Artificial Sweeteners: The 5 Worst and Healthy Alternatives

Artificial sweeteners are sugar substitutes made in a lab, such as aspartame, sucralose, acesulfame potassium and saccharin, and they're so intensely sweet that a speck can stand in for a spoonful of sugar with few or no calories.1 They're one of the swaps I don't recommend for sugar, because a sweet taste with no sugar behind it still reaches your gut bacteria and your blood-sugar system, and real sweetness, used sparingly, does the job better.23

If you switched to diet soda and "zero sugar" snacks to cut back on sugar, you were doing what you'd been told was the healthy thing, and cutting back on sugar is still the right goal, so what I'd change is the stand-in. Sugar cravings are often due to an imbalance of good bacteria in your gut,10 which is why I look for the root cause of a sweet tooth instead of covering it with a sweetener that only fools your taste buds. This guide walks through what these sweeteners are, how they work in your body, the five worst ones and what the research links each to, where they hide on labels, and the natural sweeteners I recommend instead, with recipes.

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What are artificial sweeteners?

Your tongue reads these compounds as intensely sweet, and because so little goes into a food, they add almost nothing in the way of calories. Aspartame and acesulfame potassium are each about 200 times sweeter than sugar, saccharin 200 to 700 times, sucralose about 600 times, neotame 7,000 to 13,000 times and advantame, approved in 2014, about 20,000 times.1

Two other groups of sweeteners often get lumped in with them. Sugar alcohols, such as sorbitol, xylitol and erythritol, are 25% to 100% as sweet as sugar and fill sugar-free candies, cookies and chewing gums.1 Stevia, monk fruit and allulose, meanwhile, come from plants or are rare sugars, and the FDA reviews them separately from the six artificial sweeteners.1 They're among the natural sweeteners I recommend, so you'll find them in the alternatives section below.8

One more artificial sweetener is worth knowing by name, because you may see it on imported products: cyclamate. The FDA prohibits cyclamates in the U.S., while the UK still permits them as food additive E952.19

Common artificial sweeteners: the list and label names

Here's how the common sweeteners appear on ingredient lists, including the E-numbers used on UK and European labels, how sweet each one is and where it stands with regulators.19

The first eight rows are the artificial sweeteners and their relatives. Sugar alcohols are a separate class with their own concerns, covered in the worst list, and the last two rows, stevia and monk fruit, are natural sweeteners from plants.1

Are artificial sweeteners bad for you?

My approach starts with real food, and in The Biblio Diet, the book I wrote with Jordan Rubin, artificial sweeteners are one of the Sinister Six, the six kinds of food I tell people to stop eating first, along with unclean meats, ultra-processed seed oils, added sugar, processed white flour and artificial colors.6 In my Anti-Inflammatory Reset, they sit on the cut list with sugar and sweet drinks.11 I've also written that these sweeteners are linked to more diabetes, high blood pressure and stroke,6 and the large studies in the side effects section below show those links.

Regulators see it differently: the FDA sets an acceptable daily intake for each sweetener it approves, and by its math a 132-pound adult would reach it at 75 packets of aspartame, 45 of saccharin, or 23 of acesulfame K or sucralose a day, each packet as sweet as two teaspoons of sugar.1 Europe's food safety agency re-evaluated erythritol in 2023, saccharin in 2024, acesulfame K in 2025 and sucralose in 2026, set a daily limit for each one and raised the limits for saccharin and acesulfame K.13141516

The World Health Organization asked a different question, whether these sweeteners help people over the long run, and in 2023 it advised against using non-sugar sweeteners to control weight or to lower the risk of chronic disease. It's a conditional recommendation based on low-certainty evidence, and it doesn't cover people who already have diabetes.12 In the cohort studies behind it, people who drank more beverages made with non-sugar sweeteners had 23% higher risk of type 2 diabetes, 32% higher risk of cardiovascular events and 19% higher risk of stroke.17

There are some studies suggesting artificial sweeteners may not be that bad for us, but I really think common sense is the way to go here: something that's a chemical made up in a lab isn't going to be healthy for you long term, and when there are natural alternatives that are much healthier, like monk fruit, stevia and allulose, you're much better off using those instead.2

Do artificial sweeteners raise blood sugar?

