Artificial Sweeteners vs. Sugar

By Jill Horn

An increasing awareness of the adverse health effects of ingesting too much sugar has led to a boom in the abundance and accessibility of sugar substitutes or artificial sweeteners in recent years. Including myself, a lot of people wonder whether the ingestion of artificial sweeteners as a sugar replacement produces adverse health effects, and whether there are some sugar alternatives that are better for us and should be preferred over other options. This article will outline the different kinds of artificial sweeteners and their investigation in pre-clinical and clinical trials, as well as provide an assessment of the efficacy of using sugar alternatives in weight loss and cardiometabolic health.

“Artificial sweeteners generally include sugar alternatives being either low in calories or completely non-caloric.”

Artificial sweeteners generally include sugar alternatives being either low in calories or completely non-caloric. Some common synthetic artificial sweeteners include sucralose, aspartame, and erythritol, though erythritol can occur naturally as well. The examples for naturally occurring sugar substitutes discussed in this post are stevia and monk fruit.

Sucralose is 600 times sweeter than sucrose and has been used as a replacement for sugar for two decades. In a metabolism and safety assessment, it was observed that most sucralose ingested orally in animals and human studies passed through the gastrointestinal tract and was eliminated in feces unchanged, suggesting that even our gut microbes are unable to break it down. Sucralose has been considered to have no adverse effects on human health, even if ingested frequently.

Aspartame is a very popular artificial sweetener, the safety of which has been investigated in many animal studies and a limited amount of clinical studies. The existing body of preclinical research on aspartame suggests that aspartame may disrupt the oxidant/antioxidant balance, damage the integrity of cell membranes, and induce oxidative stress, and lead to systemic inflammation, especially if ingested in high doses and on a regular basis, so it is less safe for use and should be avoided.

“Aspartame may disrupt the oxidant/antioxidant balance, damage the integrity of cell membranes and induce oxidative stress, and lead to systemic inflammation, especially if ingested in high doses and on a regular basis.”

Erythritol is a well-known sugar substitute and is widely used in low-sugar bakery products and candies, energy bars and drinks. Erythritol has been shown to have high digestive tolerance and in preclinical studies has been identified as a free radical scavenger with potential antioxidant benefits. Clinical studies found that 60%-90% of the erythritol were excreted unchanged in the urine, with the remaining amounts undergoing microbial fermentation in the intestine. Only the consumption of very high doses resulted in the production of laxative effects. Overall, erythritol has been shown to be safe in both animal and human studies, even though the long-term effects on the gut microbiome and gut health are unknown.

Stevia is a natural sweetener extracted from the Stevia rebaudiana plant, with the compound stevioside being responsible for its sweetness. In contrast to other sweeteners, stevioside is almost completely absorbed by the gut at a fast rate, and then transported to the liver where it is transformed into another compound to be excreted in the urine. Stevia has been assessed as safe for all individuals (including children and pregnant women) in a variety of clinical studies.

Monk fruit has increasingly been used as a natural non-caloric sweetener in the past few years. Plant compounds called mogrosides are responsible for the sweet taste of this sugar alternative. The safety of monk fruit hasn’t been researched sufficiently, though it has been shown to be non-toxic and generally safe for use. More research needs to be conducted on the metabolism of monk fruit and its effect human health.

Importantly, the effects of different artificial sweeteners on the gut microbiome and other indicators of gut and general health still need to be investigated further, though changes in gut microbial composition in response to artificial sweeteners have been observed in both rodent and human studies.

“Alterations in the gut microbiota as a response to saccharin ingestion were shown to induce glucose intolerance in both mice and human subjects.”

Alterations in the gut microbiota as a response to saccharin ingestion were observed in a study with both preclinical and clinical components, and were shown to induce glucose intolerance in both mice and human subjects. However, replication of such findings and the investigation of different artificial sweeteners is necessary to draw a conclusion about whether the use of non-caloric sweeteners is safe in the long term.

The question as to whether artificial sweeteners may be beneficial in the treatment of obesity and overweight was investigated in a recent systematic review and meta-analysis from the Department of Nutritional Sciences at University of Toronto. The scientists assessed whether artificial sweeteners as a substitute for sugar-sweetened beverages have positive effects on body weight and cardiometabolic risk factors. To answer this question, the researchers analyzed 17 randomized controlled trials in which artificially sweetened beverages were contrasted with sugar-sweetened beverages, and their effects on body weight, body mass index, body fat, and intrahepatocellular lipid. Statistically significant reductions in all these variables were found as a result of the study, demonstrating that artificial sweeteners may be a promising replacement of sugar-sweetened beverages.

This is particularly important because the frequent ingestion of sugar-sweetened beverages such as sodas has been identified as a significant risk factor for type 2 diabetes and heart disease. Considering safe, non-caloric alternatives for sweet tasting sucrose could therefore be a short-term strategy to move away from high-sugar beverages and foods.

“Considering safe, non-caloric alternatives for sweet tasting sucrose could be a short-term strategy to move away from high-sugar beverages and foods.”

Nevertheless, it is important to mention that water is still the “standard-of-care” substitution for sweetened beverages, and the ingestion of fiber-rich, fresh fruit and some sweet vegetables should always be considered as a replacement for table sugar first, as positive effects on gut microbial and metabolic health have been confirmed with increased consumption of fiber and fresh food as part of a balanced, Mediterranean-style diet.

Jill Horn is a recent UCLA graduate with a degree in Neuroscience. She is deeply interested in the interconnectedness of body, mind, and spirit takes an integrative approach to health and well-being.