The People's Perspective on Medicine

Are Non-Sugar Sweeteners a Healthy Choice?

Non-sugar sweeteners may not offer the expected health benefits. In fact, some research suggests that such sugar substitutes may increase inflammation.
Soda diet cold drink cola soft drink can aluminum diet soda, artificial sweetener research

When people hear that sugar-sweetened beverages pose health hazards, some respond by switching to diet soft drinks. A new analysis in The BMJ suggests that might not be the best strategy. Non-sugar sweeteners may not offer the expected advantages (The BMJ, Jan. 3, 2019).

What Are the Effects of Non-Sugar Sweeteners?

The researchers reviewed 56 studies of non-sugar sweeteners and found “no compelling evidence to indicate important health benefits.” In most of these studies comparing outcomes for people consuming artificial sweeteners to those for people consuming none, there were no significant differences. In a few small studies, people using sugar substitutes had lower fasting blood sugar and slightly better body mass index. However, these findings were statistically uncertain. Previous research has not shown strong evidence that such sweeteners help people lose weight.

Are Artificial Sweeteners Safe?

The researchers point out that these studies did not adequately address questions of safety. They call for longer-term, better-designed trials to establish clearer conclusions on safety and effectiveness of sugar substitutes.

An earlier study found some unexpected effects of such sweeteners that may have a bearing on safety.

Non-Sugar Sweeteners May Change Metabolism:

Test tube research suggests that the artificial sweetener sucralose can alter the metabolism of stem cells from fat tissue. (Stem cells are capable of becoming many different types of tissue cells, for example, muscle or bone as well as fat.)

These human cells churned out more compounds associated with inflammation and fat storage when they were exposed to sucralose. The dose was equivalent to someone drinking four cans of diet soda a day. The stem cells also showed changes in their genes that indicate fat production.

Could Sugar-Free Drinks Be Counterproductive?

If these “in vitro” laboratory results hold up in animals and humans, heavy consumption of non-sugar sweeteners could lead to fat accumulation rather than fat and weight loss. The scientists also discovered other signs of metabolic disruption due to non-sugar sweeteners. They are concerned that these changes were most noticeable in people who are already overweight or obese.

The researchers note:

“we believe that low-calorie sweeteners promote additional fat formation by allowing more glucose to enter the cells, and promotes inflammation, which may be more detrimental in obese individuals.”

Sen et al, Endocrine Society annual meeting, Orlando, FL, April 3, 2017

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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All I know is I started drinking a non-diet soft drink and eventually had all types of GI tract problems. I couldn’t figure out what was causing them. Finally I realized it had to be the soft drink and read the label–sucralose! Stopped drinking it cold turkey and all problems were gone in a week or two, never to return.

Hi . Have been using stevia for many years and cannot praise it enough . I think research is a lost cause because we are all different individuals. I think when its plant-based it’s perfect.

For many years I drank 1-2 diet sodas almost every day. About a year ago I stopped, and over the next 8 months I lost about 12 pounds. Other than drinking more water I did not change anything else.

I think that overall people are better off with a small amount of sugar (I use honey) instead of the artificial sweeteners. The problem is that packaged goods have been stuffed with sugar for many years that people got used to it and think that something that is not sweet is no good. Also if you look at recipes they tell you to use a ton of sugar. I make my own pies and other desserts: I use a regular recipe and skip the sugar; the fruit gives it enough sweetness without the added sugar.

Disagnosed with hypoglycemia years ago and told to avoid sugar. It was an easy order to obey. Eating anything with sugar sets off problems of dizzyness; can’t sleep, yet tired all the time; and no ambition to do anything as far as house or yard work. I also limit anything remade that is sugar free, as it all includes Spenda which is made from sugar. I sparingly use the generic Equal in the blue packs. Years ago with a family of five who all had sweet tooths, I cut sugar in half in all recipes calling for sugar. (No one in all these years has ever said something I baked wasn’t sweet enough). I do use Splenda when family coming and limit what I eat. Other than taking a .75 mg pill every day for low thyroid, I am one of the healthiest 82 year olds you will see.

