From the Guidelines
The current level of evidence suggests that artificial sweeteners are generally safe when consumed within acceptable daily intake limits, with no clear evidence of harm, as stated in the most recent study from 2025 1. The evidence regarding the harms of artificial sweeteners is moderate and mixed, with some studies suggesting potential associations between regular artificial sweetener consumption and increased risks of cardiovascular disease, metabolic disorders, and alterations in gut microbiota, though causation hasn't been definitively established. However, the most recent and highest quality study from 2025 1 found that for some people with diabetes who are accustomed to regularly consuming sugar-sweetened foods or beverages, a small improvement in body weight and cardiometabolic risk factors was seen without evidence of harm, and had a direction of benefit similar to that seen with water. Key points to consider include:
- Regulatory bodies, including the FDA, have approved many nonnutritive sweeteners for consumption by the general public, including people with diabetes, and consider them safe when consumed within acceptable daily intake limits 1.
- Health care professionals should promote water as the healthiest beverage option, but people with overweight or obesity and diabetes may also use a variety of no-calorie or low-calorie sweetened products in moderation 1.
- The evidence is complicated by methodological limitations in many studies, including confounding variables, self-reporting biases, and difficulties separating sweetener effects from overall dietary patterns.
- For individuals concerned about potential risks, reducing consumption of both artificial sweeteners and added sugars while focusing on whole, minimally processed foods represents a prudent approach until more definitive evidence emerges from ongoing research. It is essential to note that the most recent study from 2025 1 provides the strongest evidence, and its findings should be prioritized when making clinical decisions.
From the Research
Harms of Artificial Sweeteners
- Artificial sweeteners have been linked to various health risks, including increased risks of metabolic disorders, cardiovascular diseases, certain cancers, and weight gain 2, 3.
- High consumption of artificial sweeteners has been associated with adverse pregnancy outcomes, potential risks for individuals with low seizure thresholds, and disruptions to gut health 2.
- Artificial sweeteners can alter the composition of the microbiota, worsen glycemic control, and suppress the taste response to sugar 3, 4.
- Some studies have reported that artificial sweeteners have no effect on body weight or glycemic control, while others have shown that they can have unfavorable effects on health, including glucose intolerance and failure to cause weight reduction 3, 5.
Specific Health Risks
- Artificial sweeteners have been linked to an elevated risk of stroke, coronary heart disease, and mortality, independent of established risk factors 2.
- Certain populations, such as pregnant and lactating women, children, diabetics, migraine, and epilepsy patients, may be more susceptible to the adverse effects of artificial sweeteners 4.
- The use of artificial sweeteners in patients with diabetes mellitus should be reconsidered, and their replacement of sugar with artificial sweeteners should be tracked long-term 3.
Regulatory Oversight and Consumer Awareness
- There is a need for cautious use, informed consumer choices, and stringent regulatory oversight of artificial sweeteners 2.
- Consumers should be aware of the potential risks of using artificial sweeteners, based on current evidence-based dietary guidelines 4, 6.
- Further research is needed to elucidate the long-term health effects of artificial sweeteners and to develop strategies to mitigate these risks 2, 3.