Artificial sweeteners linked to long-term weight gain, higher body-mass index and risk of heart disease, but we don't know why

Epicurious.com

Artificial sweeteners are "dodgy" when it comes to weight management, and people who use them regularly have higher risks of developing cardiovascular disease and diabetes, and bigger body-mass indexes, a height-weight ratio that indicates obesity.

So say a group of international researchers who reviewed more than 30 studies about the long-term health effects of sugar substitutes, Cleve R. Wootson Jr. reports for The Washington Post. Their research, published in The Canadian Medical Association Journal, covered more than 406,000 people who said they used artificial sweeteners.

Researcher Meghan Azad of the University of Manitoba said that while the studies show a link between artificial sweeteners and body-mass index, “We need more evidence from better-quality studies to know for sure the cause and effect, but there does seem to be at least a question about the daily consumption of these drinks."

The U.S. market for sodas decreased by 0.6 percent between 2011 and 2016, Wootston notes, but "close to half of adults and a quarter of children consume artificial sweeteners every day, according to the Journal of the Academy of Nutrition and Dietetics."

The American Diabetes Association and the American Heart Association approved the use of artificial sweeteners in 2014, but Wootson says people have become increasingly suspicious of aspartame, sucralose and steviocide, (brand names: Equal, Splenda and Stevia, respectively) because studies have linked them to increased belly fat, and "bogus but widespread rumors that they led to things much worse."

The ADA's chief scientific medical and mission officer, William Cefalu, reviewed the study at the Post's request and also concluded that more studies are needed. "He said artificial sweeteners are still a good tool for diabetics trying to reduce carbohydrates and tightly manage their blood-glucose levels. But he stressed moderation, and agreed that more studies about the long-term effects of artificial sweeteners were needed — particularly on people with diabetes," Wootson writes.

Azad said the study found “nonnutritive sweeteners significantly associated with modest long-term increases” in body weight, BMI and waist circumference, which has been linked to a greater risk of heart disease and diabetes.

But she stressed that they still don't know why these associations exists, and noted that most of the studies focused on people who were working to lose weight or had other medical conditions.

Azad offered several possibilities for the link between artificial sweeteners and increased BMI, ranging from the sweeteners causing changes in gut bacteria to the possibility that people who are gaining weight for other reasons may seek out more artificially sweetened foods.

Meanwhile, she advises "consumers to not automatically assume artificially sweetened foods are the healthier alternative," Wootson writes.