She explains that when we’re about to eat, the body gets ready for food by increasing saliva and stomach acid. It may also release a small amount of insulin even before food hits the stomach. This is called the cephalic phase insulin response (CPIR). “It’s believed this may drop blood sugar, which can then increase hunger. There is some evidence that artificial sweeteners can stimulate CPIR as much as sugar. However, this response is still not completely understood in humans,” Kulp says.
The lack of human studies is important to note. In general, there are way more human scientific studies on the effects of sugar than there are on artificial sweeteners’ impact on humans. Michael Schopis, MD, of Manhattan Gastroenterology, says that most studies on artificial sweeteners have been done on animals, not humans, which is important to keep in mind when considering any claims about how artificial sweeteners impact health.
How to Decide: Sugar or Artificial Sweetener?
With all this in mind (and based on the scientific evidence we do have), are artificial sweeteners any healthier than sugar? According to all three experts, the jury is still out on that. But they suggest some guidelines that can be used to help you make the healthiest choice possible.
1. Know your health goals
Dr. Nahar emphasizes that deciding between sugar and a “sugar-free” version that’s artificially sweetened depends on your individual health goals. If you’re pre-diabetic or trying to lose weight, sugar-free is probably the best way to go because that option will be lower in calories and have less metabolic impact than sugar. “If someone craves something sweet, a sugar substitute like stevia or erythritol is likely a better choice due to their lower impact on blood sugar and the gut microbiome,” Dr. Nahar says.
Kulp agrees, saying, “Whether or not artificial sweeteners are a better choice than sugar depends on the person using them. If someone needs to reduce their sugar intake, like in diabetes, then using some artificial sweeteners may be a good choice. For those who just use a small amount of sweeteners in their diet and don’t have to worry about their blood sugar, then real sugar may be the best choice.”
If you’re experiencing any gut issues on a regular basis, Dr. Nahar says that some artificial sweeteners could make your G.I. symptoms worse. This is especially the case, she says, if you’re consuming a high amount of an artificial sweetener every single day—like having a large diet soda with your lunch or a smoothie made with protein powder that uses an artificial sweetener for flavoring. Over time, this could make your gut imbalance even greater. Then again, consuming lots of sugar likely will, too. “The individual response to both sugar and artificial sweeteners can vary greatly, so it’s essential to monitor personal tolerance and reactions,” Dr. Nahar says.
2. Consider natural substitutes
While all artificial sweeteners are sugar substitutes, there are sugar substitutes that aren’t artificial sweeteners; these are called “natural substitutes” because they are derived from nature. This includes monk fruit, honey, agave, coconut sugar, allulose, and xylitol. Of these, Dr. Nahar says that monk fruit seems to be a gut-friendly choice, though (again) more research needs to be done.
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