A literature review of 37 studies has found that regular consumption of artificial sweeteners is associated with long-term weight gain and an increased risk of obesity, diabetes, high blood pressure and heart disease. The review paper is published in the Canadian Medical Association Journal.
Consumption of nonnutritive sweeteners is associated with increases in weight and waist circumference, and higher incidence of obesity, hypertension, metabolic syndrome, type 2 diabetes and cardiovascular events, according to Azad et al. Image credit: Lauri Andler / CC BY-SA 3.0.
Consumption of artificial sweeteners, such as aspartame, sucralose and stevia, is widespread and increasing.
Emerging data indicate that artificial, or nonnutritive, sweeteners may have negative effects on metabolism, gut bacteria and appetite, although the evidence is conflicting.
To better understand whether consuming artificial sweeteners is associated with negative long-term effects on weight and heart disease, Dr. Meghan Azad of the University of Manitoba and co-authors conducted a review of 37 studies that followed over 400,000 people for an average of 10 years.
“We searched MEDLINE, Embase and Cochrane Library for randomized controlled trials that evaluated interventions for nonnutritive sweeteners and prospective cohort studies that reported on consumption of non-nutritive sweeteners among adults and adolescents,” the researchers explained.
“The primary outcome was body mass index. Secondary outcomes included weight, obesity and other cardiometabolic end points.”
“From 11,774 citations, we included 7 trials (1,003 participants; median follow-up 6 months) and 30 cohort studies (405,907 participants; median follow-up 10 years),” they added.
The trials did not show a consistent effect of artificial sweeteners on weight loss.
However, the longer observational studies showed a link between consumption of artificial sweeteners and relatively higher risks of weight gain and obesity, high blood pressure, diabetes, heart disease and other health issues.
“Despite the fact that millions of individuals routinely consume artificial sweeteners, relatively few patients have been included in clinical trials of these products,” said senior author Dr. Ryan Zarychanski, also of the University of Manitoba.
“We found that data from clinical trials do not clearly support the intended benefits of artificial sweeteners for weight management.”
“Caution is warranted until the long-term health effects of artificial sweeteners are fully characterized,” Dr. Azad said.
“Given the widespread and increasing use of artificial sweeteners, and the current epidemic of obesity and related diseases, more research is needed to determine the long-term risks and benefits of these products.”
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Meghan B. Azad et al. 2017. Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies. CMAJ 189 (28): E929-E939; doi: 10.1503/cmaj.161390
