Where Are We With Artificial Sweeteners These Days?

There was a time when artificial sweeteners were viewed as the cheat code for enjoying sweet foods and drinks without negative health consequences. Lower in calories than sugar, artificial sweeteners were considered the healthier option. Then came the onslaught of damning headlines. Artificial sweeteners make you fat. They destroy your microbiome. They increase the risk of cardiovascular disease. It’s enough to make you think that a can of Diet Coke should be slapped with a warning label, like a pack of Camels.

But it’s not as if sugar has made a comeback among healthy eating advocates or diet influencers. Both sugar and artificial sweeteners get a bad rap. But no one’s giving up treats entirely. So what’s the move when you want to satisfy your sweet tooth?

Artificial Sweeteners vs. Sugar: How They Compare

There are six different types of artificial sweeteners that have been approved by the Food and Drug Administration, including aspartame, sucralose, and stevia. Here’s what they all have in common: They’re sweeter than sugar, but lower in calories.

Artificial sweeteners impact the body in ways that are similar to sugar and ways that are different, according to Ritu Nahar, MD, a board-certified gastroenterologist at Allied Digestive Health. They both unfortunately promote the growth of bad bacteria in the gut while decreasing the good bacteria.

But, Dr. Nahar adds, not all artificial sweeteners influence the gut the same way—some are worse than others. “Saccharin and sucralose have been shown to disrupt microbial balance more profoundly. Aspartame has been linked to potential metabolic disruptions, but doesn’t appear to alter the microbiome as drastically,” she says.

Here’s where artificial sweeteners generally differ from sugar: Dr. Nahar says that while artificial sweeteners may kill off good bacteria in the gut because they are lower in calories than sugar, they likely have less of an overall impact metabolically. So artificial sweeteners may be less likely to lead to the metabolic conditions, like insulin resistance and obesity, that are associated with regularly loading up on sugary foods and drinks.

You may have heard that artificial sweeteners disrupt the body’s ability to regulate appetite. This would support claims about artificial sweeteners leading to weight gain. After all, if the body doesn’t properly regulate appetite, that can lead to overeating. Kim Kulp, RDN, a registered dietitian, gut health expert, and owner of Gut Health Connection, says this hasn’t technically been proven.

She explains that when we’re about to eat, the body gets ready for food by increasing saliva and stomach acid. It may also release a small amount of insulin even before food hits the stomach. This is called the cephalic phase insulin response (CPIR). “It’s believed this may drop blood sugar, which can then increase hunger. There is some evidence that artificial sweeteners can stimulate CPIR as much as sugar. However, this response is still not completely understood in humans,” Kulp says.

The lack of human studies is important to note. In general, there are way more human scientific studies on the effects of sugar than there are on artificial sweeteners’ impact on humans. Michael Schopis, MD, of Manhattan Gastroenterology, says that most studies on artificial sweeteners have been done on animals, not humans, which is important to keep in mind when considering any claims about how artificial sweeteners impact health.

How to Decide: Sugar or Artificial Sweetener?

With all this in mind (and based on the scientific evidence we do have), are artificial sweeteners any healthier than sugar? According to all three experts, the jury is still out on that. But they suggest some guidelines that can be used to help you make the healthiest choice possible.

Dr. Nahar emphasizes that deciding between sugar and a “sugar-free” version that’s artificially sweetened depends on your individual health goals. If you’re pre-diabetic or trying to lose weight, sugar-free is probably the best way to go because that option will be lower in calories and have less metabolic impact than sugar. “If someone craves something sweet, a sugar substitute like stevia or erythritol is likely a better choice due to their lower impact on blood sugar and the gut microbiome,” Dr. Nahar says.

Kulp agrees, saying, “Whether or not artificial sweeteners are a better choice than sugar depends on the person using them. If someone needs to reduce their sugar intake, like in diabetes, then using some artificial sweeteners may be a good choice. For those who just use a small amount of sweeteners in their diet and don’t have to worry about their blood sugar, then real sugar may be the best choice.”

If you’re experiencing any gut issues on a regular basis, Dr. Nahar says that some artificial sweeteners could make your G.I. symptoms worse. This is especially the case, she says, if you’re consuming a high amount of an artificial sweetener every single day—like having a large diet soda with your lunch or a smoothie made with protein powder that uses an artificial sweetener for flavoring. Over time, this could make your gut imbalance even greater. Then again, consuming lots of sugar likely will, too. “The individual response to both sugar and artificial sweeteners can vary greatly, so it’s essential to monitor personal tolerance and reactions,” Dr. Nahar says.

While all artificial sweeteners are sugar substitutes, there are sugar substitutes that aren’t artificial sweeteners; these are called “natural substitutes” because they are derived from nature. This includes monk fruit, honey, agave, coconut sugar, allulose, and xylitol. Of these, Dr. Nahar says that monk fruit seems to be a gut-friendly choice, though (again) more research needs to be done.

Honey also has been shown to have positive impacts on the gut, including promoting the growth of good gut bacteria. “Honey has a more balanced mix of fructose and glucose and contains beneficial antioxidants and prebiotic properties, which can promote gut health and offer anti-inflammatory benefits,” Dr. Nahar says. But honey is higher in calories than sugar, so your individual health goals may factor in here.

What about agave? Dr. Nahar says that though it’s from a natural source, it is high in fructose, which means it can lead to short-term annoyances (like bloating) and long-term metabolic problems (like insulin resistance and fatty liver). So just because it’s natural doesn’t mean it’s necessarily the best choice.

What all the experts agree on is that moderation is best when it comes to sugar and artificial sweeteners. “Just replacing sugar with artificial sweeteners doesn’t make for a healthier diet,” Kulp says. Even though we lack knowledge about artificial sweeteners, Dr. Yakubov says that what we do know from animal studies is that they certainly aren’t benefiting the gut (or any other part of the body, for that matter).

Artificial sweeteners aren’t a health food. But at the end of the day, sugar and their lab-made counterparts both do what they’re supposed to: Light up our taste buds and fulfill a craving. Maybe we just leave it at that.