Is the Use of Artificial Sweeteners Beneficial for Patients with Diabetes Mellitus? The Advantages and Disadvantages of Artificial Sweeteners

Abstract

Artificial sweeteners have been developed as substitutes for sugar. Sucralose, acesulfame K (ACE K), aspartame, and saccharin are artificial sweeteners. Previously, artificial sweeteners were thought to be effective in treating obesity and diabetes. Human meta-analyses have reported that artificial sweeteners have no effect on body weight or glycemic control. However, recent studies have shown that artificial sweeteners affect glucose absorption in the intestinal tract as well as insulin and incretin secretion in humans and animals. Moreover, artificial sweeteners alter the composition of the microbiota and worsen the glycemic control owing to changes in the gut microbiota. The early intake of ACE K was also shown to suppress the taste response to sugar. Furthermore, a large cohort study showed that high artificial sweetener intake was associated with all-cause mortality, cardiovascular risk, coronary artery disease risk, cerebrovascular risk, and cancer risk. The role of artificial sweeteners in the treatment of diabetes and obesity should be reconsidered, and the replacement of sugar with artificial sweeteners in patients will require the long-term tracking of not only intake but also changes in blood glucose and weight as well as future guidance based on gut bacteria data. To utilize the beneficial properties of artificial sweeteners in treatment, further studies are needed.

Behind vegan label: What's really in some certified vegan products in Brazil

“…Nevertheless, the replacement of sugar by diet sweeteners has been increasing in recent decades in Brazil, due to the population's interest in aesthetics and weight loss, in addition to the health appeal that these products present (Natividade et al ., 2011). However, recent studies indicate that the use of artificial sweeteners, including for individuals with diabetes mellitus, may be damaging to health, by promoting changes in the gut microbiota, which may increase blood glucose levels, atherosclerosis and cardiovascular risk (Del Pozo et al ., 2022; Iizuka, 2022). In addition, the WHO suggests that artificial and natural sweeteners should not be used as a means of achieving weight control or reducing the risk of chronic diseases, due to the lack of evidence demonstrating beneficial effects for these cases (Draft WHO Guideline, 2022).…”

Consumption of aspartame and other artificial sweeteners and risk of cancer in the Spanish multicase‐control study (MCC‐Spain)

“…In our study, participants with diabetes were much more likely to consume AS, so this stronger exposure gradient may explain the results with cancer risk only observed in people with diabetes. Moreover, some AS including aspartame can induce alterations in the gut microbiota, 31,32 and this might be more pronounced in people with diabetes who are more likely to present gut dysbiosis 32‐34 . Alterations in the gut microbiota are involved in cancer genesis 35 .…”

“…Moreover, some AS including aspartame can induce alterations in the gut microbiota, 31,32 and this might be more pronounced in people with diabetes who are more likely to present gut dysbiosis. [32][33][34] Alterations in the gut microbiota are involved in cancer genesis. 35 To our knowledge this is one of the first studies to explore the heterogeneity of associations of AS and cancer risk by diabetes status.…”

The consumption pattern and perception of using artificial sweeteners among the public in Tabuk region, Saudi Arabia

“…Due to how they are marketed, artificial sweeteners are considered to be healthy alternatives to calorigenic sugars which can provide the body with eatable food and palatable drinks ( 24 ). Many people use such food additives as substitutes for calorigenic sugars for weight loss and diabetes ( 25 , 26 ). However, the beneficiary effect or the deleterious effect of these artificial sweeteners is controversial.…”