27/01/2023
The negative impact of consuming sugar-sweetened beverages on weight and other health outcomes has been increasingly recognized; therefore, many people have turned to high-intensity sweeteners like aspartame, sucralose, and saccharin as a way to reduce the risk of these consequences. However, accumulating evidence suggests that frequent consumers of these sugar substitutes may also be at increased risk of excessive weight gain, metabolic syndrome, type 2 diabetes, and cardiovascular disease. This paper discusses these findings and considers the hypothesis that consuming sweet-tasting but noncaloric or reduced-calorie food and beverages interferes with learned responses that normally contribute to glucose and energy homeostasis. Because of this interference, frequent consumption of high-intensity sweeteners may have the counterintuitive effect of inducing metabolic derangements.
Consumption of sugar-sweetened beverages (SSB; see Glossary) has been increasingly associated with negative health outcomes such as being overweight, obesity, type 2 diabetes (T2D), and metabolic syndrome, for reviews, see [1–5]. Based largely on these associations, many researchers and healthcare practitioners have proposed that non-caloric, high-intensity sweeteners provide a beneficial alternative in foods and beverages [6–10]. There is no doubt that replacing caloric with noncaloric sweeteners reduces the energy density of foods and beverages. However, whether reducing energy density in this manner always translates into reduced energy intake, lower body weight, and improved metabolic health is much less certain. Recent reviews of studies spanning at least the past 40 years have concluded that high-intensity sweeteners are potentially helpful [11], harmful [12], or have as yet unclear effects [9,13–15] with regard to regulation of energy balance or other metabolic consequences. One purpose of this opinion paper is to summarize and evaluate recent research that is consistent with the rather counterintuitive claim that consuming high-intensity sweeteners may promote excess energy intake, increased body weight, and other related co-morbidities.