POINT: Artificial Sweeteners and Obesity-Not the Solution and Potentially a Problem

Abstract

Objective: Nonnutritive sweeteners (NNS) have been widely implemented as replacements for naturally occurring sugars in a wide array of foods, beverages, and non-consumables for the sake of reducing calories. The use of these products, whether naturally occurring or manufactured, have become commonplace and accepted as de facto beneficial. This point argues that rigorous analysis of the available data do not confirm benefit and indeed suggest harm.

Methods: A literature review was conducted on all the available NNS supplements that are commonly used in all types of products. There was a focus on studies that evaluated the long-term as well as neurohormonal effects of NNS products. Key words used in the search included artificial sweeteners, nonnutritive sweeteners, saccharin, aspartame, acesulfame, sucralose, stevia, xylitol, and erythritol.

Results: There was a consistent trend of no to minimal benefit when NNS were used instead of calorie-containing sweeteners particularly in persons with obesity or pre-diabetes risks. There was a consistent finding of detriment to the neurohormonal regulation of satiety, weight, and energy regulation. The only studies that were neutral to positive were biased studies funded by the large food and beverage corporations or done in healthy weight individuals without any underlying health concerns and for a very short time frame.

Conclusion: Although NNS usage has become ubiquitous, there has been very little in the way of rigorous review of the neurohormonal and physiologic effects. The arguments for NNS are purely thermodynamic in nature despite the overwhelming evidence that obesity and adiposity-related diseases are not that simplistic in their pathophysiology. Given that there are differences in how individuals process nutrition signals, very few studies focus on gender or disease predisposition differences and how they affect the outcomes when NNS are used. Studies that controlled these variables showed worsening outcomes when NNS products are used in the fight against adiposity-related diseases, such as hypertension, dyslipidemia, and diabetes. Alterations in the gut microbiome towards a more inflammatory pattern of gut microbiota is a disturbing finding in acute as well as chronic users of NNS regardless of baseline weight or disease. Most importantly, there were numerous studies that found long-term damage to the neurohormonal control of satiety in chronic users of NNS. In the fight against obesity and adiposity-related diseases, we cannot afford to blindly accept their usage based on a broken paradigm of thermodynamics and false assumptions that we are all created equal biologically.

Keywords: artificial sweeteners; caloric substitution; diabetes; nonnutritive sweeteners; obesity.