Substances like stevia, sucralose, or aspartame might increase one's risk of becoming obese over the years.
"Despite the fact that millions of individuals routinely consume artificial sweeteners, relatively few patients have been included in clinical trials of these products", Ryan Zarychanski, MD, MSc, coauthor from the University of Manitoba, said in a related press release. The data from the clinical trials did not support the anticipated benefits of artificial sweeteners for weight management, she added.
The researchers assessed 938 full-text articles, before narrowing that to conduct a systematic review of 37 studies that followed more than 400,000 people for an average of 10 years.
Lead author and assistant professor Dr Meghan Azad, added: "Caution is warranted until the long-term health effects of artificial sweeteners are fully characterised". Across the board in the studies, those who consumed more artificial sweeteners faced a "slight" increased risk of metabolic syndrome, which is a cluster of conditions from excess body fat around the waist, increased blood pressure to abnormal cholesterol. "So a reasonable assumption is, 'OK, I'll use a sugar substitute.' This says maybe don't make that immediate substitution before we have evidence".
"Evidence that sugar consumption is fueling this epidemic has stimulated the increasing popularity of nonnutritive sweeteners, including aspartame, sucralose and stevioside".
Finally, your gut microbiome - a collection of hundreds of types of bacteria - is altered by artificial sweeteners.
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Numerous clinical trials this study drew on didn't align closely with the way people consume such sweeteners in the real world - for instance, trials generally give subjects diet soda or sweetener capsules, while ignoring other sources, such as food. Yet, a relatively higher risk of weight gain and obesity, high blood pressure, diabetes, heart disease and other health issues was evident in relation with those sweeteners in long term observational studies.
Azad suggests that consumers who turn to artificial sweeteners on the assumption that they're a healthier choice should to be cautious.
"Right now, sugar is so much in the spotlight as the bad guy causing obesity, causing diabetes", Azad said. She said the studies may have neglected other things that influence weight, such as exercise or overall diet.
The experiment is meant to investigate the hypothesis that artificial sweeteners shift the gut flora in a way that predisposes us to obesity.
There's no evidence that artificial sweeteners alter the way the body processes sugar, she noted, and some research has shown that sugar substitutes do not make a person crave candies more. In 1965, only three per cent of people were drinking diet soda.
The Calorie Control Council, an association representing the low- and reduced-calorie food and beverage industry, took issue with the study's design and said that "experimental studies have not confirmed these findings", in a statement provided to TIME.