Non-Nutritive Sweeteners: What to believe?

Hannah Hughes
Apr 27, 2022
4 min read

Updated: May 17, 2022

Non-nutritive sweeteners, also known as artificial sweeteners or sugar substitutes, were first introduced in efforts to eliminate calories while still providing flavor and sweetness. Some non-nutritive sweeteners (NNS) are created in labs using various chemicals whereas some are developed from plant extracts. The most common products that use NNS are diet sodas such as Diet coke or Coke Zero but they are also frequently used in baked goods, gum, and desserts among other products.

As a Registered Dietitian and a Diabetes Educator, I am often asked by patients if they can enjoy NNS and which ones are the safest. In general, using products that are artificially sweetened can be helpful to cut down on total calories and carbohydrates consumed which can make managing blood sugar levels much easier. However, there is still a lot of controversary around these products. Are they safe for us long-term? Do they cause cancer? Do they contribute to insulin resistance? Can they be helpful in weight management?

Because there are so many varieties of NNS out there, it can be hard to give a straight forward answer to their overall safety and long-term effects. But let's look at the science:

The Food and Drug Administration (FDA) is a government agency that works to ensure our foods are safe. They are responsible for reviewing any substances that are added to food items, which encompasses NNS. The FDA will approve products if they are "safe under the conditions of its intended use" and are then given the label "Generally Recognized As Safe" or GRAS (1). Currently, there are eight NNS that have been labeled GRAS: stevia, saccharin, aspartame, sucralose, acesulfame potassium, luo han guo (monk) fruit extract, neotame and advantame. These NNS are "considered safe in the amounts that people typically eat or drink" (2). Some of the trade names for the above mentioned NNS include Sweet n' Low, Equal, Nutrasweet, and Splenda to name a few.

Weight Management: There are many studies that support the concept of NNS being useful tools to aid weight loss efforts. In order to lose weight, one must be in a calorie deficit, and NNS products make this much more attainable. The mechanism behind this is simple: by using NNS in food and drinks we can essentially enjoy certain products in larger quantities, reach satiety, and have consumed little to no calories in comparison to sugar-sweetened alternatives (3)(4).

Cancer: According to cancer.gov, there have been no clear studies indicating an association with NNS and cancer. Controversy stems from one study done on rats in 1960's that showed an association between the chemical cyclamate and bladder cancer. Cyclamate is it's own artificial sweetener. However, when further studies were done they did not yield similar results. Out of caution, the FDA banned cyclamate in 1969. Since then, scientists have proven that cyclamate is not carcinogenic, however the FDA has not lifted the ban yet due to irrelevance (5).

Diabetes: Unfortunately, there are a few studies that suggest NNS can be detrimental to managing diabetes as it is thought to contribute to insulin resistance. When we consume anything sweet tasting, our body sends out a signal to the pancreas to secrete insulin as it believes sugar is being consumed and will therefore require insulin to lower blood sugar levels. However, because it is essentially artificial sugar, we may be needlessly producing and secreting insulin that won't be used which is how we end up decreasing the effectiveness of insulin in our body over time. And when insulin resistance is present, managing blood glucose levels becomes harder and harder (6). Because of this process, it's best to avoid excessive NNS intake.

Digestion: When considering NNS and their affects on digestion, we do have evidence that one sweetener known as aspartame (Ace-K) is harmful to any individual who has been diagnosed with Phenylketonuria (PKU). Those who have this diagnosis are unable to metabolize the amino acid phenylalanine, one of the main components of aspartame (7). Luckily, PKU is not common (occurs in 1 in 10,000 newborns) and is detected shortly after birth (8).

Because there are a lot of inconsistencies across NNS recommendations amongst health organizations, it's best to err on the side of caution and limit the use of NNS to "moderate" due to the insufficient evidence and studies that point to the long-term effects of regular consumption (9). A good way to measure "moderate intake" would be to enjoy those artificially sweetened products on occasion, but to avoid consuming NNS on a daily basis. Enjoying a diet coke a couple times a week is okay, but it would be best to avoid drinking it every single day.

As the American Heart Association recommends: “For those who consume sugar-sweetened beverages regularly, a low-calorie or non-nutritive-sweetened beverage may serve as a short-term replacement strategy, but overall, people are encouraged to decrease both sweetened and non-nutritive-sweetened beverages and use other alternatives, with an emphasis on water intake.” Meaning these NNS products can be enjoying occasionally and can be helpful in weaning from sugary drink consumption.

Remember, too much of anything can be unhealthy! NNS products can help reach health goals but shouldn't be relied on for those purposes. Water will always be the drink of choice!

NOTE: Sugar alcohols (sorbitol, xylitol, lactitol, erythritol, mannitol, and maltitol) are not considered NNS as they provide carbohydrates and therefore provide calories. They are less calorie-dense than regular sugar and therefore are often used as additives in efforts to make some foods healthier by lowering the calorie and carb content. Because sugar alcohols are natural, they are also considered safe to consume, although many individuals find if consumed in too large of quantities they can cause upset stomach/indigestion.

Sources:

Take Charge of Your Health: Sodium Reduction

Non-Nutritive Sweeteners: What to believe?

Diabetes Basics

Non-Nutritive Sweeteners: What to believe?

Comentários