Excessive intake of table sugar (sucrose) leads to many health risks such as obesity,  dental problems, diabetics, heart diseases, and cancer. These concerns regarding our health and quality of life made many of us to avoid or replace sugar from our diet. Due to the recommendations and restrictions of health organizations, and the excellent marketing strategy by food manufacturers resulted in the popularity of “sugar-free” products in our everyday diet. In addition, people are more concerned about maintaining their healthy weight by choosing calorie-free or low-calorie sugar substitutes in their diet. Moreover, the food manufacturing companies consider sugar substitutes as a cheaper alternative, due to the requirement of a smaller quantity of sugar substitutes for the production, longer shelf-life, and higher sweetening intensity compared to table sugar [1][2][3].

Types of sugar substitutes

There are two types of sugar substitutes available in the market – natural sugar substitutes (produced from natural sources) and synthetic or artificial sugar substitutes (produced chemically). The major varieties of artificial sugar substitutes are Aspartame, Acesulfame potassium, Saccharin, Sucralose, Neotame, etc., which are widely used in our sugar-free food products. These artificial sweeteners are approximately 200 to 13,000 times sweeter than table sugar and require only a minimal amount to sweeten our foods[1][2][3].

Regulatory approvals

The food regulatory bodies such as US Food and Drug Administration (FDA) [4], European Food Safety Authority (EFSA) [5], World Health Organization (WHO) [6], Food Standards Australia New Zealand (FSANZ) [7], etc. approved these artificial sweeteners as safe to use in food products. However, these regulatory organizations also recommended specific Acceptable Daily Intake limit (ADI) and mandated for clear warning labels for the consumers.

Therefore, artificially-sweetened products are recognized as safe to use, and hence, most of the food manufacturing companies take this as an opportunity to make the food products cheaper by using artificial sweeteners. Many food manufacturing companies use artificial sweeteners in common food products, which are not even entitled as sugar-free products.

Bitter truth about artificial sweeteners 

Artificial sweeteners are highly recommended as a part of diabetic patient’s diet to enhance the tastiness of foods and thereby to increase nutritional consumption, and enjoy the everyday diet. In addition, many industry-initiated research claims the use of artificial sweeteners as safe with no adverse effects on humans. However, several independent studies warn the use of artificial sweeteners because they have found severe health issues associated with the consumption of artificial sweeteners on animal testing. Hence, due to these conflicting research results, the safety and health benefits of artificial sweeteners over table sugar are still controversial. Through this article, I would like to make some remarks and bring awareness about the health and safety concerns regarding the use of these artificial sweeteners as a part of our sugar-free diet.

Role of artificial sweeteners on weight loss and diabetes      

The long-term effect of artificial sweeteners on weight reduction and long-term weight maintenance is still inconclusive due to the different research outcomes on weight reduction studies. Many studies raised questions on the artificial sweeteners as to whether the use of artificial sweeteners might be fueling rather than fighting the escalating obesity epidemic.

• Consumption of low or zero calorie foods and their sweet taste stimulate the taste preferences and hence increase the desire for foods. Since the sweetness stimulates taste sense receptors without the inflow of calories, gastrointestinal reflexes fail to send hunger sensation signals to the hypothalamus, and that will lead to an increase in food consumption [8]. This will raise the cravings for high calorie (junk food) food and consequently increase body weight and thus lead to a high chance of obesity [9][10][11].
• Studies reported that artificial sweeteners such as Saccharin and Aspartame cause weight gain by raising the amount of Bacteroidetes in the gut. In addition, Saccharin and Sucralose sweeteners stimulate the amygdala area of our brain, and reward areas of hedonic eating and hence causes inflammation and obesity [8]. 

Even though the use of artificial sweeteners promises many health benefits to fight diabetes, many studies reveal the high risk of type 2 diabetes associated with the increase in intake of food resulting from the long-term consumption of artificially sweetened foods. In addition, reports suggest that the overuse of artificial sweeteners cause brain damage [12], cardiovascular diseases [13], kidney diseases [14], cancer [15], and high risk of mortality [16]. The health issues associated with different artificial sweetener food products will be discussed in my upcoming blogs. Each artificial sweetener possesses different biochemical structures with varying methods of absorption and metabolization, which affects people differently depending on their gender, age, location, dietary habits, etc. [17]. Hence more studies are required with a wide range of samples and longer study duration to get a conclusion on health benefits or hazards associated with the use of artificial sweeteners. 

Conclusion

Even though these artificial substitutes are allowed to be used as an alternative to sugar in the food industry, it is recommended to use them in moderation within the Acceptable Daily Intake (ADI). Although the current level of artificial sweetener consumption is considered safe, the use of artificial-sweetener based foods remains controversial because of the mild to serious side effects associated with them. The assumed role of artificial sweeteners in facilitating weight reduction and diabetics are still in the questioning stage because of the uncertainty of their long-term effects on metabolism and safety. 

Read next: Do you know the unhealthy sides of “tooth-friendly” or “sugar-free” products?

References

[1] Sanchari Chattopadhyay et al., Journal Food Science and Technology, 51, 2014, 611-621.

[2] Padmini Shankar et al. Nutrition, 29, 2013, 1293-1299.

[3] Rebecca J Brown et al., International Journal of Pediatric Obesity, 5, 2010, 305-312.

[4]https://www.fda.gov/food/food-additives-petitions/additional-information-about-high-intensity-sweeteners-permitted-use-food-united-states

[5] https://www.efsa.europa.eu/de/topics/topic/sweeteners

[6]https://apps.who.int/food-additives-contaminants-jecfa-database/search.aspx?fc=66#

[7] http://www.foodstandards.gov.au/consumer/additives/Pages/Sweeteners.aspx

[8] Rajeev Chawla, RSSDI Diabetes Update 2018.

[9] Sharon P. Fowler et al., Obesity, 16, 2008, 1894-1900.

[10] Jason R. Roberts, Current Gastroenterology Reports, 17, 2015, 423.

[11] Arshag D. Mooradian et al., Clinical Nutrition ESPEN, 18, 2017, 1-8.

[12] Humphries P et al., European Journal of Clinical Nutrition, 62, 2008, 451-462.

[13] Vasanti S Malik et al., Circulation, 121, 2010, 1356-1364.

[14] Vytas P Karalius et al., Advances in Chronic Kidney Disease, 20, 2013, 157-164.

[15] Mita Sanghavi Goel et al., Cancer Prevention, 2019, 7-33.

[16] Vasanti S Malik et al., Circulation, 139, 2019, 2113-2125.

[17] Thiago M Cabral et al., Health, 10, 2018, 700-717.