Are Artificial Sweeteners Safe?

WebMD gets the skinny on artificial sweeteners

Medically Reviewed by Neha Pathak, MD on November 21, 2017
From the WebMD Archives

The way artificial sweeteners were discovered could have been a scene out of the classic comedy The Nutty Professor.

In 1879, Ira Remsen, a researcher from Johns Hopkins University in Baltimore, Md., noticed that a derivative of coal tar he accidentally spilled on his hand tasted sweet. While he did not morph into the slim but obnoxious Buddy Love (as did the characters played by Jerry Lewis and later Eddie Murphy in their film versions of the comedy), his spill set the stage for the development of saccharin -- an artificial sweetener known today to many seasoned dieters as Sweet-n-Low.

Now more than 125 years later, saccharin is joined by a growing list of artificial sweeteners with varying chemical structures and uses, including acesulfame potassium (Sunett, Sweet One); aspartame (NutraSweet, Equal, Advantame); neotame (Newtame), and sucralose (Splenda).

Stevia, another sugar substitute, is an extract from a South American plant, and while it is billed as “natural,” the sugar alcohol ethanol is used as a solvent in the extraction process. SweetLeaf,Truvia, and Pure Via are other artificial sweeteners that contain stevia extract but use different manufacturing processes. (It is worth noting that “natural” isn’t a defined or regulated term in the food industry. The FDA says that for a food to be called natural, it can’t contain artificial or synthetic ingredients, including color additives.)

These products substitute for sugar. For example, they can replace corn syrup, used in many sodas and sweetened drinks, and table sugars.
But are artificial sweeteners safe? Can they help people shed extra weight, or do they lead to weight gain? What role should they play in person's diet -- if any?


One thing is certain: American consumers embrace these sweeteners: A 2017 report in the Journal of Academy of Nutrition and Dietetics found that 25% of American children and over 41% of American adults use low-calorie sweeteners. 

Here's what else WebMD found out:

Artificial sweeteners are compounds that offer the sweetness of sugar without the same calories. They are anywhere from 30 to 8,000 times sweeter than sugar and as a result, they have much fewer calories than foods made with table sugar (sucrose). Each gram of table sugar contains 4 calories. Many sugar substitutes have zero calories per gram.

"Artificial sweeteners can serve a definite purpose in weight loss and diabetes control," says New York City-based nutritionist Phyllis Roxland. "It enables people that are either carb-, sugar-, or calorie-conscious to take in a wider range of foods that they would either not be allowed to eat or could only eat in such teeny amounts that they were not satisfying." Roxland counsels patients in the offices of Howard Shapiro, MD, a weight loss specialist and author of Picture Perfect Prescription.

In other words, artificial sweeteners allow people to stick to a good diet for a longer period of time, she says. In a diet, artificial sweeteners are considered "free foods." The sugar substitutes don't count as a carbohydrate, a fat, or any other exchange.

"These products can be useful when used appropriately for people like diabetics who need to control their sugar intake and in overweight people," agrees Ruth Kava, PhD, RD, senior fellow in nutrition at the American Council on Science and Health (ACSH) in New York City.

Artificial sweeteners do not affect blood sugar levels, but some foods containing artificial sweeteners can still affect blood sugar because of other carbohydrates or proteins in these foods. In other words, while foods that contain artificial sweeteners may be sugar-free, they may not be carbohydrate-free.

Just because a food contains artificial sweeteners instead of sugar is not carte blanche for grazing, Kava points out.

"The real key to weight loss is calories," Kava points out. "If you substitute a diet soda for a sugar soda, you save 100 calories, but if you eat 15 sugar-free cookies [which have calories] instead of two regular cookies, you may not be helping yourself at all," she says.


Consume with a Grain of Salt

According to the National Cancer Institute, there's no scientific evidence that any of the artificial sweeteners approved for use in the U.S. cause cancer.

"The cancer risks are not something that an individual person should worry about," says Michael F. Jacobson, PhD, founder and chief scientist at the Center for Science in the Public Interest in Washington, D.C. "It's more a risk for the government as the potential problems occur when millions of people consume the sweeteners for years," he tells WebMD.

But cancer risk may not be the only health concern with these artificial sweeteners.

A recent meta-analysis that looked at studies involving thousands of participants found that using artificial sweeteners had either no effect on body mass index (a measurement of body fat in relation to a person’s height and weight) or led to actual weight gain and cardiac problems.

The analysis, which appeared in the Canadian Medical Association Journal in July 2017, examined the results of 7 clinical trials and 30 observational studies, finding that artificial sweeteners were associated with obesity, high blood pressure, type 2 diabetes, and heart problems.

"If somebody is trying to lose weight and cut back on calories, artificial sweeteners can add flavor to unsweetened beverages or other products," Jacobson says. "Somebody who consumes a lot of artificially sweetened foods should think twice about their diet and ought to be eating real food." 

"I don't think [artificial sweeteners] are needed at all," he adds. "I fear that in some cases people have a diet soda for lunch and then have a couple of tablespoons of ice cream -- giving up the saved calories." 

Other caveats when consuming sugar substitutes:

People with a rare disorder known as phenylketonuria (PKU) cannot metabolize phenylalanine, which is found in aspartame. PKU is detected at birth through a mandatory screening program.

In the short term, some people develop headaches after consuming foods sweetened with aspartame (Equal, NutraSweet, Advantame), Jacobson says.

In the long term, using sugar substitutes instead of sugar can lower your risk of tooth decay, but "the acid in diet soda still could contribute to dental erosion," he points out.

Still, says Roxland, you can't really overdose on artificial sweeteners. Go ahead and indulge:

"Even if a person binges on low-calorie Fudgesicles or Creamsicles, as long as their diet is otherwise healthy, there is no downside because they would probably be bingeing on something a lot worse," she says.


Show Sources

SOURCES: Phyllis Roxland. Ruth Kava, PhD, RD, nutritionist; and director, nutrition, American Council on Science and Health, New York City. Michael F. Jacobson, PhD, chief scientist, Center for Science in the Public Interest, Washington. Journal of the Academy of Nutrition and Dietetics: "Consumption of Low-Calorie Sweeteners among Children and Adults in the United States." American Diabetes Association. National Cancer Institute: “Artificial Sweeteners and Cancer."

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