Although all official organisations agree that artificial sweeteners are safe for human consumption when adhering to the acceptable daily intake (ADI), they are undoubtedly one of the most controversial food ingredients. Indeed, this over-demonisation of artificial sweeteners is encouraged by tabloid articles.
What is the real story with artificial sweeteners and their safety? Artificial sweeteners are substances that have a sweet taste and are usually several times sweeter than regular sugars, but unlike carbohydrates, they usually contain almost no calories. Thanks to the thorough approval process of artificial sweeteners before their use in food, we do not have to worry excessively about adverse effects when complying with the acceptable daily intake (ADI). Moreover, because of their high sweetness, artificial sweeteners are found in food and beverages in very low concentrations and do not even come close to the amounts commonly used in animal studies to assess their safety! Artificial sweeteners are among the most tested substances in human nutrition.
Below are my reactions to quotes taken from the Daily Mail.
❌ "The risk of premature death was highest among people who substituted sugar-sweetened drinks for those sweetened with artificial sweeteners. In addition, these people were found to have a 40% higher risk of heart disease."
In this study, there was no substitution of sweetened beverages with artificial sweeteners because the data collection was done by questionnaires or interviews only at the beginning of the study, when participants retrospectively reported the frequency and type of beverages consumed! Based on this, they were divided into groups according to the type and rate of consumption of these beverages. In the group that consumed more than 2 glasses of drinks with artificial sweeteners per day, the risk of cardiovascular disease was indeed higher, however, in the group that consumed 1-2 drinks per day the risk was already comparable. The main problem, however, is that this is an observational study, which does not prove causality but only correlation. In that study, the authors themselves change this and even admit a serious limitation by only assessing beverage intake once at the beginning of the study - because it is very likely that the intake of these beverages could have changed over the 16 years.
❌ "But the problem is that these sweeteners have an absolutely devastating effect on our gut microbiome, the 100 trillion microbes that create harmony in our gut."
There is a risk of the microbiome being damaged from regular consumption of artificial sweeteners. This information comes from a widely cited study published back in 2014 in the prestigious journal Nature, which found a link between artificial sweetener consumption, microbiome damage and impaired insulin sensitivity. The problem, however, is that most of these findings were extrapolated from animal studies conducted specifically on laboratory mice, which have a very different metabolism compared to us. Unfortunately, to date, there are only two studies conducted on humans.
The first human study was observational only and linked artificial sweetener consumption to insulin resistance. However, the problem is that people who consume artificial sweeteners usually have a higher BMI or are outright obese. And obesity is one of the risk factors and often leads to insulin resistance and later to type 2 diabetes. This means that the findings of these studies can be explained by so-called reverse causality, where obese people with pre-existing insulin resistance consume artificial sweeteners in order to lose weight.
❌ "Similar research was subsequently carried out on humans, and after drinking beverages with artificial sweeteners for a week, they also showed signs of glucose intolerance."
The second analysis by Suez on the negative impact of artificial sweeteners, or saccharin, also had many limitations. In this study, there were only 7 participants who consumed the maximum acceptable dose of saccharin for one week. After one week, 4 of the 7 subjects had a worsening glycaemic response. Surprisingly, the other 3 subjects showed a slight improvement in glycaemic response (although not significant). Another problem is that the authors of this study unfortunately do not report the exact data of these glycaemic responses and also, they were not in control of the subjects’ diets. In addition, the subjects did not regularly consume artificial sweeteners prior to enrolment in this study, and essentially from day to day, there was an increase in artificial sweetener intake from 0 to the equivalent of approximately 6 cans of Diet Coke per day, which is usually not representative of real-world conditions. Whereas we already know that our gastrointestinal tract or microbiome can adapt to different types of diet. Therefore, this study was limited by its duration and also only looked at saccharin, so its results are not automatically transferable to other artificial sweeteners.
❌ "If you can't function without a sweet taste, then stevia leaves, which have been used for centuries in Brazil for this purpose, may be a solution."
Although stevia is considered a natural sweetener, industrially produced steviol glycosides are actually used in the food industry. Paradoxically, stevia is also much less tested than aspartame or sucralose. Its safety profile is therefore generally worse, even though it is a 'natural' sweetener.
In conclusion, we would like to add that we in no way RECOMMEND drinking beverages containing artificial sweeteners on a regular basis, but what really bothers us is the false denigration of certain food ingredients and the misinterpretation of scientific research. So, if you feel like having a drink with artificial sweeteners once in a while, have it without regret, because it is still true that the scientific research to date shows that artificial sweeteners are safe for human consumption and one can of Diet Coke will do you no harm at all. However, we should still remember the principles of a healthy lifestyle and prefer to eat as few processed foods as possible (which are usually free of artificial sweeteners) and choose plain water and other unsweetened beverages such as green tea or quality coffee as the basis of our drinking regime, which have many benefits.
Literature
1. MULLEE, Amy, et al. Association Between Soft Drink Consumption and Mortality in 10 European Countries. JAMA internal medicine, 2019.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2749350
2. SUEZ, Jotham, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature, 2014, 514.7521: 181.
https://www.nature.com/articles/nature13793#nas-in-humans-associate-with-impaired-glucose-tolerance
3. DREWNOWSKI, A.; REHM, C. D. The use of low-calorie sweeteners is associated with self-reported prior intent to lose weight in a representative sample of US adults. Nutrition & diabetes, 2016, 6.3: e202.
https://www.nature.com/articles/nutd20169
4. SCHIFFMAN, Susan S.; NAGLE, H. Troy. Revisited: Assessing the in vivo data on low/no-calorie sweeteners and the gut microbiota. Food and Chemical Toxicology, 2019, 132: 110692.
https://www.sciencedirect.com/science/article/pii/S0278691518308780
5. DR MICHAEL MOSLEY: Artificial sugars can kill the bugs in your gut that keep you healthy | Daily Mail Online. [online]. Copyright © dmg media [cit. 11.09.2019]. Available at: https://www.dailymail.co.uk/health/article-7439003/DR-MICHAEL-MOSLEY-Artificial-sugars-kill-bugs-gut-healthy.html
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