It has become clear in recent decades that sugar offers little nutritional value other than to provide calories. Further, the medical community and consumers alike have recognized that diets that are high in sugar can lead to a variety of health deficits, ranging from metabolic disorders like diabetes to cognitive difficulties.1–3


As a result, the healthcare community has made a push to minimize sugar intake, and in response, the food industry has turned to artificial sweeteners. The rationale of those in the food industry has been that through these sugar alternatives, people can satisfy their cravings while avoiding the calories contained in sugary foods and drinks and the negative health consequences of high-sugar diets.



Do artificial sweeteners pose unique health risks?  


Unfortunately for the food industry and sugar lovers, the data have never made clear how healthy artificial sweeteners are, and healthcare professionals have had to struggle with whether to suggest artificial sweeteners as a way to avoid the sugary foods that many patients regularly consume. Initial concerns that artificial sweeteners may increase consumers’ risk of developing cancer have seemed to be largely put to rest after several research studies failed to identify any association between artificial sweetener intake and cancer incidence.4,5 Though the cancer debate may have died down, questions remain about the safety of artificial sweeteners and how healthcare providers should discuss their use with patients.



Do artificial sweeteners pose the same health risks as sugar?


Of particular concern is whether artificial sweeteners provide any real benefit when compared to natural sugar. A new study, published in the Journal of the American College of Cardiology, has shown that artificially sweetened beverages appear to have similar effects on heart health as beverages containing sugar.6  Specifically, an analysis of over 104,000 people from the French NutriNet-Sante cohort showed that, like those who drink sugary drinks, those who drink artificially sweetened drinks are at a higher risk for heart attack, acute coronary syndrome, angioplasty, incident stroke, and transient ischemic attack than those who do not consumer drinks containing natural or artificial sweeteners.

The participants in this new study were on average 43 years old. Their heart health was regularly monitored over the course of a decade, and they frequently provided information regarding their physical activity and diets. According to the authors of this study, the findings call into question whether products that contain artificial sweeteners should be marketed as healthy alternatives to sugar-filled products.



There is a lot of interest among consumers in the implications of eating and drinking artificial sweeteners, and people in the healthcare industry are positioned to help educate the public about the realities of these sweeteners. Are the promises of artificially sweetened foods and drinks too good to be true? While these sweeteners may not cause new health problems and may provide the potential to avoid calories, they may not be able to help consumers circumvent the health challenges related to sugar intake. Healthcare providers and counselors should continue to pay attention to emerging data to ensure that they have an up-to-date understanding of what is known about the impact of artificial sweeteners and can guide their patients to make healthy diet-related decisions based on the latest and best evidence.




  1.         Howard B v., Wylie-Rosett J. Sugar and cardiovascular disease: A statement for healthcare professionals from the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation. 2002;106(4):523-527. doi:10.1161/01.CIR.0000019552.77778.04
  2.         Johnson RJ, Sánchez-Lozada LG, Andrews P, Lanaspa MA. Perspective: A historical and scientific perspective of sugar and its relation with obesity and diabetes. Advances in Nutrition. 2017;8(3):412-422. doi:10.3945/an.116.014654
  3.         Yeomans MR. Adverse effects of consuming high fat–sugar diets on cognition: implications for understanding obesity. Proceedings of the Nutrition Society. 2017;76(4):1-11. doi:10.1017/S0029665117000805
  4.         Gallus S, Scotti L, Negri E, et al. Artificial sweeteners and cancer risk in a network of case-control studies. Annals of Oncology. 2007;18(1):40-44. doi:10.1093/annonc/mdl346
  5.         Weihrauch MR, Diehl V. Artificial sweeteners – Do they bear a carcinogenic risk? Annals of Oncology. 2004;15(10):1460-1465. doi:10.1093/annonc/mdh256
  6.         Chazelas E, Debras C, Srour B, et al. Sugary Drinks, Artificially-Sweetened Beverages, and Cardiovascular Disease in the NutriNet-Santé Cohort. Journal of the American College of Cardiology. 2020;76(18):2175-2177. doi:10.1016/j.jacc.2020.08.075