Artificial sweeteners have often been perceived as harmless, but emerging studies prompt significant health concerns about their consumption. At home, we have been using monk fruit as a way to reduce added sugar intake, which is notoriously harmful and prevalent in packaged foods like cereals and breads. My wife frequently questions whether monk fruit and similar substitutes are beneficial for our health.

The scientific community has been slow to provide clear answers. Liz Weinandy, a registered dietitian nutritionist at Ohio State University, commented, “Research on the health implications of artificial sweeteners offers mixed results. While some studies raise concerns about their usage, others indicate no adverse effects.”

However, recent findings suggesting that monk fruit could be linked to increased mortality have caused me to reconsider the safety of artificial sweeteners. As I delved deeper into research surrounding the risks associated with popular sugar alternatives, my skepticism grew, particularly regarding their effectiveness in aiding weight loss. Nutritionists are also cautious, as Weinandy notes, “Most foods containing these sugar substitutes aren’t inherently healthy, and replacing sugar can create a misleading perception that these foods are more nutritious due to the label of ‘zero added sugar.’”

The body requires sugar to function, and consuming whole foods naturally provides sufficient sugar. As Harvard health experts advise, “Natural sugars found in fruits, vegetables, grains, and dairy are acceptable.” These sugars digest slowly, supplying the body and brain with a consistent energy source. Conversely, added sugars lead to rapid spikes in blood sugar and are linked to conditions like diabetes, obesity, and heart disease.

The average adult in the U.S. consumes about 22 teaspoons of sugar daily, significantly exceeding the recommended intake of approximately 200 calories. It seems logical that many would opt for artificial sweeteners in place of added sugars, a trend that began with saccharin’s discovery in 1879. However, the popularity of these alternatives has surged, especially with marketing claims that zero-calorie sweeteners promote weight loss and better health.

While the U.S. Food and Drug Administration generally considers these substitutes safe, an increasing body of research suggests that they may not be as benign as once thought.

Monk fruit, often marketed as a calorie-free sweetener, is actually a concentrated extract from a fruit native to Southeast Asia. Typically, it's combined with erythritol, a less sweet sugar substitute derived from fermented corn. A recent study involving 4,000 adults indicated that higher levels of erythritol in the blood were associated with an increased risk of serious cardiovascular events, including heart attacks and strokes. The study's results, published in Nature Medicine, highlight the potential risks of erythritol, although it is important to note that the findings indicate correlation, not causation.

Stanley Hazen, a co-leader in preventive cardiology at the Cleveland Clinic, stated, “Our research shows that erythritol levels can remain elevated in the bloodstream for days after consuming artificially sweetened beverages.” Dolores Woods, a nutritionist at UTHealth Houston School of Public Health, expressed alarm over these findings, particularly for individuals already at risk for heart issues, as they may unknowingly consume high amounts of erythritol due to its widespread use in processed foods.

Deborah Katz, a nutritionist at the University of Washington, criticized the study's design, arguing that it contained flaws. She pointed out that the amount of erythritol consumed by participants was not assessed and noted that the body also produces erythritol during oxidative stress, complicating interpretations of the study's findings.

Other common artificial sweeteners, such as aspartame and sucralose (commonly known as Splenda), have traditionally been viewed as safe. Similarly, sugar alcohols like erythritol, sorbitol, and xylitol are also seen as acceptable, though they can cause digestive issues in some individuals. However, three recent studies have linked artificial sweeteners to negative health outcomes, revealing associations with various health problems without establishing direct causation. For instance, aspartame has been connected to an increased cancer risk, while other sweeteners were linked to cardiovascular disease and liver health disruption.

To mimic the texture and sweetness of sugar, many artificial sweeteners contain fillers such as maltodextrin and silica. This raises concerns about their effects on the gut microbiome, potentially leading to inflammation and conditions like inflammatory bowel disease (IBD) in susceptible individuals. Woods noted, “Many ultra-processed foods containing artificial sweeteners can be detrimental to gut health,” while stressing that further research is needed to establish definitive links.

Much of the existing research has been conducted on animals, complicating the translation of findings to human health. Katz remarked that studies administering excessive doses of non-nutritive sweeteners to rodents cannot be reliably applied to human consumption.

For individuals with diabetes, artificial sweeteners have long been regarded as advantageous alternatives. However, the Mayo Clinic cautions that sugar alcohols, which include mannitol, sorbitol, and xylitol, could raise blood sugar levels. Even widely accepted sweeteners like sucralose, acesulfame, aspartame, and saccharin have been linked to alterations in glucose metabolism and insulin response.

Weinandy noted, “This raises questions about the role of these non-nutritive sweeteners in diabetes.” However, she emphasized that correlation does not equal causation. Katz added that while non-nutritive sweeteners can be useful for diabetics seeking a calorie-free beverage, personalized advice from diabetes educators is essential.

One often-overlooked risk associated with sugar alternatives is their potential to lead to increased overall calorie consumption. Studies have shown that individuals who consume diet sodas may compensate for the lack of calories by indulging in high-calorie, unhealthy foods. Researchers have not yet determined whether this behavior is a result of feeling justified in eating more due to the calorie-free nature of diet sodas or if individuals genuinely require additional calories for satisfaction.

Katz summarized the ongoing debate: “There will always be new studies analyzing the health benefits and risks of various substances. Generally, most non-nutritive sweeteners are considered safe when used in moderation, but it’s challenging to assign specific health benefits to them.”

So, what should one do in light of this confusion? Weinandy advises minimizing or eliminating both sugar substitutes and artificial sweeteners while also reducing the intake of added sugars. “This may sound daunting, but it’s about returning to whole, unprocessed foods,” she explained. Experts warn that highly processed foods now account for over half of the calories consumed in the U.S. and the U.K., urging consumers to scrutinize ingredient lists and avoid products with excessive additives.

Weinandy encourages individuals to ask themselves, “What ingredients in this food will enhance my health?” Understanding that perfection is unattainable is crucial; moderation is key. My wife and I have aimed to significantly reduce our sugar intake. While I’m not perfect, I find myself reaching for fruit like oranges or apples more often when craving something sweet. Sliced bananas have become my go-to for adding sweetness to oatmeal, and dates serve as a fantastic sugar alternative in various recipes.

Rather than striving for an unrealistic ideal, I adhere to advice from nutrition experts: Identify one unhealthy food choice to replace each day with a healthier alternative, whether it’s a slice of cantaloupe or homemade bread with olive oil. Small changes can make a significant impact without overwhelming oneself.

Related resources: - Cutting Calories Slows Aging - The Majority of Food We Eat is Surprisingly Addictive and Deadly - How to Eat: Facts and Fallacies about Healthy Food

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