• Artin Entezarjou

Is Your Fear Of Artificial Sweeteners Irrational?

Consumers in today’s modern society are being reeled into a diet which is leading to an obesity pandemic. Foods with added refined sugars and fats fulfill our desire for good taste. Apart from the obvious culprits like chocolates and sodas, added sugars are also found in breads, sauces, yoghurts, cereals, and even fruits. Once you are aware of it, you will realize how hard it is to actually find products which don’t have any added sugar. The problem with adding these ingredients to our foods is that they contribute with extra calories to our meals without making us feel any fuller. Increased consumption of refined sugar is one of the most established dietary causes of obesity when looking at the scientific evidence.

In an attempt to reduce the consumption of refined sugars, the use of calorie-free sweeteners has arisen. I avoid the use of the word “artificial” sweetener as this word carries so many negative connotations, and has led to numerous claims that the “unnatural” artificial sweeteners are dangerous and best avoided. Groups using this argument are under some preconceived notion that the fact that something is found in “nature” says something about how safe it is.

Does “Natural” Really Mean “Better”?

There are plenty of toxic chemicals in natural plants that we definitely want to avoid, and there are also “artificial” chemicals found in many medications which have improved the lives of millions of people around the world, so rather than to look at something as “natural” or “unnatural” to determine its safety, one should simply look at what effects different chemicals have on the body using reliable scientific evidence. This can then allow us to make rational choices in the products we choose to consume.

If you have to choose a drink, I would definitely say that drinking water is the best choice, but when I do choose to have a sweetened drink, I always choose drinks sweetened with artificial sweeteners over refined sugars and I will sum up my reasons for this below.

Don’t Artificial Sweeteners Make You Eat More?

It is often argued that the sweet flavor of artificial sweeteners trigger us to eat more of other foods leading to weight gain. Although this might sound reasonable intuitively, we have to look at what has been observed in scientific studies. A meta-analysis (the most reliable type of study where many experts look at multiple studies) on the concluded that there is no connection between artificial sweeteners and weight gain. Meanwhile, studies have found that consuming refined sugars actually cause us to eating more of other foods compared to consuming artificial sweeteners!

But Don’t Artificial Sweeteners Cause Diabetes?

The scientific evidence that DOES connect consumption of artificial sweeteners to weight gain and other problems such as diabetes is of the so-called epidemiological study type. This type of study only fins associations and cannot say that one thing causes another. In this case the studies compare people saying that they consume artificial sweeteners with those that do not consume artificial sweeteners. Comparing these groups, the population consuming artificial sweeteners weigh more and tend to develop diabetes.

However, it is important to understand that the two groups differ in many other aspects besides the fact that one consumes artificial sweeteners, and these differences may be the actual cause of the diabetes and weight gain.

Think of the fact that many of the high consumers of artificial sweeteners are likely to be the type of people that often eat at fast-food restaurants and order diet sodas. Thus the fast-food may be the culprit of their obesity and diabetes and not the sweetener! Refined sugars are, by the way, much more consistently linked to diabetes compared to artificial sweeteners

Thus epidemiological studies don’t actually say WHAT the cause of the diabetes is, whereas experimental studies where artificially sweetened drinks have been added to people’s diets show no weight gain even after several months. Switching to drinks sweetened with refined sugar DOES however lead to weight gain and switching from drinks sweetened with refined sugars to drinks sweetened with artificial sweeteners actually leads to a small weight loss!

Aren’t Artificial Sweeteners Toxic?

The most common artificial sweetener, aspartame, has been accused of many of these. The fear that aspartame is supposedly toxic comes from that it is broken down into methanol on our bodies which is toxic in large quantities. Toxicity is, however, always related to dose and a serving of tomato juice produces up to six times the amount of methanol from the same amount of aspartame-sweetened beverage. Also, unlike the heavy metals found in some fish, our bodies are able to eliminate methanol and so it doesn’t accumulate in us over time. Several research groups have come to the conclusion that there are no known risks of aspartame consumption in the doses below acceptable daily intake, and the acceptable daily intake would require consumption of about 4 liters (1 gallon) of diet soda per day.

Not All Artificial Sweeteners are Created Equal!

I would like to mention, however, that aspartame isn’t the only artificial sweetener on the market. Others include, stevia, acesulfame k, saccharin, and sucralose. Stevia is relatively new and marketed as a “natural” calorie-free sweetener as it comes from a plant on South America, but the fact is that it isn’t nearly as well studied as aspartame and acesulfame k which are the most common artificial sweeteners. Saccharin and sucralose have been shown to affect the bacterial composition (the bacterial “flora”) in our guts. The bacterial flora has in recent research be shown to be strongly connected with our health, but which bacteria are good and which are bad is still unknown. If you want to be precautionary, you can choose to avoid saccharin and sucralose, but as of what we know today the probability that these being dangerous is very low, and if that turned out to be the case they would be banned from the market.

