The average American consumes about 7 teaspoons of added sugar per day, quickly raising calorie intake and tanking overall diet quality. It's obvious we should make every effort to reduce the impact that added sugar has on our health, and people are now looking for healthier ways to satisfy their sweet tooth. Not surprisingly, companies jumped at the chance to come up with the perfect no- or low-calorie sweeteners to provide plenty of options. But are these sweeteners really as safe and healthy as we are led to believe?

There are dozens of studies touting the benefits of these non-nutritive sweeteners--or artificial sweeteners. Advocates say that they help with weight loss, metabolic health, and blood sugar control. But some caution that there's more harm being done beneath the surface. Let's take a closer look at the pros and cons of using artificial sweeteners as a way to reduce caloric intake. And then the possible negative effects that these sugar substitutes can have on human health and the microbiome.

Is sugar really the enemy, or are alternative sweeteners even worse?

What are artificial sweeteners exactly?

Often referred to in the nutritional science community as non-nutritive sweeteners (NNS), there are multitude of artificial sweeteners such as:

Sucralose
Acesulfame-K
Saccharin
Stevia
Aspartame
Xylitol and other sugar alcohols

These artificial sweeteners are low-calorie and are commonly found in many processed foods like diet drinks, chewing gum, protein powders, sugar-free desserts, and candy—just to name a few. They even hide in places you wouldn’t suspect, like children’s cough medicine.

There are also other sugar substitutes out there to choose from, including monk fruit or polyols such as erythritol. Research on many of these more "natural sweeteners" is still unfolding.

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Good for your health, or worse than sugar?

Depending on who you ask, artificial sweeteners are either a tasty and convenient tool for weight loss or harmful food additives that ruin your gut microbiome and whose health concerns are way higher than natural sugars.

However, it's easy to see the upside if these kinds of sugar substitutes. People with a sweet tooth often struggle to lose weight, but with a sugar substitute with zero calories, you can enjoy a treat or dessert while both calorie intake and blood sugar levels are within a range that supports your goals. Because most artificial sweeteners are either low- or no-calorie, proponents argue that they're also a better alternative for long-term metabolic health, i.e. they may reduce the risk of developing type 2 diabetes, obesity, or cholesterol issues.

Though many studies have confirmed the safety of various artificial sweeteners as a sugar substitute, other studies highlight potential negative effects. Some research, for example, has indicated a potential link between artificial sweeteners and an increased risk for cardiovascular disease (1).

Alternative sweeteners alter the microbiome

When we examine the potential downside of artificial sweeteners is where we enter into a little controversy. Some experts in the health community point to studies that show that certain sweeteners can alter the composition of the gut microbiome (2). In these studies, the sweeteners changed the intestinal bacteria of mice, which play important roles in regulating metabolism, appetite, and fat storage. Given how essential the microbiome is to overall health, this is obviously a point of concern for many.

More recently, however, a randomized controlled trial using human subjects found specific changes to the gut microbiome associated with the consumption of artificial sweeteners (3). The finding is important because it presents data that challenges the assumption that sugar substitutes have zero negative effect on the human body.

This study serves as evidence that sugar substitutes like sucralose and stevia impact the gut microbiome. What researchers don’t yet know is whether those changes to our gut are detrimental. But given how important our gut health is, this is something that warrants further investigation.

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Some artificial sweeteners could actually increase obesity risk

Aspartame, commonly known as Sweet’n Low, has been shown to impair glucose tolerance, a measure of how readily the body moves sugar from the blood into muscle and fat (4). This could lead to weight gain and diabetes, and other long-term health issues.

Additionally, an article published in 2021 in Environmental Health expressed grave concern over findings confirming that aspartame is a chemical carcinogen in rodents, even at intakes similar to the Acceptable Daily Intake (ADI). Researchers go on to encourage all public health agencies to “urgently reexamine” health risks associated with aspartame, especially the risks of prenatal and early postnatal exposures (5).

Sucralose, or Splenda, is another popular artificial sweetener also under scrutiny for possible carcinogenic effects. Despite these concerns though, a large review determined that sucralose does not appear to cause cancer (6), but it did not examine the effect upon the microbiome or metabolic health. Other studies have shown that long-term sucralose consumption alters gut bacteria in a way that promotes inflammation and insulin resistance (7).

Sugar alternatives that seem “natural” but aren’t good for you

The first is agave. While most sugar substitutes have a roughly equal mix of glucose to fructose, agave is almost all fructose. This would seem to be a positive thing, since fructose does not spike blood sugar like glucose does. But research says not so.

High consumption of fructose (not including whole-food sources like fruit) is linked to high triglycerides and fatty liver (8).

The second is brown rice syrup, which is made by breaking down the starch in brown rice, and results in a thick and syrupy sweetener. It’s low in fructose, so no added stress for the liver, but there’s a different concern. Because rice absorbs arsenic from the environment, consuming higher amounts may not be healthy if your body is unable to detox this heavy metal efficiently.

Best and worst artificial sweeteners

With all the controversy surrounding artificial sweeteners, which are the safest, and which should you avoid at all costs? Let’s get some perspective.

More natural sugar alternatives include:

Dates
Honey
Maple syrup
Coconut sugar

The occasional use of stevia and monk fruit appear to also be good options.

Artificial sweeteners to avoid

The worst sweeteners include:

Sucralose
Saccharin
Aspartame
Acesulfame-K
High fructose corn syrup
Agave

It’s best to avoid these sweeteners, if possible.

Read: The Holistic Guide to Improving Gut Health

Better to use sugar or an alternative sweetener?

When it comes to sweets, opting for a balanced approach seems the best. So if you want to indulge your sweet tooth while also protecting your gut microbiome and not expose yourself to potentially harmful artificial sweeteners, keep these in mind:

Consuming a small amount of added sugars occasionally is fine for most people. Think holidays, birthdays, and other once-in-a-while celebrations.
Avoid frequent consumption of artificial sweeteners that alter the gut microbiome, like sucralose and aspartame.
Try pairing sugary foods with protein, fat, or fiber, as this will help blunt blood sugar spikes.
Go for a walk or do 10 minutes of activity after a high-sugar treat if you’re concerned about your body’s response to glucose.

If you regularly consume foods or drinks high in artificial sweeteners on a daily basis, it’s likely a good idea to get to the root of your cravings. Could it be gut dysbiosis? Candida? Or a nutrient deficiency?

A holistic nutritionist can help you figure it out.

What to remember about artificial sweeteners

Some studies suggest that long-term use of artificial sweeteners may alter the human gut microbiome, which can have negative effects on health. However, sugar alternatives do have obvious benefits for weight loss and blood sugar control. Ultimately, it’s important to be aware of both the risks and rewards associated with artificial sweeteners so you can make the best decision for your individual health. With these tips in mind, you can choose the healthiest sugar alternative for you and your family.

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About
the author

CentreSpring MD, formerly known as Atlanta Center for Holistic and Integrative Medicine, provides the best medical care by using an integrative approach to find a patient’s centre—their core—empowering them to spring forth into health.

Blog Reviewed By:

Dr. Taz Bhatia, M.D.

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At CentreSpringMD, we do medicine differently. Our focus is on giving you hope and your life back.

Our team of dedicated board-certified providers relentlessly pursue your health until you have the answers that you deserve to change the trajectory of your health—and your life.

Is Sugar the Enemy or Are Alternative Sweeteners Even Worse?