Artificial Sweeteners Tied to Increased Cardiovascular Disease Risk, Scientists Say

Many of us strive to curb our sugar intake, or even to quit eating sugar entirely. Often, that means turning to artificial sweeteners to handle those sugar cravings—but while those alternatives might seem better for your health, new research reveals that those popular artificial sweeteners are associated with a range of poor health outcomes.

That’s the main takeaway from a recent meta-analysis published in Current Atherosclerosis Reports. For the study, researchers analyzed data from 21 randomized controlled trials and 27 trial comparisons with adult participants to assess the impact of non-nutritive artificial sweeteners on cardiometabolic health. After crunching the numbers, the researchers found associations between artificial sweetener intake and both a short-term negative effect on blood sugar and a higher long-term risk of cardiometabolic diseases. The researchers also identified a potential link between artificial sweeteners’ impact on the gut microbiome and other adverse health outcomes.

So, what does this mean for you? Should you think twice before adding that sweetener packet to your next cup of coffee? Below, experts break it down.

Meet the experts: Keri Gans, M.S., R.D.N., C.D.N., nutrition consultant and author of The Small Change Diet; Cheng-Han Chen, M.D., board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center.

Why are the findings significant?

The idea that artificial sweeteners may have broader health effects isn’t a new one, according to Keri Gans, M.S., R.D.N., C.D.N., nutrition consultant and author of The Small Change Diet. “These findings are significant because they contribute to the ongoing discussion about whether non-nutritive sweeteners may have effects beyond simply reducing sugar and calories,” she explains. “However, the overall evidence remains mixed, and this review does not prove that non-nutritive sweeteners cause cardiometabolic disease.”

That’s in part because the meta-analysis primarily focuses on observational data, making it difficult to establish a true cause-and-effect relationship. Still, the association is worth noting. “Heart disease and metabolic conditions like diabetes remain some of the leading causes of illness and death worldwide,” says Cheng-Han Chen, M.D., a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, California. “That’s why it’s so important to keep identifying and managing risk factors,” such as diet and lifestyle, he adds.

While this study’s findings are consistent with previous research, it does point in an intriguing direction. “One particularly interesting possibility [the study poses] is that these effects may be tied to changes in the gut microbiome, which plays a growing role in how we understand overall health,” Dr. Chen says.

What does this mean for you?

“We already know that excess added sugar is harmful to heart health,” Dr. Chen says. But protecting your health may not be as easy as swapping real sugar for a non-nutritive artificial sweetener. Instead, Dr. Chen suggests opting for “more natural, plant-based options like stevia or monk fruit, and focusing on an overall balanced, whole-food diet.”

That doesn’t mean you have to cut sugar—or artificial sweeteners—overnight. In fact, Gans cautions against that. “Based on this review, there is no need to avoid non-nutritive sweeteners entirely. They may be a useful tool for some people, especially when replacing large amounts of added sugar,” she explains. “As with most foods and ingredients, moderation and the overall eating pattern matter more than occasional use.”

If you’re someone who relies on added sugar or sweeteners to enjoy the taste of certain foods or beverages, Gans recommends starting with small, gradual modifications. “People can gradually reduce how sweet they prefer foods and beverages to taste, or use fruit, cinnamon, vanilla, or a small amount of sugar, honey, or maple syrup,” she suggests. “Non-nutritive sweeteners can also remain an option. Sugar and sweetener intake is only one part of health, and factors such as overall diet quality, physical activity, sleep, and genetics also play important roles.”

The bottom line

The findings from this study add to the growing body of research linking artificial sweeteners to negative health outcomes, but the data is by no means definitive. “My main takeaway is that the relationship among non-nutritive sweeteners, the gut microbiome, and cardiometabolic health is complex and still evolving,” Gans says. “Some studies suggest effects on blood sugar regulation or gut bacteria, while others report neutral or potentially beneficial effects, particularly when these sweeteners replace added sugar.”

Both Gans and Dr. Chen reiterate that a true cause-and-effect relationship can’t be established from the observational data in the study, especially given that other factors may be at play. “We don’t know if artificial sweeteners directly increased [health] risk, or if people who consume them shared other underlying factors that contribute to cardiometabolic disease,” Dr. Chen points out. “People at higher risk for diabetes or heart disease may also be more likely to choose products containing non-nutritive sweeteners,” Gans adds. She also cautions against lumping all non-nutritive sweeteners into a single group, as different sweeteners may affect the body in different ways.

Ultimately, Dr. Chen says the results are worth paying attention to, but should be taken with a grain of salt (or sugar). “Diet is a major driver of heart health, but it’s still too early to make firm recommendations about artificial sweeteners based on this study alone,” he says. “More research is needed before drawing definitive conclusions.”