| Which artificial sweeteners are safe? It's very confusing, with seemingly conflicting data. — Debra, Upstate New York The so-called artificial sweeteners that have made their way into our diets in recent decades actually have a long history. Saccharin was invented in 1879 as a coal-tar derivative, and went on to become Monsanto's first product. Aspartame was originally developed as an ulcer drug in the 1960s, but a scientist realized it was sweet after he licked it off his finger. Sucralose, meanwhile, was accidentally discovered in the 1970s, a laboratory concoction of sugar and chlorination. But the longevity of these compounds hasn't necessarily translated into a strong understanding of their health impacts, according to Dariush Mozaffarian, the director of the Food is Medicine Institute at the Friedman School at Tufts University.
"All these additives are allowed for use in foods by the FDA, but unfortunately without much long-term science supporting their safety," Mozaffarian says. "While for many years scientists assumed these additives were safe, more recent research has made this less certain."
For example, aspartame is linked to higher cancer risk. In July, the World Health Organization labeled it a possible carcinogen. In one 2022 study that Mozaffarian points to, 120 healthy adults were given saccharin, sucralose, aspartame or stevia packets for two weeks, while other trial participants either received nothing, or packets of sugar. All of the artificial sweeteners significantly altered the mouth and gut microbiome composition and function of participants. Those communities of microorganisms in the body play a role in our health. Two compounds — saccharin and sucralose — also significantly worsened blood glucose responses. "In cell studies, metabolites of sucralose also cause DNA damage and gut inflammation," says Mozaffarian. Newer sugar alternatives like stevia and erythritol, he says, have been discovered from natural sources (leaves and fruits, respectively). However, like with other artificial sweeteners, there's no conclusive evidence that proves they're safe. To understand the risks for all sugar alternatives, better, long-term studies are needed. Current research does "make one thing clear: These compounds are not inert – they have effects in our bodies, and could even cause harm," Mozaffarian says.
But if you are going to consume large amounts of sugar, particularly in sweet drinks like soda, artificially sweetened diet versions may be the "lesser of two evils." There's strong evidence that drinking large amounts of sugar is bad for your health, according to Mozaffarian.
"There could still be some harms from the artificial sweeteners, but not compared to the harms of all that sugar," he says.
If a Coke or a cookie are an occasional treat, you shouldn't sweat sticking with the real stuff.
"In that case, personally I'd stick with the natural stuff – but that's my best guess as a doctor and scientist, not something clearly shown by evidence," Mozaffarian says. — Kristen V. Brown | 
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