How Sweet It Is…or Is It? - Dangers of Artificial Sweeteners

Artificial sweeteners, now known as non-nutritive sweeteners, or NNS, (since they have no nutritional value), have been around for a long time. These provide an inexpensive sugar substitute. Saccharin was the first artificial sweetener, made over a hundred years ago. NNS were approved as food additives in 1958. They are now found in over 6,000 food and beverage items, including diet drinks, snack foods, candy, yogurt, chewing gum, salad dressings, ketchup, and vitamins. The number of items containing NNS has quadrupled in the last several years. 

Packet of an artificial sweetener, now referred to as non-nutritive sweeteners.

Non-nutritive sweeteners are far sweeter than natural sugar, ranging from 200 to 20,000 times sweeter than sugar. These sweeteners do not contain calories or nutrients such as fiber, antioxidants, or minerals. The concern is that using NNS can affect taste preferences for sweet foods, creating a desire for sweeter items. Animal studies have shown an increase in insulin response to this sweetness, increasing food intake and leading to obesity. Studies in humans have given mixed results, but one thing that human studies have revealed is higher rates of metabolic syndrome and type 2 diabetes in those who regularly use NNS, primarily from diet beverages, compared to those who don’t consume these beverages. The long-term safety issues of these additives in children are largely unknown. 

The FDA has approved eight different sugar substitutes or non-nutritive sweeteners. These include:

Aspartame	NutraSweet, Equal, Sugar Twin
Acesulfame potassium	Sunnet, Sweet One
Advantame	Advantame
Neotame	Newtame
Saccharin	Sweet’N Low, Sweet Twin
Sucralose	Splenda
Luo han guo	Monk fruit in the raw, PureLo Lo
Stevia	Truvia, Pure Via, Enliten

The last two are not artificial sweeteners but are considered non-nutritive sweeteners.

Any food or beverage labeled diet, sugar-free, sugarless, low sugar, reduced sugar, reduced calorie, or low-calorie typically contains an NNS.

A pile of pure cane sugar next to a pile of Stevia comparing how much less Stevia is needed than sugar for sweetness. Stevia is 250-300 times sweeter than sugar, and is not an artificial sweetener but is considered an NNS.

Reducing sugar intake for everyone is worthwhile, but artificial sweeteners may not be a better alternative, especially for children. The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) state that sugar substitutes should not be given to children under two and should be limited in children. The AAP has called for regulations for food manufacturers to label the amount of NNS contained, not simply list the type in the ingredients. The AAP also recommends that children avoid NNS as much as possible. There has not been enough research on children to warrant their frequent or long-term use. Due to their smaller body size and relatively high beverage intake, children consume more NNS per pound of body weight per day than adults.

In September of 2023, a research article was published in the Journal of the American Medical Association Network that reported consuming high amounts of ultra-processed foods (nine or more servings daily), specifically food and beverages containing artificial sweeteners, could increase the development of depression by as much as 50%. This study was conducted over 14 years and included over 31,000 women. The researchers did not conclude that these foods cause depression but that there is a definite link between artificial sweeteners and depression. They also found that limiting your intake to three or fewer servings daily lessened the risk.

Aspartame, specifically, has been linked to behavioral and cognitive problems. Possible symptoms of excess aspartame intake include learning problems, headaches, migraines, anxiety, depression, and insomnia. When this chemical is metabolized, it breaks down into 

Aspartic acid

Phenylalanine

Methanol

Methanol breaks down further into formaldehyde. These components can cross the blood-brain barrier and increase levels in the brain, acting on neurotransmitters to decrease dopamine, serotonin, and norepinephrine, all of which are linked to mental health issues.

So how do we satisfy that sweet tooth for ourselves and our children?

Sugar in and of itself is not bad as long as we limit intake and consider our sources.

Naturally sweet foods - for example, whole fruit - are nutrient-dense and high in fiber. Whole foods like fruits, vegetables, whole grains, and dairy products provide healthy carbohydrates and sugar.

Fruit can be served fresh, frozen, or canned in juice with no sugar added. 

Other common natural sweeteners include:

• honey*

• dates

• sugar

• coconut sugar

• maple syrup

• molasses

• agave nectar*

*Infants cannot have honey or agave nectar. Agave nectar is unpasteurized, and honey can cause botulism.

Any natural sweeteners should also be limited in amount.

Bowls with a variety of natural sweeteners including pure cane sugar, brown sugar, coconut sugar, and maple syrup which can be used sparingly to provide sweetness instead of artificial sweeteners.

Many desserts and treats can be made using fruit and/or vegetables, limiting the sugar and providing fiber and nutrients. Look for recipes online for items such as 

Brownies, cookies, and muffins made with avocado, sweet potatoes, black beans, and chickpeas

Pudding with ripened bananas and avocado

Healthy granola and protein bars

Read food labels to look for the sources of sweeteners and the presence of NNS. Avoiding diet, sugar-free, and reduced-sugar food and beverages can significantly lower your intake of NNS.

The takeaway message is that some foods can harm our physical and possibly our mental health. The bottom line is that artificial sweeteners have not been studied adequately in children and adolescents. The AAP recommends limiting these in children.