Patients may ask providers how to switch from sugar-sweetened beverages (SSB) to a healthier beverage, and if artificially sweetened beverages (ASB) are a healthy option. A recent study in the Journal of the American College of Cardiology found that high daily intakes (>176mL/6oz) of both SSB and ASB were associated with higher risk of cardiovascular disease (CVD). Compared to non-consumers, high consumers of SSB and ASB had significantly elevated CVD risk (hazard ratios of 1.2 and 1.32, respectively).1
Artificially sweetened beverages are defined as beverages that contain non-nutritive sweeteners, such as aspartame, acesulfame potassium, Luo Han Guo (monk) fruit extract, neotame, saccharin, stevia, sucralose, and advantame, all of which are approved by the U.S. Food and Drug Administration.2 They often are marketed as “healthier” alternatives to SSB for consumers trying to reduce sugar and/or caloric intake.
The strong evidence linking SSB intake to weight gain and adverse cardiometabolic health outcomes also has contributed to an increased use of ASB.3 However, evidence supporting the use of ASB to promote weight loss is conflicting, and questions remain about their benefit as a long-term weight loss strategy.4
With growing evidence that higher ASB consumption has adverse cardiovascular effects, it is recommended to encourage patients to limit both ASB and SSB, while emphasizing water intake.
- Chazelas E, Debras C, Srour B, et al. Sugary drinks, artificially-sweetened beverages, and cardiovascular disease in the NutriNet-Santé Cohort. J Am Coll Cardiol. 2020;76(18) 2175-2177. https://doi.org/10.1016/j.jacc.2020.08.075.
- FDA Center for Food Safety and Applied Nutrition. Additional Information About High-Intensity Sweeteners. https://www.fda.gov/food/food-additives-petitions/additional-information-about-high-intensity-sweeteners-permitted-use-food-united-states. Published 2020. Accessed January 6, 2021.
- Borges MC, Louzada ML, de Sá TH, et al. Artificially sweetened beverages and the response to the global obesity crisis. PLoS Med. 2017;14(1):e1002195. doi:10.1371/journal.pmed.1002195.
- American Diabetes Association. 5. Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021 Jan;44(Suppl 1):S53-S72. doi:10.2337/dc21-S005.