Because they are widely used and consumed by many people, artificial sweeteners
have been extensively studied and require approval by the FDA. The eight FDA
approved artificial sweeteners are:
• Aspartame (Equal® or NutraSweet®)
• Acesulfame potassium (ACK, Sunett® and Sweet One®)
• Neotame (Newtame®)
• Saccharin (Sweet ‘N Low®, Sweet Twin® and Sugar Twin®)
• Sucralose (Splenda® and Equal Sucralose); can be used as a replacement for
sugar in cooking and baking
• Stevia (Truvia®, Stevia in the Raw®, SweetLeaf® Sweet Drops™, Sun
Crystals® and PureVia®); extracted from the leaves of the stevia plant
• Luo han guo (Monk fruit extract) (Monk Fruit in the Raw ®); natural
sweetener made from crushed monk fruit
• Advantame; not commonly used at this time
The FDA has not permitted the use of whole-leaf Stevia or crude Stevia extracts
because these substances have not been proven to be safe but has allowed the use
of certain highly refined Stevia preparations in food products. Sugar alcohols,
another class of sweeteners, can also be used as sugar substitutes. Examples include
sorbitol, xylitol, lactitol, mannitol, erythritol, and maltitol. They are mainly used to
sweeten sugar-free candies, cookies, and chewing gums.
The FDA has reviewed hundreds of safety studies, including animal studies with
much higher doses than people would possibly consume, and concluded that available
evidence shows that they do not cause cancer or pose any other threat to human
health. A National Cancer Institute study found no increase in the risk of
lymphoma, leukemia, or brain cancer in the highest categories of consumption of
aspartame-sweetened beverages (equivalent to 7 to 11 cans of soft drinks daily)
compared with the lowest categories of consumption. Individuals who have phenylketonuria
(PKU), an inherited error of metabolism, have a decreased ability to
metabolize the amino acid phenylalanine. They should avoid aspartame because it
breaks down to form phenylalanine.
Although there is a popular belief that sugar and artificial sweeteners are associated
with hyperactive behavior and cognition problems among children, studies have
found no evidence that high consumption of sucrose or aspartame affects children’s
or adult’s behavior or cognitive function.
At one time, it was thought and reported in the medical literature that low-calorie
sweeteners stimulate appetite or adversely affect mechanisms that regulate hunger
and satiety. According to a Canadian Diabetes Association National Nutrition
Committee Technical Review, current evidence does not support this belief. Although
studies suggest that artificial sweeteners are generally safe, there is little
consistent evidence that they assist weight loss or cause weight gain and some evidence
that they disrupt gut bacteria and normal bodily metabolism in ways that
favor deposition of fat.
The Nurses’ Health Study and Health Professionals Follow-up Study found that
over 28 years of follow-up for women and 22 years of follow-up for men, a greater
consumption of both sugar and artificially sweetened soft drinks was each independently
associated with a higher risk of stroke.
A 2017 study in the journal Stroke reported that consuming a can a day of a low- or no-sugar soft drink, but not sugar-sweetened beverages, is associated with a higher risk of having a stroke or developing dementia. The associations with dementia were not statistically significant after additional adjustment for vascular risk factors and diabetes. A 2019
meta-analysis of 56 studies found that some studies linked non-sugar sweeteners
to a reduced risk of diabetes and overweight, but other research suggests that they
increase the risk of these conditions and cancer. The study found no evidence of
substantial harm, but negative health effects from long-term high dose use could
not be ruled out.
The 2015 DGAC report states that aspartame in amounts commonly consumed is
safe and poses a minimal health risk for healthy individuals, but that additional
study of safety is advisable because limited and inconsistent evidence suggests a
possible association between aspartame and risk of some blood cancers (non-Hodgkin
lymphoma and multiple myeloma) in men (but not women). In addition,
limited and inconsistent evidence indicates a potential for risk of preterm delivery
for pregnant women. The 2015 DGAC recommends that individuals should stay
below the aspartame Acceptable Daily Intake (ADI) of no more than 50 mg/kg/
day or 3500 mg/day for a 70 kg person. Since a 12-ounce diet beverage contains
approximately 180 mg of aspartame, this would imply a limit of nineteen 12-ounce
servings per day for a 154-pound person. The bottom line is that for most of us, usual levels of consumption of aspartame,
the most commonly used artificial sweetener, probably present a low risk to health.
This risk can be eliminated by drinking water, a less expensive drink.
This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel,