Artificial Sweeteners
Artificial sweeteners are synthetic sugar substitutes. They mimic the sweetness of sugar while providing fewer calories. Caution should be used in deciding if artificial sweeteners are a better alternative for children than natural sugars.
Quick Facts
What are Artificial Sweeteners?
Artificial sweeteners are synthetic sugar substitutes. They mimic the sweetness of sugar while providing fewer calories.
They may be entirely artificial or manufactured from natural sources. For example, monk fruit and stevia are derived from plants, although they can be heavily processed.
Many artificial sweeteners are much sweeter than sugar itself. So you can use less and still achieve the desired level of sweetness.
It was thought that artificial sweeteners passed through the body undigested but new research is finding that they may in fact be broken down and metabolized. [6]
What are Sugar Alcohols?
Sugar alcohols are not considered artificial sweeteners. They are a type of sugar substitute and are generally recognized as safe (GRAS). This means that they do not have or require FDA approval because experts have agreed that these products are safe to consume.
Sugar alcohols are naturally occurring, although they can be man-made and often are when used in processed foods.
Sugar alcohols include mannitol, sorbitol, xylitol, lactitol, isomalt, maltitol, hydrogenated starch hydroxylates (HSH), and erythritol.
Sugar alcohols are typically less sweet than sugar and contain about half the calories, so they are considered low-calorie sweeteners. Sugar alcohols do affect blood sugar levels, though they may cause bloating and diarrhea when eaten in excess.
Caution with Artificial Sweeteners
Humans have evolved to enjoy the taste of sugar because sugar provides calories/energy for our bodies and those calories allow us to survive. The incoming nutrition from sugar excites certain parts of our brains and results in the release of feel-good chemicals. The more we eat sweet things, the more we will crave them. Artificial sweeteners have a sweet taste but don’t provide the calories/energy that our bodies have learned to associate with them. Because of this, artificial sweeteners may trick our brains, making us think that calories and nutrition are coming, when in fact they are not. This may cause us to overeat in an attempt to make up those calories, to feel satisfied, or it may cause us to crave even more sweetness later on. [10-11]
Artificial sweeteners have been found to change the composition of the gut microbiota. The microbiome is integral to human health and involved in metabolism, immunity, and gastrointestinal health. More research is needed to fully understand the extent to which human health may be impacted due to alterations in the microbiome from artificial sweeteners. [2, 7, 9, 12]
Foods Containing Artificial Sweeteners
Typically if a product is labeled sugar-free but still tastes sweet, it will contain an artificial sweetener. Some foods include:
Soda and soft drinks, especially diet options
Powdered drink mixes
Sugar-free candy
Baking mixes
Pudding and jello
Ice cream
Toothpaste, mouthwash, and chewing gum often contains sugar alcohols
Common artificial sweeteners
The best way to determine if a food contains an artificial sweetener is to look on the ingredients list. The following are names of common, FDA approved, artificial sweeteners [1] :
Acesulfame K (aka Sunett or Sweet One)
Advantame
Aspartame (aka Equal or Nutrasweet)
Neotame (aka Newtame)
Saccharin (aka Sweet ‘N Low or Sweet Twin)
Sucralose (aka Splenda)
The following artificial sweeteners are labeled GRAS or “generally recognized as safe”.
Stevia (aka Pure Via or Truvia)
Monk fruit extract (aka Monkfruit in the Raw or PureLo)
Artificial Sweetener alternatives
Stevia or Monk Fruit (see example)
Dates (sugar or syrup)
See the “Sweeteners” note for more information.
Chemical reactions
The body can respond to foods and/or chemicals in many different ways including allergies and sensitivities. If you suspect a chemical reaction, you can either choose to avoid the chemical or additional testing.
Artificial Sweeteners & Autism in the Research
The research on artificial sweeteners as they relate specifically to autism is lacking. However, there is an abundance of research that can help you make an informed decision for your child with autism.
