Assessing the Health Impact of Artificial Sweeteners

The World Health Organization, the Centers for Disease Control and Prevention, and several other organizations recommend limiting intake of added sugars to less than 10% of our total daily calories (WHO 2015, CDC 2024). Artificial sweeteners have thus emerged as a promising alternative to sugar in both manufactured and homemade foods and beverages. Yet, claims that artificial sweeteners are linked to weight gain, adverse cardiometabolic outcomes, and cancer have gained widespread attention in the media, causing many consumers to shy away from their use. However, one must always interpret such claims with caution in light of the existing evidence—evidence that this article will sort through with a goal of bringing some clarity to the questions surrounding artificial sweeteners.

Artificial sweeteners—sometimes referred to as low-calorie or non-nutritive sweeteners—are chemically synthesized compounds intended to replace or reduce added sugar in foods and beverages (Toews et al. 2019). Of note, this definition excludes those non-sugar, high-intensity sweeteners derived from plants, such as stevia and monk fruit, as well as sugar alcohols and low-calorie sugar isomers, such as allulose. There are six artificial sweeteners approved for use in the United States by the U.S. Food and Drug Administration (FDA): aspartame, saccharin, acesulfame-K, sucralose, neotame, and advantame (FDA 2024). The European Food Safety Authority (EFSA) has approved cyclamate in addition to these same six sweeteners, albeit with slightly different acceptable daily intakes (Toews et al. 2019, EFSA 2025).

The cardiometabolic impact of artificial sweeteners is primarily attributed to their alleged effects on body weight and risk of type 2 diabetes. Addressing the question of body weight, a 12-week randomized control trial from 2019 demonstrated that while consumption of beverages sweetened with sucrose or saccharin appeared to increase body weight, beverages sweetened with sucralose, aspartame, or stevia did not result in a significant change in body weight. It is worth mentioning, however, that participants in this study each drank over 1 L of their assigned beverage per day, likely exceeding the average intake of most consumers (Higgins and Mattes 2019). On the other hand, a 2022 systematic review and meta-analysis found that substituting beverages sweetened with low- or no-calorie sweeteners for sugar-sweetened beverages resulted in small reductions in body weight, averaging about 2.3 lb, among overweight and obese adults. Aspartame was the primary sweetener used in the studies analyzed, although acesulfame-K, sucralose, and saccharin were each used in at least one study (McGlynn et al. 2022).

Artificial sweeteners also appear to have no impact on the development of type 2 diabetes. Many studies linking the consumption of artificial sweeteners to risk of type 2 diabetes were subject to publication bias, with authors omitting studies that did not demonstrate a correlation between the two variables. Illustrating this discrepancy, authors of a 2017 meta-analysis concluded that consumption of artificially sweetened beverages increased the risk of type 2 diabetes (Azad et al. 2017). This supposed correlation was only seen with analysis of observational studies, which in the field of nutrition are almost always confounded by such factors as body weight and other dietary habits. Moreover, when the findings were adjusted to account for the omitted data, no such correlation was seen. The analyzed randomized control trials found no association between artificial sweetener intake and indicators of diabetes, and the aforementioned 2022 meta-analysis found that substituting low- or no-calorie sweetened beverages for sugar-sweetened beverages was associated with a reduction in cardiometabolic risk factors (Azad et al. 2017, McGlynn et al. 2022).

Lastly, with respect to the possible carcinogenic properties of artificial sweeteners, here too studies have failed to demonstrate a correlation. As in the case of diabetes, many of the studies cited as proving the link between artificial sweeteners and cancer had major flaws and limitations. For instance, an oft-cited 1979 study concluded that saccharin intake was associated with increased rates of bladder cancer. However, this study was done in lab rats exposed to supranormal levels of the sweetener, 40 to 80 times the maximum daily intake defined by the FDA (Chowaniec and Hicks 1979). More recently, both a 2019 systematic review and meta-analysis and a 2023 prospective cohort study found no association between cancer risk and non-sugar sweeteners, including artificial sweeteners (Toews et al. 2019, Zhao et al. 2023).

Despite data supporting their safety, claims that artificial sweeteners are deleterious to one’s health remain. How should manufacturers respond to this skepticism? Given the preponderance of evidence, there is little reason to remove artificial sweeteners from product formulations across the board. If companies want to avoid the controversy altogether, then they may consider utilizing stevia, monk fruit, sugar alcohols, allulose, or any of the other approved, non-artificial sweeteners. But perhaps a longer-lasting solution would be to invest in improving consumer education and scientific literacy to counteract the misinformation related to artificial sweeteners. It seems likely that artificial sweeteners are here to stay. As is so often the case, moderation is key.ft