Why is it so difficult for the FDA and responsible testing groups to determine if and what effects using the various artificial sweeteners individually, have on our bodies??

I would be interested in more information COMPARING different non-sugar sweeteners. Which are safest? What are the consequences of each specific kind?

Kassy, I believe the answer is money. The researchers themselves say that the studies are flawed in that the data is inconclusive. From the article: quote “The researchers point out that these studies did not adequately address questions of safety. They call for longer-term, better-designed trials to establish clearer conclusions on safety and effectiveness of sugar substitutes.” My question is why conduct a study that does not satisfy the desired outcome? Were the researchers that ignorant of the original problem? Answer: Probably not. I believe they just want to do a longer-term and better-designed trial afterwards that will cost even more money.

This article mentions Sucralose, but not any other non-sugar sweeteners. I’m curious about the research on stevia, which I believe is not produced artificially but is made from plant material. Is there any evidence that it causes metabolic changes or other bad effects?

There is a table in the BMJ review article, which shows that sugar alcohols are not classified as non-sugar sweeteners. Good to know.


There were only a few studies of stevia included in the analysis. Here’s one comment from the research: “There seemed to be no consistent difference in effect between studies using aspartame, stevia, or a combination of sweeteners as the intervention.”

No mention about natural sweeteners like Stevia. Any concerns about this or similar products?

Has stevia been tested to see if it also has negative effects on inflammation and metabolic processes?

You don’t mention stevia. I have looked at several websites, but there doesn’t seem to be clear evidence that it’s safe. (Maybe no one knows yet.)
After several unsuccessful attempts, I succeeded two years ago in totally eliminating added sugar from my diet. I did it by two months of no sugar whatsoever – not even fruits or beets. I was uncomfortable for the first two days but OK after that with only occasional, manageable longings. After two months sugar-free, I was not even interested in sugar. If it had disappeared from the planet, I wouldn’t have noticed.
After two years, I was able to eat the occasional cookie or pastry at a party without re-activating the cravings.
I occasionally get a craving for chocolate, which I satisfy with a few squares of Lily’s dark chocolate, made with stevia and no added sugar. I plan not to eat this regularly though, even though chocolate in moderation is supposed to be good, for fear of reactivating the old sugar cravings (even with stevia – not physical, but psychological).

Nutrition Action has looked at the safety of sugar substitutes and opined that stevia, so far, appears to be OK. Monkfruit has not been studied well enough yet to tell if it is safe.

Does red wine contribute to the amount of sugar one ingests? I do not drink soft drinks but I do like a glass of wine or two in the evenings.

It was not included in the analysis, so we can’t answer.

We don’t drink sugary drinks or use much sugar in our household.
What about the sweetener, Stevia? We have been using it for a couple years and felt it was a safe choice. Your comments, please. Thank you!

I wish there was more detail on the types of NSS used: did these studies include xylitol, malitol, stevia, agave?

When you refer to non-sugar sweeteners, do you mean artificial sweeteners? Or are you including non-sugar products such as stevia? Please clarify. So far, the only negative with stevia would appear to be allergy (it’s evidently part of the ragweed family, so anyone with that specific allergy could be affected).

What about STEVIA ? ANY OTHER sweeteners-monk fruit etc? I wish articles named sweetener KINDS by name, at least.

What about Stevia ?

Only a few of the studies in the analysis compared stevia to placebo or other sweeteners. ie, need more data.

I have been using Stevia for about four years. At the time, I was told that it is a plant-based product and is safer. It is the nearest thing to a sugar taste that I have experienced. In that time, I have lost about 40 pounds and my blood sugar has dropped considerably. I drink a lot of iced tea sweetened by Stevia. Unless someone convinces me that the negatives are greater than the positives, I will continue as I am doing now.

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