Skip to main content

Advertisement

SpringerLink
Log in

Decoding the mystery of non-nutritive sweeteners

  • Review Article
  • Published:
International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Background

This commentary explores the landscape of non-nutritive sweeteners, further delves into the historical trajectory and the contemporary surge in the consumption of non-nutritive sweeteners (NNS), along with the accompanying controversies concerning their safety.

Objective

The aim is to provide a comprehensive understanding of the influences of NNS, drawn from global studies and diverse perspectives.

Methods

The commentary synthesizes findings from global studies, notably the NutriNet-Santé cohort, exploring associations between specific NNS and health consequences such as cerebrovascular events and malignancies. Additionally, it examines the research on consequences of NNS on gut microbiota and explores concerns linked to gestational diabetes, fetal exposure, and health of the offspring.

Results

While caution is advised during pregnancy and fetal development due to potential risks, NNS show promise in weight management and short-term dietary goals when used cautiously in lower amounts. The commentary underscores the necessity for inclusive, long-term studies to guide evidence-driven policies and guidelines.

Conclusion

While the article underscores the complexities and debates surrounding non-nutritive sweeteners (NNS), it also sheds light on the positive aspects. In the Indian context, where the intake of sweeteners is relatively low and mainly limited to beverages (tea or coffee), NNS appear to be safe, but prudent use is advocated. The article emphasizes the value of public education on NNS usage and concludes that, overall, NNS are reasonably safe when consumed in moderation. Continued research is needed to elucidate their intricate effects on health and impact on global health outcomes.

Implications

The article concludes with clear guidelines for using NNS in India, highlighting the need for informed decision-making and ongoing research to elucidate their broader health consequences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. The long, tortured history of artificial sweeteners. American Council on Science and Health.2021. https://www.acsh.org/news/2021/08/18/long-tortured-history-artificial-sweeteners-15738.

  2. Wadia R. Impact of artificial sweeteners on caries. Br Dent J. 2023;234(12):923. https://doi.org/10.1038/s41415-023-6015-2.

    Article  Google Scholar 

  3. Patil S, Jalal RAS, Albar DH, Bansal SJ, Patil S, Nagaral S, Finch J, Bernard CA, Baeshen HA, Awan KH. Intake of artificial sweeteners by children: boon or bane? J Contemp Dent Pract. 2023;24(2):137–45. https://doi.org/10.5005/jp-journals-10024-3435.

    Article  PubMed  Google Scholar 

  4. Sharma A, Amarnath S, Thulasimani M, Ramaswamy S. Artificial sweeteners as a sugar substitute: are they really safe? Indian J Pharmacol. 2016;48(3):237–40. https://doi.org/10.4103/0253-7613.182888.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Basson AR, Rodriguez-Palacios A, Cominelli F. Artificial sweeteners: history and new concepts on inflammation. Front Nutr. 2021;8. https://doi.org/10.3389/fnut.2021.746247.

  6. Non-nutritive sweeteners (artificial sweeteners). 2023. www.heart.org. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/nonnutritive-sweeteners-artificial-sweeteners#main-content

  7. Aspartame and other sweeteners in food. Aspartame and other sweeteners in food | FDA.2023. https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food.

  8. Rios-Leyvraz M, Montez J. Health effects of the use of non-sugar sweeteners: a systematic review and metaanalysis. Geneva: World Health Organization; 2022.

  9. Singh AK, Singh A, Singh R, Joshi SR, Misra A. Non-sugar sweeteners and health outcomes in adults without diabetes: deciphering the WHO recommendations in the Indian context. Diabetes Metab Syndr Clin Res Rev. 2023;17(8):102829. https://doi.org/10.1016/j.dsx.2023.102829.

    Article  CAS  Google Scholar 

  10. RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020. International Journal of Diabetes in Developing Countries, 40 Suppl 1: 1–122. https://doi.org/10.1007/s13410-020-00819-213.

