The Truth About Artificial Sweeteners is Not So Sweet – Dr. Ralph E. Carson

While there are some conflicting studies on artificial sweeteners and human health, several recent studies give us pause and make us question the excess consumption of beverages and foods containing artificial sweetener.&nbsp;This doesn&rsquo;t mean that the occasional consumption of artificial sweeteners or an occasional diet soda is bad.&nbsp;However, <em>heavy consumption</em> of artificial sweeteners is likely to, at some point, affect your health. But how much is too much?

Approximately 20 to 25 percent of Americans will drink diet soda on any given day —according to CDC and Gallup polls. All diet sodas contain some type of artificial sweetener.
While there are some conflicting studies on artificial sweeteners and human health, several recent studies give us pause and make us question the excess consumption of beverages and foods containing artificial sweetener.
According to research studies, the amount of artificial sweetener in as few as two cans of diet soda (or in, as some studies suggest, over 14 cans) could be detrimental to our health.
This doesn’t mean that the occasional consumption of artificial sweeteners or an occasional diet soda is bad.
There are no “good” or “bad” foods.
However, heavy consumption of artificial sweeteners is likely to, at some point, affect your health. But how much is too much?
Artificial sweeteners and health
The health concerns over artificial sweeteners (known by many names such as aspartame, Equal®; saccharine, NutraSweet®, sucralose, Splenda®, Acesulfame K, Sunett®, etc.) begs us to ask if choosing them over sugar has any real benefit? Some experts may even contend that artificial sweeteners are a less desirable choice than more natural forms of sugar (maple syrup, honey, stevia, agave, etc.)
Overconsuming artificial sweeteners, which are synthetic chemicals, challenges nutritional common sense. Our bodies were simply not designed to digest and metabolize these foreign particles in excess over a long period of time. When people do so, it can be problematic to one’s health and well-being.
Research studies have found a number of potential negative health outcomes associated with artificial sweetener, including:

  • Dental decay (outcomes are mixed) (Brand ’11; Namimi ‘11; Cochrane ’14; Bassiouny ‘13)
  • Increased cravings for sweets (Nelson ‘16; Tietelbaum ’16; Anton ’10; Wang ‘16)
  • Stimulating insulin release; resulting in lowering your blood sugar; making you hungrier and perhaps even craving sweets later in the day (Brown ’09, ‘10; Pepino ’13; De Koning ’11; Dus ’15; Frank ‘08) Note: This particular effect depends on whether one’s individual taste buds perceive the artificial sweetener to resemble sugar. Some individuals report artificial sweeteners having an unpleasant, metallic taste; these specific individuals would likely not experience this insulin response (Tey ’16; McQuillan ’05, ’09; Davidson ‘15)
  • Binge eating on foods loaded with sugar and fat as compensation for the absence of calories in diet drinks (An ‘16)
  • Taste buds getting used to sweetness and then requiring more and more to feel satisfied (Nelson ‘16; Tietelbaum ’16; Anton ‘10) 
  • Metabolic problems (insulin resistance, metabolic syndrome, high blood pressure, diabetes, heart disease) (Nelson ‘16; Tietelbaum ’16; Nettleton ’09; Fantino ‘13); A few studies find artificial sweeteners to be a healthy alternative at reducing diabetes (Calorie Council ’11; Catenacci. 2014; Rogers ’15; Phelan ‘09)
  • Weight gain (or absence of weight loss) (Madjd ’16; Kuk ’16; Chen ’09; Gul ’16; Kaliannan ‘13); Some studies concluded that artificial sweeteners improved weight loss (Sørensen ’14; Blackburn ’97; Catenacci ’14; Peters ’14; Phelan ’09; Tate ’12); Other studies find artificially sweetened beverages (ASB) no more helpful for maintaining a healthy weight than their full-sugar versions (Borges ’17; Mattes ’09)
  • Increased obesity and abdominal fat (Yang ’10; Fowler ‘05; ’08; ’15; Nettleton ’09; Nelson ’16; Hootman ‘17); One study found no increase in caloric intake or weight (Tey ’16)
  • Reduction in friendly gut bacteria (Abou-Conia ’08; Gophna ’11; Suez ’14; Schiffman ‘13)
  • Depression (Chen ’13; Guo ‘14) 
  • Alzheimer’s (Pase ’17; Gardener ’12; Duffey ‘12)
  • Stroke (Pase ’17; Gardener ’12; Duffey ‘12)
  • Kidney disease (Lin ‘09, ‘11)
  • Alcohol intoxication (Stamates ‘15; Wu ’06; Rossheim ’11; Marczinski ‘13)
  • Osteoporosis/hip fractures (Tucker ’06; Fung ’14; Teofilo ‘10)
  • Problems with pregnancy, nursing, infants and children (Azad ’16; Sylvestsky ’11, 16; Brown ‘10); Studies examined the effect of artificial sweeteners on a child’s future taste preferences, weight and future metabolic problems; although limited controlled studies supported these conclusions. 

