gives us a green light for artificial sweeteners as far as blood sugar is concerned, but people with diabetes have to remember everything else that's there around the artificial sweetener," she said.
Nelson pointed out that some people say that artificial sweeteners do have an impact on their blood sugar. But, again, she said, it's important to consider what else has been consumed with the artificial sweetener.
For example, if someone has black coffee with an artificial sweetener, their blood sugar might go up because of the caffeine in the coffee. Or, if someone has coffee with an artificial sweetener and a splash of low-fat milk, the milk has carbohydrates that can raise blood sugar.
Although sugar alcohols were not included in this study, Nelson said people should be aware of the potential digestive problems linked to these sweeteners. If eaten in larger quantities, they can cause gas, bloating and diarrhea.
The study was published recently in the European Journal of Clinical Nutrition.