Touro University California, Joint Master of Physician Assistant Studies and Master of Public Health Program, Vallejo (Dr. Dugan); San Joaquin General Hospital, French Camp, Calif (Dr. Chiu); Touro University California, College of Osteopathic Medicine, Vallejo (Drs. Shubrook and Young) Clipper.young@tu.edu
The authors reported no potential conflict of interest relevant to this article.
The 2015 US Scientific Reports on Dietary Guidelines provided a consensus statement saying, “Future experimental studies should examine the relationship between artificially sweetened soft drinks and biomarkers of insulin resistance and other diabetes markers.”42
DO NNSs HAVE ANY ADVERSE HEALTH EFFECTS?
Maybe.Many individuals avoid NNSs due to fear of developing cancer. While rat studies have previously shown a dose-dependent increased risk of developing cancer, epidemiologic studies in humans have not confirmed an association.43 The National Cancer Institute reports that carcinogenicity studies of NNSs have not shown an association with cancer in humans.44
A prospective study—the Nurses’ Health Study, which followed over 88,000 women for 24 years—found that consumption of > 2 diet sodas per day was associated with an increased risk for coronary heart disease (CHD) and chronic kidney disease (CKD) compared with consumption of < 1 diet soda per month.45 However, other prospective studies have shown that these specific negative health effects may not be present when controlling for weight.45,46
While the prospective studies found some associations between medical conditions (eg, CHD and CKD) and NNS consumption, the literature is limited to intake from beverages and does not include NNS-containing foods. More studies are needed to determine the relationship between NNSs and potential adverse health events, since the current literature is observational and cannot predict causation.
Patients at risk for, or who have been diagnosed with, type 2 diabetes mellitus can include non-nutritive sweeteners in their diet without fear of disturbing their glycemic levels.
A 2019 study explored the associations between long-term consumption of sugar-sweetened beverages and artificially sweetened beverages (ASBs) and the risk of mortality in the United States.47 This study included 37,716 men from the Health Professionals Follow-up Study and 80,647 women from the Nurses’ Health Study. Subjects who had the highest consumption of ASBs had higher risks for total and cardiovascular disease mortality.47 Cohort-specific analyses showed that an association between ASB consumption and mortality was observed in the participants from the Nurses’ Health Study but not in those from the Health Professionals Follow-up Study, warranting further investigation.47 Cancer mortality and ASB consumption were not shown to have an association in this study.
