Are Artificial Sweeteners Safe?

From diet sodas to sugar-free desserts and candies, sugar substitutes are practically everywhere today. Once considered a panacea for reducing the risk of food-related health issues (obesity, diabetes, tooth decay), artificial sweeteners have today come under increasing scrutiny by some who suggest that they may not be as safe as we think.

Granules of sugar or sugar substitute falling on a spoon

ASColgan Photography / Getty Images

Types of Sugar Substitutes

The term "sugar substitute" refers to both naturally sweet compounds other than table sugar (sucrose) and artificially synthesized sweeteners produced through chemical synthesis.

Naturally sweet compounds include substances like sorbitol found in apples and corn syrup, lactose found milk, and xylitol found some fruits and vegetables. They are inherently sweet substances with varying degrees of sweetness. 

Artificially synthesized compounds do not come from nature and include such popular brands as Equal (aspartame), Splenda (sucralose), and Sweet'N Low (saccharin). Stevia, a product often thought to be artificial, is actually derived from the Stevia rebaudiana plant.

From Sugar to Artificial Sweeteners

Most people are aware of the dangers of eating too much sugar. The current epidemic of obesity, diabetes, heart disease, hypertension, and kidney disease is largely a result of the excessive amounts of sucrose consumed by the average American. It is a state that health officials refer to as a "cardiorenal epidemic," wherein high rates of heart and kidney disease are directly linked to the foods we eat, including sugar.

In response to this epidemic, sugar substitutes have been aggressively marketed to the public as a means to literally "have your cake and eat it, too." Unfortunately, this solution is not as easy as it sounds, and we have come to realize that sugar substitutes affect our bodies in complex and often contradictory ways.

Comparing Artificial Sweeteners

In an extensive review conducted in 2012, the U.S. Food and Drug Administration (FDA) asserted that artificial sweeteners were "safe for the general population under certain conditions of use." This included recommendations not to exceed the acceptable daily intake (ADI) outlined by the agency.

Of the currently approved sweeteners, the FDA has conducted a battery of studies to determine what, if any, concerns the public should have about their use. Of the three most popular products:

  • Aspartame (Equal) was one of the earliest mass-produced sugar substitutes and, in that time, has attracted a fair share of controversy. While there were early concerns about aspartame's link to leukemia, lymphoma, and brain cancer, the official word today from both the FDA and National Cancer Institute is that no such association has been found.
  • Saccharin (Sweet'N Low) was reported to cause bladder cancer in lab rats; the same effect has not been seen in humans. These early fears led Canada to ban the product in 1977. The U.S. came close to doing the same but instead required the product to carry a warning label. This requirement was lifted in 2001 after research from the National Toxicology Program concluded that saccharin did not have carcinogenic (cancer-causing) properties.
  • Sucralose (Splenda) was discovered in 1976 and released in the U.S. in 1998. The FDA has conducted close to 100 studies and found no known association between sucralose and either cancer or heart disease.

Adverse Physiological Effects

The fact that the FDA deemed artificial sweeteners safe for human consumptions shouldn't suggest they can be used with impunity. While artificial sweeteners are able to mimic the sensation of sugar, the physiological response to their use can often quite different.

Normally, the body's response to sucrose is to reduce appetite and create a feeling of fullness, thereby reducing caloric intake. The same response does not seem to happen with artificial sweeteners, undermining the claim that they are "diet" products. This phenomenon is referred to as "caloric compensation" wherein people will often continue to eat despite not being hungry.

At the same time, artificial sweeteners may trigger an insulin spike, something that diabetics may not realize when eating certain "diabetic" candies. Together, these effects can take back any of the gains promised to people who are either obese, diabetic, or suffering from chronic kidney disease.

In 2012, the American Heart Association and American Diabetes Association issued a statement by which they both gave a guarded nod to artificial sweeteners, confirming their "appropriate use" as part of an informed dietary strategy. The statement also highlighted the risk of calorie compensation and warned consumers against using sweeteners as a "magic bullet" to fight obesity and diabetes.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

By Veeraish Chauhan, MD
Veeraish Chauhan, MD, FACP, FASN, is a board-certified nephrologist who treats patients with kidney diseases and related conditions.