  11. Health effects of the use of non-sugar sweeteners: a systematic review and meta-analysis. Health effects of the use of non-sugar sweeteners: a systematic review and meta-analysis. 2022. https://www.who.int/publications/i/item/9789240046429.

  12. Tips to enjoy food you love | ADA. Tips to enjoy food you love | ADA. (n.d.).https://diabetes.org/healthy-living/recipes-nutrition/eating-well/top-5-ways-enjoy-food.

  13. McGlynn ND, Khan TA, Wang L, Zhang R, Chiavaroli L, Au-Yeung F, Lee JJ, Noronha JC, Comelli EM, Blanco Mejia S, Ahmed A, Malik VS, Hill JO, Leiter LA, Agarwal A, Jeppesen PB, Rahelić D, Kahleová H, Salas-Salvadó J, Kendall CWC, Sievenpiper JL. Association of low- and no-calorie sweetened beverages as a replacement for sugar-sweetened beverages with body weight and cardiometabolic risk. JAMANetwork Open. 2022;5(3):e222092. https://doi.org/10.1001/jamanetworkopen.2022.2092.

    Article  Google Scholar 

  14. Mohan V, Kuzhanthaivelu A, Rajagopal G, Vasudevan K, Nagamuthu G, Shekinah D, Unnikrishnan R, Mohan Anjana R, Vasudevan S, Kamala K. 614-P: Effect of non-nutritive sweetener sucralose on cardiometabolic risk factors among overweight and obese adults in India—a randomized clinical trial. Diabetes. 2023a;72(Supplement_1):614-P. https://doi.org/10.2337/db23-614-P.

    Article  Google Scholar 

  15. Mohan V, Kuzhanthaivelu A, Rajagopal G, Gunasekeran G, Soundararajan P, Marimuthu R, Unnikrishnan R, Mohan Anjana R, Vasudevan S, Kamala K. 615-P: Effect of nonnutritive sweetener sucralose on cardiometabolic risk factors among adults with type 2 diabetes in India—a randomized clinical trial. Diabetes. 2023b;72(Supplement_1):615-P. https://doi.org/10.2337/db23-615-P.

    Article  Google Scholar 

  16. Stepien M, Duarte-Salles T, Fedirko V, Trichopoulou A, Lagiou P, Bamia C, Overvad K, Tjønneland A, Hansen L, Boutron-Ruault MC, Fagherazzi G, Severi G, Kühn T, Kaaks R, Aleksandrova K, Boeing H, Klinaki E, Palli D, Grioni S, et al. Consumption of soft drinks and juices and risk of liver and biliary tract cancers in a European cohort. Eur J Nutr. 2014;55(1):7–20. https://doi.org/10.1007/s00394-014-0818-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Zhang X, Li X, Liu L, Hong F, Zhao H, Chen L, . . . Luo P. Dose–response association between sugar- and artificially sweetened beverage consumption and the risk of metabolic syndrome: a meta-analysis of population-based epidemiological studies. Public Health Nutr. 2021;24(12), 3892–3904. https://doi.org/10.1017/S1368980020003614.

  18. Steffen BT, Jacobs DR, Yi SY, et al. Long-term aspartame and saccharin intakes are related to greater volumes of visceral, intermuscular, and subcutaneous adipose tissue: the CARDIA study. Int J Obes. 2023. https://doi.org/10.1038/s41366-023-01336-y.

    Article  Google Scholar 

  19. Debras C, Deschasaux-Tanguy M, Chazelas E, Sellem L, Druesne-Pecollo N, Esseddik Y, De Edelenyi FS, Agaësse C, De Sa A, Lutchia R, Julia C, Kesse-Guyot E, Allès B, Galan P, Hercberg S, Huybrechts I, Cosson E, Tatulashvili S, Srour B, Touvier M. Artificial sweeteners and risk of type 2 diabetes in the prospective NutriNet-Santé cohort. Diabetes Care. 2023;46(9):1681–90. https://doi.org/10.2337/dc23-0206.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Plaza-Diaz J, Pastor-Villaescusa B, Rueda-Robles A, Abadia-Molina F, Ruiz-Ojeda FJ. Plausible biological interactions of low- and non-calorie sweeteners with the intestinal microbiota: an update of recent studies. Nutrients. 2020;12(4):1153. https://doi.org/10.3390/nu12041153.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Suez J, Korem T, Zeevi D, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514:181–6. https://doi.org/10.1038/nature13793.

