There are a variety of sugar substitutes widely used in products today. They range from natural sweeteners to those that are artificial (although may be derived from natural components). While sugar substitutes may provide a way to enjoy sweet items with fewer calories, some people do experience negative side-effects from consuming the ingredients. Symptoms can range from headaches, digestive issues, mood changes, and even dizziness. For some, the sensitivity can be more serious (as with those that have certain metabolic disorders), and specific artificial sweeteners must be avoided altogether.
The American Heart Association (AHA) and American Diabetes Association (ADA) have given a cautious nod to the use of sugar substitutes in place of sugar to combat obesity, metabolic syndrome, and diabetes, all risk factors for heart disease. Yet that may change as several new studies have revealed concerning links to cardiac issues related to the consumption of artificial sweeteners.
The most recent study, published September 2022 in The BJM journal, included over 103,000 French adults that took part in the observational research. Study participants submitted questionnaires about their diet, health, physical activity, and personal information such as education, smoking status, and occupation. Throughout the study, participants reported detailed information about their food consumption throughout 24-hour periods.
Study results show that 37% of participants consumed artificial sweeteners in some form. On average, these people consumed about 42 milligrams per day, equivalent to one individual packet of tabletop sweetener or 3.4 ounces (100 milliliters) of diet soda. The average American consumer in contrast has been found to consume double that quantity- over two packets of sweetener per day. This is significant as the study found that the more artificial sweeteners were consumed, the higher the risk (up to 18% higher) of stroke or another type of cerebrovascular disease compared to non-consumers. Consider that research on American intake of artificial sweetener has shown that more than 7 million Americans consume the equivalent of 10 packets of sugar substitutes a day- setting up our population for a potential cascade of health concerns.
In the French study, those who consumed higher amounts of artificial sweeteners, specifically aspartame, acesulfame potassium, and sucralose, had a 9% higher risk of cardiovascular disease compared to people who didn’t consume any artificial sweeteners.
People who consumed higher amounts of artificial sweeteners tended to be younger, have a higher body mass index (BMI), and were more likely to smoke, be less physically active and follow a weight-loss diet. The results mirror those of other research- people that consume higher amounts of sugar substitutes often consume less healthy food, including fiber, polyunsaturated fats (learn the difference between dietary fats, here), carbohydrates, and fruits and vegetables. They also tend to consume higher amounts of sodium, red and processed meats and dairy products.
This combination is the beginning of a perfect storm for health concerns. Turning away from healthy foods that provide nutritional value leaves your body vulnerable to a variety of issues. Fruits and vegetables are high in nutrients, low in glycemic load, and high in fiber, while also providing a bit of natural sugar. All those factors benefit our health. Sugar substitutes increase blood glucose levels, cause inflammation and free radicals, and can increase the risk for serious health concerns like diabetes and cardiovascular disease.
Sugar substitutes may also prevent us from associating sweetness with caloric intake, leading us to crave more sweets and potentially gain weight. Participants in a San Antonio Heart Study who drank more than 21 diet drinks per week were twice as likely to become overweight or obese as people who didn’t drink diet soda, further increasing the risk of cardiovascular issues in addition to other health concerns tied to obesity.
To top it all off, research has shown that sweeteners alter your gut microbiota, sometimes leading to glucose intolerance, and an increased risk for diabetes. Healthy bacteria within the gut is targeted as “food” for unhealthy bacteria, leading to an imbalance of bacteria due to some sweeteners not being absorbed. This can wreak havoc on your body- as you’ll read here, where we discuss the importance of gut health.
The researchers behind the latest study alert that sugar substitutes “should not be considered a healthy and safe alternative to sugar,” they wrote, especially with the “extensive use of these substances in products on the global market.” While heavily marketed as a healthy alternative and a way to cut calories and achieve a healthy weight, the risk to our health outweighs any potential benefit. Time and time again, research solidifies that it comes down to the basics; there is no shortcut to weight loss. A lifestyle built around regular physical activity, a balanced diet that includes whole foods, adequate sleep, hydration, and other factors are what will help weight loss and sustainability of an overall healthy body.