This question has two parts. The first is whether a sweetener lifts your blood sugar the moment you swallow it, and the answer is no: when researchers pooled 29 randomized trials of aspartame, saccharin, stevia compounds and sucralose, with 741 people in all, sweetener intake didn't raise blood glucose from where it started.18 In the WHO's review, trials that ran mostly 3 months or less found no significant effect on fasting glucose, insulin or HbA1c, your average blood sugar over about three months.17

The second question is whether a sweetener changes how your body handles the sugar you eat later, and that's where the gut comes in. In a 2022 trial in Israel, 120 healthy adults who normally avoided sweeteners took sachets of saccharin (180 mg a day), sucralose (102 mg), aspartame (240 mg) or stevia (180 mg), a glucose-only sachet or nothing, 20 to a group, for 2 weeks; people knew which sweetener they got. Saccharin and sucralose raised the blood-sugar response to a glucose drink, while aspartame and stevia didn't.3

A separate trial randomized 54 healthy adults, 46 of whom finished, to capsules of pure saccharin at 400 mg a day, the top of the 5 mg-per-kg daily limit the researchers followed, or to comparison groups that included a placebo for 2 weeks, with neither the people nor the researchers knowing who got what, and it found no change in glucose tolerance or gut bacteria.19 The two trials differed in one way that may matter, because the sachets in the 2022 trial carried glucose as their filler, the way tabletop packets do, while the saccharin-only trial used pure saccharin in capsules.319

For sucralose, the pattern shows up even in a single sitting. In 17 adults with obesity who each tried both, 48 mg of sucralose in water taken 10 minutes before a glucose drink raised the peak rise in blood sugar to 4.8 mmol/L, against 4.2 mmol/L after plain water, and insulin rose about 20% more.20 If steadier blood sugar is your goal, an insulin resistance diet and the natural sweeteners further down are the place to start.

How do artificial sweeteners work in your body?

A sweetener's work in your body starts on your tongue, where it reads as sweet, but it doesn't end there, because your body uses little or none of it for fuel, and whatever it doesn't absorb keeps traveling through your gut. Follow sucralose from your tongue to your colon and you can see why your gut microbiome comes into the picture.

That person-to-person difference fits how I think about sweet cravings in the first place.

Traditional Chinese medicine also looks at sweetness through digestion, and my Healthy Weight & Metabolic Reset follows its advice to favor warm, cooked food and bitter, aromatic herbs such as ginger, cinnamon and green tea, and to avoid cold, sweet and greasy foods. The protocol also names the two TCM patterns to watch for: Spleen Qi deficiency, a weak "transformation" of food, and Damp accumulation, a heavy, bloated feeling.22 Either way, the answer starts with caring for your gut and needing less sweetness, and a calorie-free stand-in only keeps the sweetness coming.

Artificial sweetener side effects and dangers

These are concerns I've raised on my show.

1. May keep your sweet tooth going

Because sucralose is about 600 times sweeter than sugar, I've written that it can easily contribute to an addiction to overly sweet foods and drinks.6 Animals show how strong the pull of sweetness can be: when rats could choose between water sweetened with saccharin and intravenous cocaine, 94% chose the saccharin.24

In people, a 2026 randomized trial tested the sweet-tooth question directly. For 6 months, 180 healthy adults were given about half their daily food, with 7%, 35% or 80% of it tasting sweet from sugars, low-calorie sweeteners, fruit and dairy, and neither their liking for sweet taste nor how sweet foods tasted to them changed in any group.25 An earlier randomized trial of 33 healthy adults found a shift when the sugar itself came down: after 3 months of replacing 40% of their simple-sugar calories with other foods, the low-sugar group rated puddings about 40% sweeter than the comparison group did, while liking them just as much, so the sweetness that's left can start to taste stronger as you cut back.26

2. Linked to weight gain

Diet drinks are sold to help with weight, and in short trials, sweeteners do trim a little. In the WHO's pooled analysis of 29 randomized trials in 2,433 adults, body weight was 0.71 kg (about 1.6 pounds) lower with non-sugar sweeteners, though the WHO rated that evidence low-certainty.17 A 2022 pooled analysis of 17 trials in 1,733 adults with overweight or obesity found 1.06 kg (about 2.3 pounds) less weight in the 12 trials, with 601 adults, where diet drinks replaced sugary ones; its authors report fees and funding from sweetener-industry groups.27

Over years, though, the picture runs the other way, and in the WHO review's cohort studies, people with higher intakes had 76% higher risk of obesity.17 A 2017 review of 30 cohort studies, following 405,907 people for a median 10 years, linked sweetener use to higher weight and waist size and to more obesity, high blood pressure, metabolic syndrome and type 2 diabetes, while its 7 randomized trials, with 1,003 people followed a median 6 months, found no significant effect on body mass index.28 The part of a diet-drink swap that helps is dropping the sugar, and sparkling water with a squeeze of lemon does that without a sweetener.