    Article  ADS  CAS  PubMed  Google Scholar 

  22. Mohan V, Abirami K, Rajagopal G, Soundararajan P, Unnikrishnan R, Mohan Anjana R, Vasudevan S, Kamala K. 46-LB: Effect of nonnutritive sweetener (sucralose) on gut microbiome in Asian Indian adults with type 2 diabetes—a randomized clinical trial. Diabetes. 2023;72(Supplement_1):46-LB. https://doi.org/10.2337/db23-46-LB.

    Article  Google Scholar 

  23. Richardson IL, Frese SA. Non-nutritive sweeteners and their impacts on the gut microbiome and host physiology. Front Nutr. 2022;9. https://doi.org/10.3389/fnut.2022.988144.

  24. Kumar V, Agarwal S, Saboo B, Makkar B (2022) RSSDI Guidelines for the management of hypertension in patients with diabetes mellitus. International journal of diabetes in developing countries, 42(Suppl1):1–30. Advance online publication. https://doi.org/10.1007/s13410-022-01143-7.

  25. Salis S, Vora N, Syed S, Ram U, Mohan V. Management of gestational diabetes mellitus with medical nutrition therapy: a comprehensive review. J Diabetol. 2021;12(Suppl 1):S52–8. https://doi.org/10.4103/jod.jod_44_21.

    Article  Google Scholar 

  26. Nicolì F, Prete A, Citro F, Bertolotto A, Aragona M, de Gennaro G, Del Prato S, Bianchi C. Use of non-nutritive-sweetened soft drink and risk of gestational diabetes. Diabetes Res Clin Pract. 2021;178:108943. https://doi.org/10.1016/j.diabres.2021.108943.

    Article  PubMed  Google Scholar 

  27. Cai C, Sivak A, Davenport M. Effects of prenatal artificial sweeteners consumption on birth outcomes: a systematic review and meta-analysis. Public Health Nutr. 2021;24(15):5024–33. https://doi.org/10.1017/S1368980021000173.

    Article  PubMed  Google Scholar 

  28. Leth-Møller M, et al. Transplacental transport of artificial sweeteners. Nutrients. 2023;15:2063.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Concha F, Sambra V, Cáceres P, López-Arana S, Carvajal B, Gotteland M. Maternal consumption and perinatal exposure to non-nutritive sweeteners: should we be concerned? Front Pediatr. 2023;11:1200990. https://doi.org/10.3389/fped.2023.1200990.

  30. Li G, Wang R, Zhang C, Li L, Zhang J, Sun G. Consumption of non-nutritive sweetener during pregnancy and weight gain in offspring: evidence from human studies. Nutrients. 2022;14(23):5098. https://doi.org/10.3390/nu14235098.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Azad MB, Sharma AK, de Souza RJ, Dolinsky VW, Becker AB, Mandhane PJ, Turvey SE, Subbarao P, Lefebvre DL, Sears MR, Canadian Healthy Infant Longitudinal Development Study Investigators. Association between artificially sweetened beverage consumption during pregnancy and infant body mass index. JAMA Pediatr. 2016;170(7):662–70. https://doi.org/10.1001/jamapediatrics.2016.0301.

