The Truth About Sugar Substitutes: Are Stevia, Sucralose, and Saccharin Safe?

Do you read food labels? Do you use products marketed as low in sugar or made with a sugar substitute? Do you trust they are the best choice for your health? Food labels provide a wealth of information – the brand name, images, and graphics to inform and entice consumers. They list protein, carbohydrates, fat, cholesterol, added sugar, sodium content, and more. But how much do you know about sugar substitutes in your favorite foods? Read on to learn more about these popular alternatives and the concerns that surround them.

Non-Nutritional Sweeteners

Non-nutritional sweeteners (NNS), also known as sugar substitutes, are synthetically produced or natural, non-caloric sweeteners. They mimic the sweetness of sugar but have zero or negligible calories or carbohydrates, with a much higher sweetness intensity.

Types of NNS

This article focuses on artificial and natural non-nutritive sweeteners. Saccharin, the first non-nutritive sweetener, was developed in 1878 and introduced to the food market in the 1950s. From the 1980s onward, additional sugar substitutes were developed.

Artificial NNS include saccharin (Sweet n’ Low®), aspartame (Equal®), sucralose (Splenda®), Advantame®, Ace-K/Acesulfame Potassium, and Neotame.

Natural NNS include steviol glycosides (Stevia), monk fruit (Luo Han Guo), and thaumatin, which have entered the food industry in the last two decades. The emergence of artificial and natural NNS in food manufacturing correlates largely with the global obesity epidemic.

Sources of NNS

These popular sugar substitutes are found in many packaged foods, including ice creams, frozen desserts, chocolates, yogurt, other dairy products, jams, jellies, gelatin, salad dressings, breakfast cereal, baked goods, canned foods, sugar-free cocoa mix, chewing gum, candy, soft drinks and other beverages, and more. If a processed food or beverage labels says sugar-free, it likely contains a non-nutritive sweetener.

Sweetness Intensity

If you’ve ever used Stevia or other sugar substitute, you know it takes only a tiny amount to sweeten something compared to table sugar or natural sucrose. NNS sweetness intensity is extraordinarily high.

Sweetener Relevant Sweetness

Advantame 20,000x

Acesulfame-K 200x

Aspartame 200x

Luo Han Guo 100-250x

Neotame 7000-13,000x

Saccharin 200-700x

Sucralose 600x

Stevia/Steviol Glycosides 200-400x

Thaumatin 2000-3000x

Table Sugar/Sucrose 1

Effects of NNS

While the use of a sugar substitute may reduce total sugar consumption, many question the long-term effects of NNS use, especially artificial substitutes. Here are some updated findings.

Concerning Effects of Long-Term NNS: Metabolic

A 2024 comprehensive review found that consumption of artificial NNSs, mainly in diet sodas, are associated with an increased risk of obesity, metabolic syndrome, prediabetes and type 2 diabetes. Other studies have shown impaired glucose tolerance, increased body weight and calorie intake.

Gut Health Changes

A significant amount of research has focused on NNS and their effects on gut microbiome. Artificial sweeteners, in particular, have been shown to alter the gut microbiome, which can lead to glucose intolerance. This effect of altered gut flora and ratios may increase the risk for developing obesity. Findings show that chronic NNS use  reduces beneficial bacteria such as Lactobacillus and Akkermansia muciniphilia. Other issues include increased flatulence and a laxative effect.

Additional findings show increased biofilms formation in the gut, antibiotic resistance, and gut microbiome dysbiosis. Furthermore, increased ROS free radical production and increased intestinal permeability occur with aspartame and sucralose.

Sweetness Recognition and Satiety Dysregulated

Research shows that sugar substitutes may disrupt  taste and sweetness recognition mechanisms in the hypothalamus, tongue, and in the small intestine, especially when combined with a typical high-fat diet. NNS sweetness, with no accompanying calories, can interfere with brain-gut feedback mechanisms, dampening the feeling of satiety. This dysregulation may lead to increased sugar cravings, higher appetite, and elevated fasting blood sugar levels.