3. Linked to type 2 diabetes and metabolic syndrome

Diet products are often the first switch people make to protect their blood sugar, yet over the years, people who use more sweeteners develop type 2 diabetes more often. The NutriNet-Santé study in France has followed more than 100,000 adults through detailed food records. Over a median 9.1 years, among 105,588 adults with 972 new cases of type 2 diabetes, people whose sweetener intake was above the median (16.4 mg a day for men and 18.5 mg for women) had 69% higher risk than people who had none, a hazard ratio of 1.69. The hazard ratios were 1.70 for acesulfame K, 1.63 for aspartame and 1.34 for sucralose.4

Diet soda shows the same pattern in the U.S. In the Multi-Ethnic Study of Atherosclerosis, which enrolled 6,814 adults aged 45 to 84, those who drank diet soda at least daily had 36% higher risk of metabolic syndrome and 67% higher risk of type 2 diabetes than adults who drank none.29 Those numbers describe diet soda rather than any one sweetener, and swapping it for sparkling water or unsweetened tea takes the question off the table.

4. Linked to heart disease, stroke and brain aging

Your heart and blood vessels show the same pattern: in 103,388 NutriNet-Santé adults, total sweetener intake was linked to 9% higher risk of cardiovascular disease and 18% higher risk of cerebrovascular disease, the strokes and related events of the brain's blood vessels, at 195 against 150 cases per 100,000 person-years. Aspartame was linked to 17% higher cerebrovascular risk, while acesulfame K and sucralose were linked to 40% and 31% higher risk of coronary heart disease.5

In the U.S. Framingham Offspring Study, which followed 2,888 adults over 45 for stroke and 1,484 adults over 60 for dementia for 10 years, people who drank artificially sweetened soft drinks daily had about three times the risk of ischemic stroke (a hazard ratio of 2.96) and of Alzheimer's disease (2.89) compared with people who drank none. Sugary drinks weren't linked to either.30 And in 12,772 Brazilian adults followed for 8 years, people under 60 with the highest sweetener intakes showed faster declines in memory and thinking scores, with no such link at 60 and older.31

5. Linked to higher cancer risk

Among 102,865 NutriNet-Santé adults followed for a median 7.8 years, with 3,358 cancers diagnosed, higher artificial sweetener intake was linked to 13% higher overall cancer risk. Aspartame was linked to 15% higher risk and acesulfame K to 13% higher risk, and aspartame was linked to 22% higher risk of breast cancer, while sucralose showed no link to cancer.23 The WHO's cancer agency reviewed aspartame in 2023, and its classification is in the aspartame entry below.32

6. Changes in your gut bacteria

The gut question started in 2014, when researchers in Israel found that common sweetener products made mice glucose intolerant by changing their gut bacteria, and a small group of volunteers showed similar changes.33 The 2-week human trial in the blood-sugar section above found a gut shift with every sweetener tested, and as I see it, some studies show that saccharin and sucralose appear to change your gut microbiome, so they don't get a free pass.83 If you're working on leaky gut or other gut problems, artificial sweeteners are one of the easiest things to take off your plate.

The 5 worst artificial sweeteners to avoid

Where artificial sweeteners hide

Artificial sweeteners hide anywhere a label says "diet," "sugar-free," "zero sugar," "lite," "reduced sugar" or "no added sugar," and in plenty of foods that don't advertise them at all. These are the places to check:

• Diet sodas and other "zero sugar" drinks32

• Chewing gum and breath mints, often sweetened with sugar alcohols as well321

• Gelatin, puddings, ice cream and other frozen desserts32

• Flavored yogurt and breakfast cereal32

• Protein powders and shakes, where acesulfame K is common6

• Toothpaste, cough drops and chewable vitamins32

• Sugar-free candies, cookies and baked goods, usually with sugar alcohols1

• Tabletop packets for coffee and tea1

The ingredient list tells you what's really in the package, so learn the names in the table above and the E-numbers on imported products. My guideline for packaged foods is five ingredients or fewer,6 and a short list of real foods rarely has room for a sweetener you can't pronounce. The same habit helps you spot hidden sugar, and every swap toward whole food moves you away from the ultra-processed foods where these sweeteners live.

