How Safe are Artificial Sweeteners?

For millions of American who rely on artificial sweeteners to help control their weight, a new report issued by the World Health Organization may leave a sour taste in their mouths.

The WHO, whose previous guidelines advise consumers to limit their sugar intake, urges people to cut out non-sugar sweeteners (NNS) from their diets—entirely. And that includes both natural and artificial sugar substitutes.

“Replacing free sugars with NSS does not help with weight control in the long term. People need to consider other ways to reduce free sugars intake, such as consuming food with naturally occurring sugars, like fruit, or unsweetened food and beverages,” says Francesco Branca, WHO Director for Nutrition and Food Safety.

The agency also reports that long-term use of NSS may also increase the risk of Type 2 diabetes, cardiovascular disease and early death.

To help us better understand the new guidelines, Renato Concepcion, M.D., a board-certified endocrinologist with Lee Physician Group Endocrinology, answers our questions.

Q: Research continues to emerge that sugar substitutes may not be as safe as we thought. Are there any specific artificial sweeteners that could put me at increased risk for stroke, heart attack, or other health problems?

In general, sugar substitutes are safe.  There are certain sugar substitutes that have been identified as posing safety concerns. These include saccharin, which has been previously listed as a potential carcinogen and erythritol which has been recently linked to a higher incidence of heart attack and stroke.

In the 1980s, because saccharin was associated with bladder cancer in rates, it was listed as a potential cancer-causing agent (carcinogen). However, because no such association has been identified in humans, in 2000 it was removed from the list of potential human carcinogens. 

Recently, the Cleveland Clinic Lerner Research Institute published research suggesting that erythritol, a popular artificial sweetener, is associated with an increased risk of heart attack and stroke. The study reported people with existing risk factors for heart disease, such as diabetes, were twice as likely to experience a heart attack or stroke if they had the highest levels of erythritol in their blood.

It’s theorized erythritol may cause changes in the functioning of the platelets that lead to increases in blood clot formation. But, as the authors note, follow-up studies are needed to confirm their findings in the general population. The study also had several limitations, including that clinical observation studies demonstrate association and not causation.

Q: What about natural sweeteners? Are they harmful?

The word natural can mean a number of things.  It could mean honey, maple syrup or agave nectar.  It could also mean regular white sugar from sugar cane or Stevia from the stevia plant. Currently, there’s no evidence that any of these can lead to any harmful effects when taken in moderation.

But, as noted in the previous answer, erythritol has been linked to heart attack and stroke. This low-calorie sweetener is often used to add bulk or sweeten stevia. Refined sugars taken in excess can increase the risk of obesity and its ravages, including diabetes and heart disease.

Q: How would I go about cutting the use of sugars and sweeteners from my diet?

As individuals, we all have different tastes. For example, I drink my coffee without sugar and my wife drinks hers with two heaping teaspoons of white sugar.  But for the rest of the day, she doesn’t eat any more carbs. I might have a sandwich for lunch and rice for dinner. But we both exercise regularly.  I think the most important aspect of controlling our sugar intake is awareness of its potential risks and balancing it with our own personal tastes.