What are the currently used artificial sweeteners in the United States and what is the scientific evidence regarding their safety and potential health risks?

From the Guidelines

The currently used artificial sweeteners in the United States include saccharin, aspartame, acesulfame potassium, sucralose, neotame, stevia, and advantame, which are generally recognized as safe when consumed within acceptable daily intake levels, although some studies suggest potential associations with altered gut microbiota and metabolic changes 1. The FDA has approved these nonnutritive sweeteners for use in the U.S., and they are 180 to 20,000 times sweeter than sugar, potentially affecting preferences for sweet taste. Some key points to consider about these sweeteners include:

• They can reduce weight gain or promote small amounts of weight loss when substituted for caloric-sweetened foods or beverages, particularly in individuals with conditions such as obesity and type 1 or 2 diabetes mellitus 1.
• However, health care providers should be aware that nonnutritive sweetener use in isolation is unlikely to result in important weight loss, and observational studies show that nonnutritive sweetener intake is associated with higher rates of metabolic syndrome and diabetes 1.
• There are no absolute contraindications to the use of nonnutritive sweeteners by children, except for aspartame and neotame in children with phenylketonuria 1.
• The use of nonnutritive sweeteners has been associated with a reduced presence of dental caries 1. It is essential to note that the long-term safety of nonnutritive sweeteners in childhood has not been assessed in humans, and more research is needed to understand their effects on the microbiome and metabolism 1. Additionally, the FDA should require products marketed in the United States to include labels that list the type and quantity of any nonnutritive sweetener contained per serving of a product, to better inform the public about consumption of nonnutritive sweeteners 1. While an older study from 2006 also confirmed the safety of nonnutritive sweeteners, including acesulfame potassium, aspartame, neotame, saccharin, and sucralose 1, the most recent and highest quality study from 2019 provides more comprehensive information on the current state of knowledge regarding nonnutritive sweeteners 1.

From the Research

Currently Used Artificial Sweeteners in the United States

• The six low-calorie sweeteners currently approved for use in foods in the U.S. are:
  • Stevia
  • Acesulfame-K
  • Aspartame
  • Neotame
  • Saccharin
  • Sucralose 2
• These artificial sweeteners are used as alternatives to table sugar and are many times sweeter than natural sugar, containing no calories, which may be used to control weight and obesity 2

Scientific Evidence Regarding Safety and Potential Health Risks

• Extensive scientific research has demonstrated the safety of these six low-calorie sweeteners, if taken in acceptable quantities daily 2
• However, recent evidence suggests that high consumption of artificial sweeteners may be associated with increased risks of:
  • Metabolic disorders
  • Cardiovascular diseases
  • Certain cancers
  • Weight gain
  • Adverse pregnancy outcomes
  • Potential risks for individuals with low seizure thresholds 3
• Artificial sweeteners like saccharin have been linked to inflammatory bowel diseases, gut microbiota disruption, increased intestinal permeability, and dysbiosis, leading to metabolic disturbances such as impaired glucose tolerance, insulin resistance, and heightened systemic inflammation 3
• Some studies have reported that artificial sweeteners may affect glucose absorption in the intestinal tract as well as insulin and incretin secretion in humans and animals, and alter the composition of the microbiota, worsening glycemic control 4
• Epidemiological studies in humans did not find the bladder cancer-inducing effects of saccharin and cyclamate that had been reported from animal studies in rats, and there is no evidence that aspartame is carcinogenic 5
• A large cohort study showed that high artificial sweetener intake was associated with all-cause mortality, cardiovascular risk, coronary artery disease risk, cerebrovascular risk, and cancer risk 4

Health Benefits and Risks

• Artificial sweeteners may be beneficial for individuals who cannot tolerate sugar in their diets, such as diabetics 6
• However, the potential health risks associated with artificial sweetener consumption, such as metabolic disorders and cancer, cannot be ignored 3, 5, 4
• The role of artificial sweeteners in the treatment of diabetes and obesity should be reconsidered, and further studies are needed to utilize the beneficial properties of artificial sweeteners in treatment 4