Healthy alternatives to artificial sweeteners

If you're going to use a sweetener, honey should be your number-one sweetener, and after that, monk fruit, stevia and allulose are the next best options.8 Even though some of these are sweet and carry sugar, they'll satisfy your cravings without doing harm to your body if you use them in moderation.10

Raw honey

Raw honey is my first choice because it's a whole food, made by bees from flower nectar, and it brings more to the table than sweetness. If you're going to add a sweetener in, honey is the best, and a teaspoon up to a tablespoon of raw local honey a day is plenty.7

The research on honey points the same way. In a pooled analysis of 18 controlled trials in 1,105 people, eating a median 40 g of honey a day (about 2 tablespoons) for a median 8 weeks lowered fasting blood sugar by 0.20 mmol/L (about 3.6 mg/dL), total cholesterol by 0.18 mmol/L, LDL cholesterol by 0.16 mmol/L and triglycerides by 0.13 mmol/L, and raised protective HDL cholesterol by 0.07 mmol/L, with low-certainty evidence for most results and high certainty for HDL. Raw, clover and robinia honey showed the benefits on fasting glucose and cholesterol, while processed honey didn't.48

For your gut, I'd say Manuka honey specifically is probably the best form of carbohydrate for balancing out your gut microbiome,8 and with a lot of my patients who have had leaky gut, SIBO or IBS, I have them use Manuka honey as their only sweetener if they're going to use a sweetener.7

Honey is still sugar, and I counsel the same moderation Scripture does: "Hast thou found honey? eat so much as is sufficient for thee, lest thou be filled therewith, and vomit it" (Proverbs 25:16, KJV). Used that way, a spoonful of raw honey in place of other sweeteners is one of the simplest upgrades in your kitchen.

Monk fruit

Monk fruit, also called luo han guo, is a fruit native to Southern China, and its sweetness comes from compounds called mogrosides. Its extract is 100 to 250 times sweeter than sugar, and the FDA has reviewed it as generally recognized as safe.1 In China, monk fruit has been used for more than 300 years as a natural sweetener and as a traditional remedy for sore throats and coughs, and it's one of the first plants China recognized as both a food and a medicine.49

Where monk fruit stands out is blood sugar: in a 2025 review of five randomized trials, monk fruit extract lowered blood sugar after meals by 10% to 18% and insulin responses by 12% to 22%, with no serious side effects.50 It also sweetens a drink without the first-hour spike that sugar brings: when 30 healthy men each tried drinks sweetened with aspartame, monk fruit, stevia or sugar, only the sugar drink spiked blood sugar and insulin in the first hour, though lunch ran bigger after the calorie-free drinks, so total calories for the day and total blood sugar over three hours came out about the same.51

Stevia

I'm a fan of stevia,10 and for most people it's a completely fine and good natural sweetener, along with monk fruit and, of course, fruit.2 It comes from the leaves of a plant native to parts of South America, and its sweet compounds, steviol glycosides, are 200 to 400 times sweeter than sugar. The FDA has reviewed highly purified steviol glycosides as safe, while whole-leaf and crude stevia extracts aren't permitted as sweeteners in the U.S.1

In the 2-week gut trial of 120 adults, stevia didn't raise the blood-sugar response.3 And in a study of 19 lean and 12 obese adults, each of whom tried stevia-, aspartame- and sugar-sweetened snacks on separate days, a stevia-sweetened snack before lunch and dinner didn't lead people to eat more later, so their calories for the day came in 301 lower than on the day with a sugar-sweetened snack, and stevia lowered blood sugar after the meal compared with sugar.52

Allulose

Allulose is a rare sugar that the FDA has reviewed as safe.1 In a 2026 pooled analysis of 20 controlled trials, 12 of them on allulose, it lowered the rise in blood sugar and insulin after meals, with moderate-certainty evidence, though it didn't change HbA1c, fasting blood sugar, cholesterol or body composition.53 At home, Chelsea and I use raw local honey as our number-one sweetener when we make recipes, and when we don't, or alongside it, we use a monk fruit and allulose blend, or some fruit or dates.2

Fruit and dates

Whole fruit brings its sweetness with fiber attached, and berries are the best, since they have more fiber, they're lower glycemic and they have less sugar.2 Even something like dates is a sweetener we use at home in certain recipes. They're more concentrated sugar, but there are loads of antioxidants, fiber and nutrients in there that slow down the sugar absorption.2 In a study of five date varieties in 13 healthy adults and 10 adults with type 2 diabetes, their glycemic indices ran from 46 to 55 in the healthy group, all in the low range, and were similar in the group with diabetes.54 Dates are high in calories, so enjoy them in moderation, and try Medjool dates blended into a paste in the recipes section below.6

Maple syrup and coconut sugar

Maple syrup and coconut sugar are on my sweetener list too, as small-amount swaps that replace other sugar rather than adding to it.6 They're less processed than white sugar, and they're still sugar, so honey stays first.

