The World Health Organization, Health Canada and the Canadian Diabetes Association all recommend that sugar intake contribute to less that 10% of total energy intake^1,2,3. This refers to “added sugar” which is what we add to sweeten food. These recommendations are based on evidence showing that eating too much sugar contributes to greater energy intake, weight gain, dental problems, and increased risk of other chronic diseases ^1,3. Therefore, based on current evidence it is safe to say that sugar intake should be limited. The question that rises is whether artificial sweeteners should be used instead of sugar.

There is some evidence showing that the use of artificial sweeteners instead of sugar helps with weight loss and weight management ^4,5. This makes sense because artificial sweeteners have no calories, thereby if used properly they can help decrease overall caloric intake. In addition, if you have diabetes or know someone with diabetes, you probably know that they use artificial sweeteners to make food more enjoyable while helping them manage their blood sugar ⁵.

On the other hand, a number of studies point to harmful effects of certain artificial sweeteners, saying that they may impact blood sugar levels because of changes that they cause to the beneficial bacteria that live in our gut^{7, 8}.  While these findings are very valuable, you should know that many of them were done on mice and more studies on humans is needed to make conclusions. Also, you should know that the human studies involve contradictory findings and should be redesigned and rerun to ensure that findings are reliable ⁷. Confusing, right? This is always the case when we research new trends. Meanwhile, we need to able to make a decision that is most sound.

Overall, the use of artificial sweeteners remains as a controversial topic. The current evidence does not encourage the use of artificial sweeteners; however, knowing that too much added sugar (which is the case if you follow a typical North American diet) has harmful effects, artificial sweeteners could be considered as a tool to help those who may benefit from it. As a dietitian, I would recommend that you limit their added sugar intake to less than 10% of your daily caloric intake. This means that if you eat 2000 calories in a day, no more that 200 calories should come from added sugar (e.g. white or brown sugar, honey, syrup, pop, etc.). However, if you absolutely need to use artificial sweeteners to make your food edible (considering taste preferences), I would encourage you to make sure that you don’t exceed acceptable daily intake (ADI). Remember that artificial sweeteners are not an anti-obesity drug, do no promote weight reduction and that artificially sweetened drinks should not substitute nutritious foods.

References:

1. Guideline: Sugars intake for adults and children. Geneva: World Health Organization; 2015.
2. Health Canada. Eating Well With Canada’s Food Guide (2007). H164-38/1-2007E. 2007. Ottawa ON, Health Canada
3. Canadian Diabetes Association. (2017). Canadian Diabetes Association: Sugars Position Statement. Retrieved from https://www.diabetes.ca/getmedia/9d0baffb-6268-4762-acc7-e52575c40c55/cda-position-on-sugars.pdf.aspx
4. Miller, P. E., & Perez, V. (2014). Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies. The American journal of clinical nutrition, 100(3), 765-777.
5. AZAD, M. K., & GUPTA, S. (2017). Artificial Sweeteners, Diabetic Foods & Supplements Myths & Facts [A Meta Analysis]. Indian Journal of Applied Research, 6(12).
6. Mattes RD, Popkin BM. Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. American Journal of Clinical Nutrition2009;89(1):1-14.
7. Suez, J., Korem, T., Zeevi, D., Zilberman-Schapira, G., Thaiss, C. A., Maza, O., … & Kuperman, Y. (2014). Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature, 514(7521), 181-186.
8. Romo-Romo, A., Aguilar-Salinas, C. A., Brito-Córdova, G. X., Diaz, R. A. G., Valentín, D. V., & Almeda-Valdes, P. (2016). Effects of the Non-Nutritive Sweeteners on Glucose Metabolism and Appetite Regulating Hormones: Systematic Review of Observational Prospective Studies and Clinical Trials. PloS one, 11(8), e0161264.