• The World Health Organisationrecommended against using artificial sweeteners to achieve weight loss and prevent lifestyle diseases such as  The report emphasised that while there was a need to cut intake of sugar, it should not be replaced by artificial sweeteners.
• Artificial sweeteners provide the sweet tastewith very little to no calories. Many diabetics use the sweeteners in their tea and coffee, but there is a growing market for packaged foods and beverages using these sweeteners to offer low-calorie options.
• “WHO suggests that non-sugar sweeteners (NSS) not be used as a means of achieving weight controlor reducing the risk of non-communicable diseases,” was the highlight of 90-page report based on nearly 283 studies.
• There are currently six artificial sweeteners approved by the FDA:
  • Saccharin
  • Aspartame
  • Sucralose
  • Acesulfame potassium
  • Neotame
  • Advantame

Health concerns

1. Increased appetite

Some research has suggested that artificial sweeteners may activate reward pathways in the brain that increase appetite. In fact, evidence suggests that, compared to consuming sugar or water, regularly consuming aspartame is linked with increased caloric intake, hunger, and sugar cravings.

2. Weight gain

Most people assume that artificial sweeteners will help with weight loss or weight management since they contain no calories. However, there is evidence linking long-term consumption of diet soda to increased body fat in older adults and higher BMI in children. Research is ongoing to better understand the correlation between artificial sweeteners and weight gain.

3. Poorly regulated blood sugar

While artificial sweeteners do not increase blood sugar levels, there is some evidence that they may increase insulin levels in the blood. Because of their sweet taste, the pancreas can mistake them for sugar. It’s possible that there may be a link between long-term use of artificial sweeteners and insulin resistance (Type 2 diabetes). But more research is needed to better understand this relationship.

Consuming artificial sugars may also increase the frequency of reactive hypoglycemia (low blood sugar after eating). This is because these sweeteners cause an increase of insulin, which lowers blood sugar even though the body hasn’t gotten any calories or energy from the sweetener. So even though artificial sweeteners don’t raise blood sugar directly, they can still lead to poorly controlled blood sugar levels.

4. Altered gut microbiome

Bacteria in the gut react differently to artificial sweeteners than they do to real sugar. Saccharin and sucralose have been found to change the gut microbiome and have been linked to dysbiosis in humans. Dysbiosis is an imbalance of good and harmful bacteria in the gut and can lead to:

• Bloating
• Thinning of the barrier surrounding the intestines
• Migraines
• Autoimmune conditions
• Mood changes
• Irritability
• Anxiety

5. Increased risk for stroke and heart disease

A recent study done by the American Heart Association reported that frequently consuming artificially sweetened beverages in mid and late life was associated with a higher risk of stroke and other heart-related events. But more studies are needed to understand this relationship.

6. Increased risk for metabolic syndrome

Research has linked the intake of artificial sweeteners to the development of metabolic syndrome.

Metabolic syndrome is a term for a number of risk factors that raise your risk of major health problems such as heart disease, diabetes, and stroke. These risk factors include:

• Fat around the waistline
• High triglyceride levels
• Low HDL cholesterol
• High blood pressure
• High blood sugar

WHO recommendation on artificial sweeteners

• While there could be some weight-lossand reduction in Body Mass Index in the short term as the artificial sweeteners bring down the calories consumed, but in the long run they have been linked to weight gain, the WHO report said. The sweeteners have also linked to an increased risk of Type-2 diabetes, cardiovascular diseases, and mortality in the long run. Some low certainty data also linked the use of such artificial sweeteners to bladder cancer and preterm birth when consumed by pregnant women.
• The meta-analysis foundthat higher intake of NSS was associated with a 23% increase in the risk of type-2 diabetes when consumed in the form of beverages and 34% when added to foods. Higher intake of these sweeteners was also linked with 32% increase in the risk of cardio-vascular disease – including a 19% increase in risk for stroke – and 13% increase in the risk for hypertension.
• It was also linked with a 25% increase in the risk for pre-term birth.“Long-term adverse effects in the form of increased risk of death and disease offset any potential short-term health benefit resulting from the relatively small reduction in body weight and BMI observed in randomized controlled trials,” the report said.
• The WHO has made these recommendations for everyone other than those who are already diabetic. “Replacing free sugars with non-sugar sweeteners does not helpwith weight control in the long term. People need to consider other ways to reduce free sugars intake, such as consuming food with naturally occurring sugars like fruit, or unsweetened food and beverages,” says Francesco Branca, WHO Director for Nutrition and Food Safety, in a release.

Is this the first-time artificial sweeteners have been linked to such adverse impacts?

• The analysis of WHOis based on already existing studies, results for which have been pooled to reach the conclusions. In fact, the WHO said that it was a “conditional recommendation” because the evidence was of low certainty. However, the recommendations come on the heels of two important studies that have shown the long term consequences.
• A large French study that followed those taking artificial sweeteners for nearly eight yearssaid that it increased the risk of cancers. Another large study published earlier this year showed that the artificial sweetener erythritol increased the risk of clotting and can lead to heart attacks or strokes.

What do the doctors recommend?

• Dr Anoop Misra, Chairman at Fortis CDOC Hospital for Diabetes and Allied Sciences, said that the artificial sweetenersshould absolutely not be consumed by non-diabetics for weight loss. “Even among diabetics I would recommend it very selectively to those who have good control over their sugars. In fact, I would suggest that they have ½ a tsp of sugar rather than the artificial sweeteners,” he said.
• He added: “If the sweeteners have been linked to increased risk for cardio-vascular diseases or cancer, the recommendation should also apply to diabetics as they are anyway at a higher risk of getting these diseases than the general population,” he said.
• Dr Ambrish Mithal, Chairman and Head, Endocrinology and Diabetes, Max Healthcare, said that while the artificial sweetenerswere developed as a low-calorie alternate to sugar for those with diabetes, it is now being used by healthy individuals. “Because the calories from the artificial sweeteners is much lower than the calories from sugar, people have started substituting it for sugar as a possible tool to lose weight. This hasn’t been proven in any study. In fact, studies suggest that they can lead to an increase the risk of insulin resistance and type-2 diabetes.”
• Here, Dr Misra makes a special mention of erythritol that can stay in the body for several days after being consumed. “It is usually mixed with other sweeteners to give them a more natural flavour, but it should not be consumed at all. Try and read the label to avoid it.”

Why are diet colas damaging?

• Dr Mithal explains that while the normal cola contains an extremely high amount of sugar– around 12 spoons in 500 ml – diet colas promise zero calories. These zero calories is achieved by using artificial sweeteners. “People tend to drink it more because they think they are consuming fewer calories. But this can lead to long-term negative consequences, including insulin resistance and diabetes,” he said.
• He added artificial sweeteners are also intensely sweet, much more than sugar. So, it makes normal sweets taste less sweet and makes you crave for more sweets.