For more options, including how each one bakes, see sugar substitutes.

How to cut back on artificial sweeteners

The easiest way to cut back is to work on the cravings themselves and change your palate a little at a time. If you are craving sugar, one of the best things you can do is embrace what I call the power of sour.10 Sour foods take the edge off sugar cravings, so try apple cider vinegar in your dressings, Granny Smith apples, kombucha, and lemon or lime in your drinks.10

Natural herbs and spices help too. Pumpkin pie spice, apple pie spice and cinnamon lower the amount of sugar you need, so stir them into smoothies, applesauce, or goat's milk or coconut yogurt.10 More protein, fiber and water help reduce sugar cravings too, and I recommend about 30 to 50 grams of protein per meal, 30 to 40 grams of fiber a day and at least half your body weight in ounces of water.10 Stress drives cravings as well, so getting your body out of that stress state helps: take a walk, read a book or have lunch with a good friend.2

Then make the swaps one at a time. Trade diet soda for sparkling water with lemon or lime, or for unsweetened herbal tea, and trade "sugar-free" snacks for fruit or a small spoonful of honey. Our guide to sugar withdrawal can help with the first few days, and the pudding trial above shows what's waiting on the other side: as your palate gets less sugar, foods start to taste sweeter on their own.26

Recipes sweetened the natural way

You don't need a lab-made sweetener to make something taste like a treat, and these recipes and ideas use real sweetness instead.

• Watermelon agua fresca: blended watermelon with lime juice and a touch of raw honey, topped with sparkling water, in place of a diet soda on a hot day.
• Peppermint patties: a peppermint center made with coconut oil and Manuka or raw honey, coated in dark chocolate that's at least 72% cacao.
• Honey and date cinnamon rolls: Chelsea made cinnamon rolls with sourdough, and we used honey in them and mixed some dates and cinnamon in there.2
• Sourdough pancakes, waffles and crepes: when we make these at home, raw local honey is what sweetens them.2
• Date paste for baking: blend dates with water into a paste and use it one to one in place of sugar.6
• Sweet spices: using herbs like pumpkin pie spice can also add some sweetness to your recipes, and a homemade blend is easy to keep on hand.2
• Flavors that read as sweet: vanilla, cinnamon, nutmeg and unsweetened cocoa add depth to oatmeal, smoothies and baked goods, so you can use less of any sweetener.

Who should be most careful with sweeteners

• Phenylketonuria (PKU): aspartame contains phenylalanine, which people with this rare inherited condition have difficulty breaking down, so U.S. labels must say "PHENYLKETONURICS: CONTAINS PHENYLALANINE."159 If you have PKU, choose honey, monk fruit, stevia or allulose instead.
• Pregnancy and breastfeeding: in a Canadian study of 3,033 mothers and babies, the 5.1% of mothers who drank artificially sweetened drinks daily during pregnancy had babies with about twice the odds of being overweight at age 1 (an odds ratio of 2.19).55 After 40 nursing mothers drank a diet juice with sucralose and acesulfame K, both reached their milk, and the babies' estimated dose through milk, adjusted for body weight, came to 1.59% of the mother's for acesulfame K against 0.04% for sucralose.56 If you're pregnant or nursing, sparkling water with lemon is an easy swap, and the pregnancy diet guide has more.
• Sensitive guts, IBS or SIBO: if "sugar-free" foods leave you gassy or bloated, check the label for anything ending in "-itol" and cut it first.34 A few people get an upset stomach from stevia too, and if that's you, switch to honey or monk fruit.2
• Heart disease or clotting problems: the erythritol and xylitol findings in the sugar alcohols entry are reason to leave both out.4547
• Dogs: in dogs, xylitol causes a rapid release of insulin and a dangerous drop in blood sugar, so keep sugar-free gum, mints and baked goods out of reach.57
• Babies under 12 months: never give honey to a baby under 1 year old, because of the risk of infant botulism.58

