A new meta-analysis and systematic review finds mixed evidence to support use of artificial sweeteners for weight loss and suggests routine consumption may be associated with long-term weight gain and an increased risk of cardiometabolic disease. Nonnutritive sweeteners, such as aspartame, sucralose and

stevioside, are widely consumed, yet their long-term health impact is uncertain. The authors synthesized evidence from prospective studies to determine whether routine consumption of nonnutritive

sweeteners was associated with long-term adverse cardiometabolic effects. The authors searched MEDLINE, Embase and Cochrane Library (study inception to January 2016) for randomized controlled trials (RCTs) that evaluated interventions for nonnutritive sweeteners and prospective cohort studies

that reported on consumption of nonnutritive sweeteners among adults and adolescents. The primary outcome was body mass index (BMI). Secondary outcomes included weight, obesity and other cardiometabolic end points.

Results were derived from 11 774 citations, which included 7 trials (1003 participants; median follow-up 6 months) and 30 cohort studies (405 907 participants; median follow-up 10 year). In the included RCTs,

nonnutritive sweeteners had no significant effect on BMI (mean difference–0.37 kg/m2; 95% confidence interval [CI] –1.10 to 0.36; I2 9%; 242 participants). In the included cohort studies, consumption of nonnutritive sweeteners was associated with a modest increase in BMI (mean correlation 0.05,

95% CI 0.03 to 0.06; I2 0%; 21 256 participants). Data from RCTs showed no consistent effects of nonnutritive sweeteners on other measures of body composition and reported no further secondary outcomes. In the cohort studies, consumption of nonnutritive sweeteners was associated with increases

in weight, waist circumference and higher incidence of obesity, hypertension, metabolic syndrome,

type 2 diabetes and cardiovascular events. Publication bias was indicated for studies with diabetes as an outcome.

“People are generally consuming nonnutritive sweeteners (NNS) believing they are a ‘healthy choice,’ but this may not be true,” study author Dr Meghan Azad said. “More important, our results send a strong message to researchers and research funding bodies that more studies are needed to understand the long-term health impacts of artificial sweeteners.” The lack of studies looking at long-term effects is surprising, given that more than 40% of adult Americans regularly consume NNS, such as aspartame, sucralose, and stevia, she said. In addition, studies measuring NNS in blood and urine show that many people who report not using NNS are unknowingly consuming these sweeteners in foods.

The authors concluded that evidence from RCTs does not clearly support the intended benefits of nonnutritive sweeteners for weight management, and observational data suggest that routine intake of nonnutritive sweeteners may be associated with increased BMI and cardiometabolic risk. Further research is needed in the author’s opinions to fully characterize the long-term risks and benefits of

nonnutritive sweeteners.

Dr Lawrence Cheskin (Johns Hopkins Weight Management Center, Baltimore, MD) said, “Even though they point to some observational studies and say there is more diabetes, there’s no experimental evidence that that occurs in humans. Nor heart disease.” He feels it is unlikely  that artificial sweeteners directly cause heart disease. “It may be associated with people who have somewhat higher risks of heart disease because they’re heavier and have bad habits and are drinking diet soda to make up for the other things they’re doing that aren’t so good,” he speculated. In addition to the confounding factor of selection bias, Cheskin pointed out that the seven randomized trials were in small numbers of people followed for relatively short periods of time and looked only at certain types of sweeteners available at the time and in beverages, not in other foods. In four of the trials, participants using NNS were also on a weight-loss program.

For its part, the Academy of Nutrition and Dietetics, the largest organization of food and nutrition professionals in the US, says NNS play a role in weight and blood glucose control.

As always, readers of this blog are highly encouraged to read the complete sources/references listed below thoroughly and in full to contextualize the complete information provided. Additionally, interested parties on this topic important topic about the serious problem of opioid diversion within our health systems should seek further information on this topic from scientific and medical information readily available in the public domain as well as speak with their health care provider.


  • Artificial Sweeteners Linked to Higher BMI, Cardiometabolic Risk – Medscape – Jul 31, 2017
  • AZAD MB, et al. CMAJ July 17, 2017 189:E929-E939; doi:10.1503/cmaj.161390