Artificial Sweeteners May Pose Same Risks to Heart Health as Sugar, Study Shows

Drinking soda

Key Takeaways

  • Beverages sweetened with non-sugar alternatives may have just as much cardiovascular disease risk as sugary drinks, a recent study suggests. 
  • Previous research has linked sweetened beverages to negative impacts on cardio-metabolic health.
  • More research needs to be done to study long-term effects, but some studies have pinpointed other negative health effects of artificial sweeteners.

Beverages that contain artificial sweeteners may have just as much of a negative impact on cardiovascular and metabolic health as drinks that rely on sugar-based sweeteners, according to a research letter in the Journal of the American College of Cardiology.

Also called non-nutritive sweeteners, these include sugar substitutes like aspartame, saccharin, sucralose, and rebaudioside-A, and have often been touted as a "healthier" alternative to sugars like high fructose corn syrup or cane sugar, according to study lead author Eloi Chazelas, PhD(c), member of the Nutritional Epidemiology Research Team at Sorbonne Paris Nord University.

"Our study suggests they may not be as healthy as people think, since the heart health issues may be similar to sugary drinks," he says. Although more research needs to be done, add Chazelas, the potential link between artificial sweeteners and cardiovascular risk should be noted by those who may have switched to these alternatives for health reasons.

What the Study Found

Researchers looked at findings from the French NutriNet-Santé study, which has collected data from over 170,000 participants since 2009 in order to investigate relationships between nutritional choices and health outcomes.

Surveying about 104,000 of those participants, Chazelas and his team collected three dietary records over 18 months, including beverages and frequency of consumption. Researchers also looked at cases of cardiovascular events in this participant pool from 2009 to 2019. Those included:

  • Stroke
  • Transient ischemic attack
  • Myocardial infarction
  • Acute coronary syndrome
  • Need for angioplasty

They found that participants with frequent consumption of either sugary drinks or of artificially sweetened beverages had a higher risk of experiencing a cardiovascular event compared to participants who did not consume sweetened drinks.

The Physiological Mechanism is Unclear

Previous research that has linked sugary drinks to cardiovascular effects—such as one in JAMA that found a significantly higher risk of dying of heart disease with high sugar consumption—hasn't pinpointed specific reasons for why this might be.

Eloy Chazelas, PhD

Evidence is not yet clear about how these artificially sweetened beverages affect cardiometabolic processes. It may come as a result of factors like altered gut microbiota, increased belly fat, or impaired glucose regulation.

— Eloy Chazelas, PhD

Theories include sugar's tendency to raise blood pressure, increase chronic inflammation, and increase fat in the liver, which are all heart disease risks.

In terms of why non-nutritive sweeteners would increase disease prevalence, that's another area that needs more study, Chazelas says.

"Evidence is not yet clear about how these artificially sweetened beverages affect cardiometabolic processes," he notes. "It may come as a result of factors like altered gut microbiota, increased belly fat, or impaired glucose regulation."

All three of those potential mechanisms have been linked to negative outcomes for cardiovascular and metabolic health. For example, increased fat around the belly is a predictor for heart failure and other cardiovascular events, regardless of overall body mass index, according to a study in the European Journal of Heart Failure.

More People Are Choosing Artificial Options

The findings of this recent study come at a time when sugar substitute consumption is on an upward trajectory.

A study published in the Journal of the Academy of Nutrition and Dietetics about purchasing trends from 2002 to 2018 in U.S. households, found a decrease in sugar consumption, but a boost in non-nutritive sweeteners. In that research, the largest change was in rebaudioside-A, also known as stevia, which went from 0.1 percent to 26 percent.

But given how relatively new these sweeteners are, it's unknown what type of effect these additives have over time, according to dietitian Melissa Hooper, RD

"We know some sugar alcohols such as sorbitol and xylitol can cause diarrhea and bloating," Hooper says. Stevia, derived from a plant in the same family as ragweed, can cause some allergic reactions for those with sensitivity or allergies to those plants, she adds.

One research review listed potential adverse reactions as:

  • Headaches
  • Depression
  • Behavioral and cognitive effects
  • Risk of preterm delivery
  • Cardiovascular effects
  • Risk of chronic kidney disease

However, those researchers concluded that, overall, the evidence is inconsistent and there are "numerous gaps in the evidence base."

What This Means for You

The takeaway here, says Hooper, may be that tried-and-true mantra of nutrition: everything in moderation. After all, in the recent study, it was frequent consumption of sweetened beverages that raised risk, and those in low-consumption groups didn't see those dangers.

5 Sources
Verywell Fit uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Chazelas E, Debras C, Srour B, et al. Sugary drinks, artificially-sweetened beverages, and cardiovascular disease in the NutriNet-Santé CohortJ Am Coll Cardiol. 2020;76(18):2175-2177. doi:10.1016/j.jacc.2020.08.075

  2. Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added sugar intake and cardiovascular diseases mortality among US adultsJAMA Intern Med. 2014;174(4):516-524. doi:10.1001/jamainternmed.2013.13563

  3. Russo C, Sera F, Jin Z, et al. Abdominal adiposity, general obesity, and subclinical systolic dysfunction in the elderly: A population-based cohort studyEur J Heart Fail. 2016;18(5):537-544. doi:10.1002/ejhf.521

  4. Dunford EK, Miles DR, Ng SW, Popkin B. Types and amounts of nonnutritive sweeteners purchased by US households: A comparison of 2002 and 2018 Nielsen Homescan PurchasesJ Acad Nutr Diet. 2020;120(10):1662-1671.e10. doi:10.1016/j.jand.2020.04.022

  5. Lohner S, Toews I, Meerpohl JJ. Health outcomes of non-nutritive sweeteners: analysis of the research landscapeNutr J. 2017;16(1):55. Published 2017 Sep 8. doi:10.1186/s12937-017-0278-x

By Elizabeth Millard, CPT, RYT
Elizabeth Millard is a freelance journalist specializing in health, wellness, fitness, and nutrition.