Applied Evidence

What we know—and don’t—about non-nutritive sweeteners

J Fam Pract. 2019 July;68(6):310-315

References

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WHY ARE THE DATA INCONCLUSIVE?

Nutritional studies are hard to complete accurately outside of the laboratory setting. Also, the science of NNSs is new and evolving.

With regard to obesity and NNSs, it is possible that findings have been due to reverse causation. People who are overweight or obese are more likely to consume low-calorie foods and beverages; they are also at greater risk for developing diseases, such as T2DM.^48,49

HOW SAFE ARE NNSs?

They appear to be safe, but more data are needed. Each of the 7 FDA-approved NNSs has passed extensive laboratory, animal, and human testing, and appears to cause no harm in the human body when consumed.⁴⁹ But clearly the data are incomplete. As we continue to gain a greater understanding of the metabolism of NNSs, we may need to revisit the issue of safety.

ARE THERE ANY NNSs THAT SOME PEOPLE SHOULD AVOID?

Yes. People with phenylketonuria, who have difficulty metabolizing phenylalanine (a component of aspartame), should avoid consumption of aspartame.⁵⁰

Reverse causation may be at work with obesity and non-nutritive sweeteners. That is, people who are overweight or obese are more likely to consume low-calorie foods and beverages.

In addition, NNSs have been found to be present in breast milk.⁵¹ While the significance of this finding is yet to be determined, we warn against the use of NNSs by women who are breastfeeding.⁵¹

WHAT EFFECT—IF ANY—DO NNSs HAVE ON GUT MICROBIOTA?

We don’t know. Disruptions in the gut microbiome have been linked to numerous metabolic abnormalities, including obesity, insulin resistance, and diabetes, as well as cardiovascular disorders.^52,53 Diet is a main determinant of balance in the gut microbiota.⁵⁴ The gut microbiota are centrally involved in energy harvest, and studies have suggested that low gut bacterial diversity is associated with increased adiposity, insulin resistance, and low-grade inflammation.^55-60 Whether NNSs have a relationship with abnormal changes in gut microbiota requires further study.

CORRESPONDENCE
Clipper F. Young, PharmD, MPH, CDE, BC-ADM, BCGP, Touro University California, College of Osteopathic Medicine, 1310 Club Drive, Vallejo, CA 94592; Clipper.young@tu.edu.