The Takeaway...

I used to criticize my friend for always choosing diet sodas, warning him that he will get diabetes, but as a medical student a big part of our job is to evaluate the evidence for various therapies. When I applied this mindset to artificial sweeteners, I was surprised by how easily I had been persuaded by superstitious headlines. Even though studies on animals show mixed results, no studies have yet proven that our current consumption of aspartame is hazardous for us as humans. No convincing connections to weight gain, diabetes, or cancer. Meanwhile there is no doubt about the connection between refined sugars and diabetes, weight gain and associated cancers. Thus I make the rational decision and choose artificial sweeteners over refined sugars when ordering my soda, and if everyone did the same, the evidence actually points towards that we can avoid weight gain and reap all the benefits!

By: Artin Entezarjou

EBT - Evidence Based Training @ebtofficial

A little more...

Add on by: Giulianni Giraldo

The acceptable daily intake for artificial sweeteners is the maximum amount considered safe to consume each day over the course of your lifetime. A value established by the FDA. These ADI's are intended to be about 100 times less than the smallest amount that might cause health concerns.

And the ADI for aspartame is the equivalent of 50mg per kilogram, or the equivalent of 18-19 cans of soda. So technically, you would need 1,800-1,900 cans of diet soda in one day for aspartame to cause harm.

Which means you will die drowning in soda before you feel any side effects of the artificial sweeteners.


The FDA (Food and Drug Administration), The National Cancer Institute, The American Cancer Society, the European Food Safety Authority (EFSA), Cancer Research UK, The Scientific Committee On Food (SCF), and the vast majority of the scientific community agree that artificial sweeteners are safe for human consumption at the current ADI. And even a better alternative to regular sugar due to its lack of calories in regards to weight management.

“I personally could not find any research showing a causal relationship between artificially sweetened soft drinks and weight gain, let alone research indicating a thyroid-mediated mechanism for this phenomenon. Among the research that does exist, the majority of studies lasting beyond the acute phase have demonstrated the superior effectiveness of artificially sweetened beverages to sugar-sweetened ones for weight loss. Therefore, the claim that diet soft drinks cause weight gain is nothing but a false alarm.” Alan Aragon


1. Miller PE, Perez V. Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies. Am J Clin Nutr. 2014 Sep;100(3):765-77.1. Miller PE, Perez V.

2. Greenwood DC et al. Association between sugar-sweetened and artificially sweetened soft drinks and type 2 diabetes: systematic review and dose-response meta-analysis of prospective studies. Br J Nutr. 2014 Sep;112(5):725-34.

3. Maersk M et al. Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Am J Clin Nutr. 2012 Feb;95(2):283-9.

4. de Ruyter JC et al. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med. 2012 Oct 11;367(15):1397-406.

5. Raben A et al. Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight subjects. Am J Clin Nutr. 2002 Oct;76(4):721-9.

6. Ebbeling CB et al. A randomized trial of sugar-sweetened beverages and adolescent body weight. N Engl J Med. 2012 Oct 11;367(15):1407-16.

7. Tate DF et al. Replacing caloric beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial. Am J Clin Nutr. 2012 Mar;95(3):555-63.

8. EFSA, ANS. Panel (EFSA Panel on Food Additives and Nutrient Sources added to Food). Scientific Opinion on the re-evaluation of aspartame (E 951) as a food additive. EFSA Journal, 2013, 11.12: 3496.

9. Marinovich M et al. Aspartame, low-calorie sweeteners and disease: regulatory safety and epidemiological issues. Food Chem Toxicol. 2013 Oct;60:109-15.

10. Magnuson BA et al. Aspartame: a safety evaluation based on current use levels, regulations, and toxicological and epidemiological studies. Crit Rev Toxicol. 2007;37(8):629-727.

11. Renwick AG, Nordmann H. First European conference on aspartame: putting safety and benefits into perspective. Synopsis of presentations and conclusions. Food Chem Toxicol. 2007 Jul;45(7):1308-13.

12. M. Yanina Pepino. Metabolic effects of non-nutritive sweeteners. Physiology & Behavior Volume 152, Part B, 1 December 2015, Pages 450–455.

13. Artificial sweeteners--do they bear a carcinogenic risk? Weihrauch MR, Diehl V.

14. Position of the American Dietetic Association: Use of nutritive and nonnutritive sweeteners. J Am Diet Assoc. 2004

15. http://www.cancer.gov/about-cancer/causes-prevention/risk/diet/artificial-sweeteners-fact-sheet

16. http://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm208580.htm

17. http://m.cancer.org/cancer/cancercauses/othercarcinogens/athome/aspartame

18. Artificial sweetener use: current controversies. By: Alan Aragon