    Article  PubMed  Google Scholar 

  32. Zhu Y, Olsen SF, Mendola P, Halldorsson TI, Rawal S, Hinkle SN, Yeung EH, Chavarro JE, Grunnet LG, Granström C, Bjerregaard AA, Hu FB, Zhang C. Maternal consumption of artificially sweetened beverages during pregnancy, and offspring growth through 7 years of age: a prospective cohort study. Int J Epidemiol. 2017;46(5):1499–508. https://doi.org/10.1093/ije/dyx095.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Debras C, Chazelas E, Sellem L, Porcher R, Druesne-Pecollo N, Esseddik Y, de Edelenyi FS, Agaësse C, De Sa A, Lutchia R, Fezeu LK, Julia C, Kesse-Guyot E, Allès B, Galan P, Hercberg S, Deschasaux-Tanguy M, Huybrechts I, Srour B, Touvier M. Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort. BMJ (Clin Res ed). 2022;378:e071204. https://doi.org/10.1136/bmj-2022-071204.

    Article  Google Scholar 

  34. Debras C, Chazelas E, Srour B, Druesne-Pecollo N, Esseddik Y, Szabo de Edelenyi F, Agaësse C, De Sa A, Lutchia R, Gigandet S, Huybrechts I, Julia C, Kesse-Guyot E, Allès B, Andreeva VA, Galan P, Hercberg S, Deschasaux-Tanguy M, Touvier M. Artificial sweeteners and cancer risk: results from the NutriNet-Santé population-based cohort study. PLoS Med. 2022;19(3):e1003950. https://doi.org/10.1371/journal.pmed.1003950.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Aspartame hazard and risk assessment results released. Aspartame Hazard and Risk Assessment Results Released. 2023. https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released.

  36. Hoffmann BR, Haspula D, Roethle M, Cabrera S, Moosreiner A, Hessner M. Effects of chronic artificial sweetener consumption on type 1 diabetes susceptibility. FASEB J. 2020;34(S1):1–1. https://doi.org/10.1096/fasebj.2020.34.s1.06118.

    Article  Google Scholar 

  37. Devitt L, Daneman D, Buccino J. Assessment of intakes of artificial sweeteners in children with type 1 diabetes mellitus. Can J Diabetes. 2004;28.

  38. Singh S, Kohli A, Trivedi S, Kanagala SG, Anamika F, Garg N, Patel M, Munjal R, Jain R. The contentious relationship between artificial sweeteners and cardiovascular health. Egypt J Intern Med. 2023;35:43. https://doi.org/10.1186/s43162-023-00232-1.

    Article  Google Scholar 

  39. Magnuson BA, Burdock GA, Doull J, Kroes RM, Marsh GM, Pariza MW, Spencer PS, Waddell WJ, Walker R, Williams GM. Aspartame: a safety evaluation based on current use levels, regulations, and toxicological and epidemiological studies. Crit Rev Toxicol. 2007;37(8):629–727. https://doi.org/10.1080/10408440701516184.

    Article  CAS  PubMed  Google Scholar 

  40. American Diabetes Association Professional Practice Committee. 5. Facilitating positive health behaviors and well-being to improve health outcomes: standards of care in diabetes—2024. Diabetes Care. 2024;47(Supplement_1):S77–110.

    Article  Google Scholar 

Download references

Acknowledgements

The Madras Diabetes Research Foundation (MDRF) with which Dr. V. Mohan is associated has received funding from M/S Zydus Wellness for studies on Non-Nutritive Sweeteners (Stevia). However, the funders had no role in the conduct of that study or in this article.

Author information

Authors and Affiliations

  1. Dietary Department, Tamil Nadu Government Multi Super Specialty Hospital, Chennai, India

    Sachdev Meenakshi

  2. Department of Diabetology, Madras Diabetes Research Foundation, (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan’s Diabetes Specialities Centre, (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India

    Viswanathan Mohan

Authors
  1. Sachdev Meenakshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Viswanathan Mohan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Viswanathan Mohan.

Ethics declarations

Competing interests

Zydus Wellness has supported studies on Sucralose done by the Madras Diabetes Research Foundation.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meenakshi, S., Mohan, V. Decoding the mystery of non-nutritive sweeteners. Int J Diabetes Dev Ctries 44, 3–9 (2024). https://doi.org/10.1007/s13410-024-01323-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13410-024-01323-7

Keywords

Search

Navigation