Kidney and Liver Function

While research on NNS and kidney function is limited, concerns exist. NNS can increase the kidneys’ workload, as these compounds must be filtered out. This extra load can stress the filtering system, and cause structural and functional changes, compromising long-term health.

An 18-week study on mice showed that daily consumption of Stevia (natural) and sucralose (artificial) led to increased liver and kidney function enzyme levels, elevated pro-inflammatory cytokines, and decreased anti-inflammatory cytokines. Biopsy results showed severe damage in liver and kidney tissues. Aspartame and saccharin have also shown toxicity to the liver, causing injury. Chronic use of artificial NNS may also lead to NAFLD or fatty liver.

Other Effects of Synthetic NNS

High use of artificial NNS compounds is linked to increased overall mortality, heart disease, and cancer. Chronic use may also lead to headaches and mood disorders.

Engage in Critical Thinking

Most research on negative effects focuses on artificial sugar substitutes. Controversy remains regarding long-term, high-frequency Stevia and other natural sugar substitute usage. Humanity has only recently begun consuming high doses of processed Stevia and monk fruit across various foods. Historical and occasional use is very different from regular high consumption. What might this mean for your body in the long term?

Research calls for more studies to weigh the benefits and risks. As science battles these questions, I encourage you to do your own critical thinking on this topic. The NNS mentioned in this article are FDA approved and are generally regarded as safe (GRAS).

My concern for you is the chronic significant use of one or more of these non-nutritive sweeteners. Whether you consume sugar substitutes several times a day, weekly, or infrequently, you must ask what is your body’s tolerance and response.

Studies show chronic NNS use, especially alongside a high fat diet, changes your gut microbiome, increases intestinal permeability, changes the brain satiety recognition mechanisms, and structurally changes the filtration structures in your kidneys and liver. These effects are concerning and worth discussion, especially with regular consumption or if you find that it affects your health.

Other factors like Roundup/glyphosate, gluten intolerance, antibiotics, and medications also stress the gut microbiome, kidneys, liver, and other systems. How many challenges can your body handle when your body is already overloaded from other things?

Some individuals may even become “addicted” to sugar substitutes because of their intense sweet taste. Are you willing to take a break or stop using sugar substitutes? If not, you must ask if this is indicative of changes to your taste and satiety receptors from the NNS?

Natural Support

As you ponder this information, I encourage you to read food and beverage labels and monitor your intake of both artificial and natural NNS products. If you are concerned about your health, consider taking a break from foods with added NNS to see how your body responds.

Care for your body by consuming whole, unprocessed foods. Reduce added sugars in ultra-processed foods. Opt for natural sugars from raw honey, pure maple syrup, coconut, non-GMO beet sugar, or other raw sugar forms, as well as fresh or frozen fruits and vegetables. These sources provide sweetness along with nutritional benefits and without hijacking your sweet taste receptors.

Sugar Busting Nutrients and Gut Lining Support

For sugar cravings, add sugar craving busting herbs Inula racemosa, Gymnema sylvestre, chromium and glutamine to help stem that urge. Aim for optimal protein intake, complex carbohydrates and quality fats from seeds, nuts, oils, and saturated fats to help you maintain blood sugar stability and support satiety. Additional support with Berberine Ultra, a natural GLP-1 inhibitor/satiety/blood sugar support, and Tributyrin Plus for post-biotic and intestinal lining repair can help as well.

History is filled with examples of products once considered safe but later found to cause adverse risks and changes to one’s health. Asbestos, nicotine and tobacco products, vaping, thalidomide, Round-up and glyphosates, baby powder, aspirin and NSAIDs, and so on have all led to health challenges for billions of people around the globe over the last several decades. What will science say about the chronic, high intake of NNS in another 10-50 years?

Additional resources:

Stevia – The Dark Side of This Natural Sweetener

This is Your Brain on Pop

Your Sweet Tooth Adversely Impacts Gut and Brain Health