Does aspartame (artificial sweetener) cause hyperglycemia (elevated blood glucose)?

From the Guidelines

Aspartame does not cause hyperglycemia in most people, and its use as a replacement for sugar-sweetened products in moderation is acceptable if it reduces overall calorie and carbohydrate intake. According to the most recent and highest quality study, 1, non-nutritive sweeteners like aspartame are safe when consumed within the acceptable daily intake levels established by the Food and Drug Administration. The study recommends that people with prediabetes and diabetes use water over nutritive and non-nutritive sweetened beverages, but notes that non-nutritive sweeteners can be used in moderation as a replacement for sugar-sweetened products.

Key points to consider:

• Aspartame is metabolized differently than sugar and does not significantly impact blood glucose levels 1.
• The use of non-nutritive sweeteners like aspartame may help reduce overall calorie and carbohydrate intake, which can be beneficial for people with diabetes or those trying to manage their blood sugar 1.
• Some individuals may experience indirect effects that could influence blood sugar, such as increased cravings for sweet foods or changes in gut microbiota, though these effects vary greatly between individuals.
• People with phenylketonuria (PKU) should avoid aspartame entirely, not because of blood sugar concerns, but because they cannot properly metabolize phenylalanine, one of aspartame's breakdown products.

In terms of dietary recommendations, the study suggests that people with diabetes or prediabetes should focus on individualized meal plans that keep nutrient quality, total calories, and metabolic goals in mind, rather than restricting specific foods or food groups 1. Additionally, the study recommends emphasizing key nutrition principles, such as inclusion of non-starchy vegetables, whole fruits, legumes, whole grains, nuts/seeds, and low-fat dairy products, and minimizing consumption of meat, sugar-sweetened beverages, sweets, refined grains, and ultraprocessed foods 1.

From the Research

Aspartame and Hyperglycemia

• The relationship between aspartame consumption and hyperglycemia is complex and has been studied extensively 2, 3, 4, 5, 6.
• Some studies suggest that aspartame may not have a significant effect on blood glucose levels in healthy individuals or those with type 2 diabetes 3, 5, 6.
• However, other studies have found that aspartame consumption may lead to impaired blood glucose tolerance and increased risk of weight gain, which can contribute to hyperglycemia 2, 4.
• The mechanisms by which aspartame may affect blood glucose levels are not fully understood, but may involve changes in gut microbial activity, insulin resistance, and cortisol levels 2, 4.

Key Findings

• A 2018 review of studies on aspartame and type 2 diabetes found that aspartame may exacerbate the condition and contribute to the global burden of disease 2.
• A 2020 study found that consumption of a beverage containing aspartame and acesulfame K for two weeks did not adversely affect glucose metabolism in adult males and females 5.
• A 2020 clinical trial found that daily consumption of pure aspartame or sucralose for two weeks had no effect on glucose metabolism or insulin sensitivity in healthy adults 6.
• A 2022 review of the advantages and disadvantages of artificial sweeteners, including aspartame, found that their use may not be beneficial for patients with diabetes mellitus and may even worsen glycemic control 4.

Study Limitations

• Many of the studies on aspartame and hyperglycemia have methodological limitations, such as small sample sizes and short durations 3, 5, 6.
• More research is needed to fully understand the effects of aspartame on blood glucose levels and to determine the optimal use of artificial sweeteners in the management of diabetes 2, 4.