Low-calorie sugar substitutes have been the source of heavy debate for years now. Many health experts point to studies that suggest the sweeteners’ negative role in cancer, diabetes, metabolic disorders and more.

However, one new systematic review is telling a different side of the story. Artificial sweeteners may not be showing the harmful health effects people often think they have.

The review was conducted by Ingrid Toews and colleagues, and its findings were published in the BMJ (1). The paper assessed 56 studies on the topic, making it the most comprehensive review of artificial sweeteners to date.

Unlike other scientific reviews, the authors of this study didn’t limit study type, says researcher Vasanti S. Malik in an editorial about the paper (2). Malik was not involved in the study.

The wide study pool provided the opportunity to involve a variety of data, including studies on children and adults.

This allowed researchers to assess the association between non-sugar substitutes and health outcomes like blood sugar levels, oral health and cardiovascular health.

What may intrigue many consumers and health professionals, though, are the study’s conclusions—or lack thereof.

Researchers found that most health outcomes weren’t statistically significant in groups who used sugar substitutes compared to those who didn’t. In adults, some small studies suggested a slight benefit on body mass index and fasting blood sugar levels, the paper states.

For children who used artificial sweeteners, researchers found a slightly higher body mass index compared with those who used sugar. However, the children’s weight proved unaffected.

In addition, researchers saw no evidence of health effects on overweight or obese adults and children who were using sugar substitutes.

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The researchers do present this information with a caveat, though. Due to limitations on study size and length, “confidence in the reported results is limited,” the paper states. The review also found few studies to assess per health outcome.

In addition, some studies may have lent themselves to a specific result based on “reverse causation,” says Malik in the editorial.

This may have happened due to dieters using sugar alternatives as a strategy for losing weight. Such a situation may skew results since people could have been using other weight loss strategies too.

Malik recommends that experts should not set aside individual, high-quality studies.

As an example, Malik points out several studies that have used a large audience size and comprehensive methods. Those studies have shown that artificial sweeteners have a positive effect on children’s weight gain, even after 1-year of follow-up.

The authors of the review call for more research to define more conclusive results. According to them, future studies should involve long-term follow-up, specific reporting and several populations and subgroups.

Indeed, the authors found no evidence to support the negative connotation of artificial sweeteners. However, “potential harms from the consumption of non-sugar sweeteners could not be excluded.”

In other words: use artificial sweeteners at your own risk.


  1. Toews, I., Lohner, S., de Gaudry, D. K., Sommer, H., & Meerpohl, J. J. (2019, January Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies. BMJ, 364, k4718. doi: https://doi.org/10.1136/bmj.k4718.

2. Malik, V. S. (2019, January 3). Non-sugar sweeteners and health. BMJ, 364, k5005. doi: https://doi.org/10.1136/bmj.k5005.