The intake of artificial sweeteners like, aspartame, sucralose and stevia have become widespread and increasing.
Seven of these studies were randomized controlled trials, considered to be the gold standard in clinical research, which included 1003 people followed for 6 months on average. Furthermore, over the long term, the observational studies indicated the sweeteners were not only associated with weight gain, they were also linked to diabetes, obesity, high blood pressure and heart disease.
And while the longitudinal studies point to an association, they aren't able to determine cause and effect.
"The message is there isn't strong evidence for a benefit from these products - and there's potential evidence for harm", Dr. Azad said. There are also those who are not even aware that they are eating them in yogurts, granola bars, and similar products.
Ordering a diet soda as a "healthier" choice may be backfiring. The group represents the low- and reduced-calorie food and beverage industry. For instance, the effects of synthetic versus natural low calorie sweeteners have not been thoroughly explored.
Dr Azad and his team are now working to understand how artificial sweetener consumption by mothers-to-be may affect weight gain and gut bacteria in their infants. BMI is a measurement of body fat, based on height and weight.
Researchers at the University of Manitoba's George & Fay Yee Centre for Healthcare Innovation reviewed 37 studies that followed over 400,000 people for an average of 10 years. "Everyone is told don't eat sugar, period". "I think we are at a place where we can say that they don't help".
One school holds that the sweeteners might influence dieters' behavior in unhealthy ways. "They're shifting calories to other foods", Azad explained.
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This is quite the opposite of their intended use, since artificial sweeteners have been developed to combat obesity.
Marissa Miller calls herself an artificial sweetener junkie.
Researchers from the University of Manitoba warned against the long-term health impact of the sweeteners which have no nutritional value.
Lauri Wright is an assistant professor of nutrition and dietetics with the University of North Florida.
Many dieters switch to the sugar substitutes to avoid the calories while still getting their sweet-tooth rush.
"Evidence that sugar consumption is fueling this epidemic has stimulated the increasing popularity of nonnutritive sweeteners, including aspartame, sucralose and stevioside". "Those kind of factors confound what we are seeing in these observational studies", Wright said.
And, she says, one option is to reduce your taste for sweet altogether rather than choosing between a sugar-sweetened or artificially-sweetened drink or food.
Another possibility, Azad said, is that we compensate and think that drinking a diet pop permits us to enjoy pizza and cake later.