Artificial sweeteners and children
It has been suggested that the dissociation of the sensation of sweet taste from caloric intake may promote appetite, leading to greater food consumption and weight gain. [10]
Consumption of an artificial sweetener in conjunction with a sugar-containing food or drink could lead to more rapid sugar absorption and insulin secretion, potentially affecting weight, appetite, and blood sugar. [10]
Increased consumption of added caloric sweeteners has been associated with lower diet quality in children, perhaps by altering taste preferences toward sweetened foods, this mechanism could apply to artificial sweeteners as well. [7, 10]
Data supports an association between artificially-sweetened beverage consumption and weight gain in children. [5, 8]
Artificial sweeteners can interfere with basic learning processes regarding the normal consequences of consuming sugars, leading to overeating, diminished release of hormones, and altered gut microbiota which can impair blood glucose regulation. [7]
Artificial sweeteners and metabolic syndrome
Non-caloric artificial sweeteners (NAS) alter microbial metabolic pathways and are linked to susceptibility to metabolic disease, and demonstrate similar NAS-induced dysbiosis and glucose intolerance in healthy human subjects. [9]
Data in animals and humans suggest that artificial sweeteners change the host microbiome, lead to decreased satiety, and alter glucose homeostasis, and are associated with increased caloric consumption, metabolic syndrome, weight gain, and the obesity epidemic. [2]
Consumption of artificial sweeteners might actually contribute to the development of metabolic derangements that lead to obesity, T2D, and cardiovascular disease. [7, 8, 12]
Aspartame
Recent studies show that consumption of aspartame may cause obesity, metabolic syndrome, and alteration in gut microbiota. In animal studies, long-term consumption of aspartame has led to increased free radicals in renal tissues as well as kidney injury. [3]
Aspartame is broken down into phenylalanine (50%), aspartic acid (40%), and methanol (10%) during metabolism in the body. The excess of phenylalanine blocks the transport of important amino acids to the brain contributing to reduced levels of dopamine and serotonin. Aspartic acid at high concentrations is a toxin that causes hyperexcitability of neurons and is also a precursor of excitatory glutamates. Their excess in quantity and lack of astrocytic uptake induces excitotoxicity and leads to the degeneration of astrocytes and neurons. [6]
Studies show that a metabolite of aspartame - diketopiperazine - contributes to the formation of tumors in the CNS. [6]
Acesulfame-K
Ace-K consumption was found to perturb the gut microbiome of mice after a 4-week treatment and increased weight gain of male but not female mice. [4]
References
[1] Familydoctor.org. 2020. Sugar Substitutes. [online] Available at: <https://familydoctor.org/sugar-substitutes/> [Accessed 17 April 2021].
[2] Pearlman M, Obert J, Casey L. The Association Between Artificial Sweeteners and Obesity. Curr Gastroenterol Rep. 2017;19(12):64.
[3] Ardalan MR, Tabibi H, Ebrahimzadeh Attari V, Malek Mahdavi A. Nephrotoxic Effect of Aspartame as an Artificial Sweetener: a Brief Review. Iran J Kidney Dis. 2017;11(5):339-43.
[4] Bian X, Chi L, Gao B, Tu P, Ru H, Lu K. The artificial sweetener acesulfame potassium affects the gut microbiome and body weight gain in CD-1 mice. PLoS One. 2017;12(6):e0178426.
[5] Brown RJ, de Banate MA, Rother KI. Artificial sweeteners: a systematic review of metabolic effects in youth. Int J Pediatr Obes. 2010;5(4):305-12.
[6] Rycerz K, Jaworska-Adamu JE. Effects of aspartame metabolites on astrocytes and neurons. Folia Neuropathol. 2013;51(1):10-7.
[7] Swithers SE. Artificial sweeteners are not the answer to childhood obesity. Appetite. 2015;93:85-90.
[8] Young J, Conway EM, Rother KI, Sylvetsky AC. Low-calorie sweetener use, weight, and metabolic health among children: A mini-review. Pediatr Obes. 2019;14(8):e12521
[9] Suez J, Korem T, Zeevi D, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514(7521):181-6.
[10] Brown RJ, de Banate MA, Rother KI. Artificial sweeteners: a systematic review of metabolic effects in youth. Int J Pediatr Obes. 2010;5(4):305-12.
[11] Frontiers for young minds. 2019.Trick or Treat? How Artificial Sweeteners Affect the Brain and Body. [online] Available at: <https://kids.frontiersin.org/article/10.3389/frym.2019.00051#ref1> [Accessed 20 April 2021].
[12] Ruiz-Ojeda FJ, Plaza-Díaz J, Sáez-Lara MJ, Gil A. Effects of Sweeteners on the Gut Microbiota: A Review of Experimental Studies and Clinical Trials. Adv Nutr. 2019;10(suppl_1):S31-S48.
Authors
Brittyn Coleman, MS, RDN/LD, CLT
