Sugar is highly pervasive in our diet. Approximately 75 percent of processed foods and drinks contain added sugar. The consumption of sugar-sweetened beverages has increased fivefold since the 1950s and is linked to cardiovascular disease, metabolic syndrome, and diabetes.

According to a 2014 study, artificial sweeteners may drive diabetes and obesity. A Nature study suggested artificial sweeteners – including saccharin, sucralose and aspartame – interfere with gut bacteria, increasing the activity of pathways associated with obesity and diabetes.

Several observational studies and meta-analyses have correlated artificially sweetened beverages with increased body mass index and a higher risk of cardiometabolic diseases, such as type 2 diabetes and stroke. Randomized controlled trials of artificially sweetened beverages have shown either no effect at all on weight loss, or only minor reductions in weight.

Artificial sweeteners are central to the huge market of diet- and sugar-free food and drinks. Their attraction today is not only how cheap they are, but their potential to combat the increasing threat of obesity and its associated health impacts.

There are two broad categories of artificial sweeteners: sugar alcohols and high-intensity sweeteners. Sugar alcohols are structurally like sugars but less readily metabolized, whereas high-intensity sweeteners are small compounds many times sweeter than sugar. The high-intensity sweeteners include saccharin and aspartame. Saccharin is over 200 times sweeter than sugar but has zero calories.

Concern that artificial sweeteners could be carcinogenic stems from a 1978 study which found that rats that were fed saccharin developed bladder cancer. Since then, it has been shown that this only happens in rats, and saccharin does not cause cancer in humans.

Not just saccharin, but all the FDA and EU approved artificial sweeteners have undergone testing both in laboratory animals and data from humans. None of the approved sweeteners have any connection to cancer.

There is plenty of evidence that they are safe.

The main attraction of artificial sweeteners is that they can replace sugar. There is a huge amount of evidence suggesting high sugar consumption is bad for health. Sugary drinks in particular can lead to weight gain, metabolic diseases, and type 2 diabetes.

As for weight loss, a 2018 meta-analysis study, which combined the results of 56 different studies, concluded that in most cases groups of people using artificial sweeteners did not lose more weight than those using sugar. On the whole, switching from sugar to sweeteners has a neutral to positive effect on weight loss. It is likely that the impact of sweetener on weight loss depends on the original weight and diet of the individual.

In the America that I love, a diet drink might be better than a sugary one, but water might be even better.

Professor Randolph M. Howes, MD PhD, is a surgeon, scientist and patient advocate who lives in the Kentwood area. His website is

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