Should you cut back?
For those of you that opt for artificial sweeteners as a way to cut calories or reduce the amount of sugary foods you eat, it could be helpful to at least reconsider the consequences of this consumption.
When you drink diet soda and your brain detects sweetness — but your body receives no calories (fuel/energy) — the brain sends a message to overcompensate. This may mean that sweets will be even more desirable to you later in the day.
Here’s why: The artificially-sweetened beverage sufficed and successfully tricked your brain, but, later, you may be more likely to binge on sweets — and that late-night binge could be stored as fat.
The reason that this happens is that our brains need glucose (sugar) from foods to supply much-needed fuel to function. When we are hungry and reach for diet soda instead of a nutritious snack, the brain says, “You’ve tricked me! That tasted sweet but provided me no fuel! Now I will make you crave the very thing you were trying to avoid!” As a result, we may be driven to overeat later in the day after drinking diet soda. 
Reducing diet soda consumption
You may read this and think, “Dr. Carson, I really like to have a diet soda or two each day. I like the taste and the caffeine buzz and it helps me get my work done!” My response is what you might expect, “OK, then, just have them in moderation.”
If you want to have one or two diet sodas a day, you’re probably going to be OK. But, if you’d like to take steps to reduce your consumption of artificial sweetener, here are a few suggestions

  1. Look at your habits when dining out - Most people who order sodas at restaurants tend to overdo it. Restaurant workers are trained to continually offer you free refills. You may end up consuming three or more servings of diet soda at one meal — without even realizing it. Opt for water instead or simply be mindful and stop after drinking 16 ounces or less.
  2. Identify why you drink diet soda – Is it the caffeine you crave? Are you trying to cut calories? Do you feel like you are addicted to your diet soda habit? If you are having more than two diet sodas a day, ask yourself: Why? And if you regularly choose diet soda instead of having a regular (sugary) small soda, ask yourself: Why?
  3. Choose water instead – Instead of diet soda, why not just drink water? Do you not like the taste of water? If it’s the fizziness you crave, try sparkling water. Add a splash of cranberry juice, lemon or lime to sparkling water or try one of the many flavored sparkling water drinks on the market that do not contain artificial sweetener.
  4. Stop buying artificial sweetener and diet soda — If controlling the intake of diet sodas is a problem, don’t buy them; don’t keep them in the house and encourage family members to keep them out of the house as well.
  5. Set goals or limits — For instance, you can decide to only have diet soda when hanging out with friends. Or, set a weekly limit and once you have reached it cease further intake until next week.

Another strategy is to not get in the habit of drinking diet soda with meals. Instead, have it as a thirst quencher or pleasurable addition to your day.
Diet soda and weight loss
For those who drink soda regularly, the decision to drink fewer sugary sodas — or replacing sugary soda with diet soda — could result in weight loss. Likewise, reducing diet soda consumption and choosing water instead may also result in weight loss.
Studies have found that people who consume just three diet sodas per week are more than 40 percent more likely to be obese (Fowler ‘05; ‘08). The risk of becoming overweight or obese increased with each diet soda consumed per day. However, it’s important to note that this study is not necessarily implying a cause and effect relationship. In other words, this is an observation and it does not prove that diet sodas cause weight gain or assume that people of higher weight drink diet sodas. 
Many people choose diet sodas thinking that they are a smart alternative to sugary drinks. One may choose diet soda instead of sugary soda as a way to reduce health problems, mitigate cravings and lose weight.
Unfortunately, this is not necessarily the case: beverages that contain artificial sweeteners are not as healthy for us as some people like to believe. Artificial sweeteners do not nourish the body.
On the other hand, artificial sweetener — in the amounts that most people consume it — is not life threatening or so dangerous that we should completely omit it from our diets. If we find diet soda to be refreshing and enjoyable, an occasional drink is fine. This is why moderation is so important.
In my professional opinion, when we choose sweets (or any foods/drinks for that matter), the source of the sweets should resemble something that is as close to nature as possible. Each day, we have a choice to make as to what we will consume. And, as Yogi Berra was famously quoted as saying, “When you come to a fork in the road, take it.”
Ralph Carson, RD, PhD, is a nutritionist and exercise physiologist with over 40 years of experience. He is currently Vice President of Science and Innovation for Eating Recovery Centers (ERC). Dr. Carson is an active member on the board of the International Association of Eating Disorder Professionals (iaedp) and author of The Brain Fix: What’s the Matter with Your Gray Matter.


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