The bottom line

Artificial sweeteners: frequently asked questions

References

1. US Food and Drug Administration. Aspartame and Other Sweeteners in Food. Content current as of February 27, 2025; accessed 2026-11-04.
2. Axe J. 11 Foods with SHOCKINGLY High Amounts of Sugar (Best Sugar Substitutes). The Dr. Josh Axe Show. July 22, 2024 (solo; at 19:55, 20:15, 20:21, 21:06, 23:11, 23:29, 26:46, 26:53, 30:46, 31:03, 31:14, 31:29 and 39:32 in the YouTube captions, https://www.youtube.com/watch?v=KG7_2ZYmHLU).
3. Suez J, Cohen Y, Valdés-Mas R, Mor U, Dori-Bachash M, Federici S, et al. Personalized microbiome-driven effects of non-nutritive sweeteners on human glucose tolerance. Cell. 2022;185(18):3307-3328.e19. doi:10.1016/j.cell.2022.07.016. PMID:35987213
4. Debras C, Deschasaux-Tanguy M, Chazelas E, Sellem L, Druesne-Pecollo N, Esseddik Y, et al. Artificial Sweeteners and Risk of Type 2 Diabetes in the Prospective NutriNet-Santé Cohort. Diabetes Care. 2023;46(9):1681-1690. doi:10.2337/dc23-0206. PMID:37490630
5. Debras C, Chazelas E, Sellem L, Porcher R, Druesne-Pecollo N, Esseddik Y, et al. Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort. BMJ. 2022;378:e071204. doi:10.1136/bmj-2022-071204. PMID:36638072
6. Axe J, Rubin J. The Biblio Diet. Hachette Book Group; 2025. ISBN 9781546008439. "The Sinister Six" (ebook p. 37); artificial sweeteners, sucralose and acesulfame potassium (ebook p. 39); sugar alcohols, erythritol among them (ebook p. 40); food lists, sweeteners (eat and avoid columns).
7. Axe J. What Happens In Your Body If You Eat Honey Every Day? The Dr. Josh Axe Show. October 20, 2025 (solo; at 08:14 and 19:25 in the YouTube captions, https://www.youtube.com/watch?v=TwgZOTXEWKg).
8. Axe J. The Shocking Reason Your Anxiety, Brain Fog & Bloating May Start in Your Gut. The Dr. Josh Axe Show. June 15, 2026 (solo; at 20:34, 45:22, 45:28 and 45:42 in the YouTube captions, https://www.youtube.com/watch?v=yumJczZ1_JM).
9. UK Food Standards Agency. Approved additives and E numbers (section 5, Sweeteners). Accessed 2026-11-04.
10. Axe J. Heavy Metals, Sugar Cravings, & Natural Flavors | Q&A. The Dr. Josh Axe Show. 2024 (solo Q&A; at 06:04, 06:21, 06:42, 07:11, 07:34, 08:24, 08:55 and 09:17 in the YouTube captions, https://www.youtube.com/watch?v=MnYj3zCU4ek).
11. Axe J. The Anti-Inflammatory Reset: The 30-Day Healing Protocol. DrAxe.com protocol. 2026. "Cut these — they feed the fire" list, p. 20.
12. World Health Organization. Use of non-sugar sweeteners: WHO guideline. Geneva: WHO; 2023. ISBN 9789240073616.
13. EFSA Panel on Food Additives and Flavourings (FAF), Younes M, Aquilina G, Castle L, Degen G, Engel KH, Fowler PJ, et al. Re-evaluation of erythritol (E 968) as a food additive. EFSA J. 2023;21(12):e8430. doi:10.2903/j.efsa.2023.8430. PMID:38125972
14. EFSA Panel on Food Additives and Flavourings (FAF), Castle L, Andreassen M, Aquilina G, Bastos ML, Boon P, Fallico B, et al. Re-evaluation of saccharin and its sodium, potassium and calcium salts (E 954) as food additives. EFSA J. 2024;22(11):e9044. doi:10.2903/j.efsa.2024.9044. PMID:39553702
15. EFSA Panel on Food Additives and Flavourings (FAF), Castle L, Andreassen M, Aquilina G, Bastos ML, Boon P, Fallico B, et al. Re-evaluation of acesulfame K (E 950) as food additive. EFSA J. 2025;23(4):e9317. doi:10.2903/j.efsa.2025.9317. PMID:40309404
16. EFSA Panel on Food Additives and Flavourings (FAF), Castle L, Andreassen M, Aquilina G, Bastos ML, Boon P, et al. Re-evaluation of sucralose (E 955) as a food additive and evaluation of a new application on extension of use of sucralose (E 955) in fine bakery wares. EFSA J. 2026;24(2):e9854. doi:10.2903/j.efsa.2026.9854. PMID:41710869
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19. Serrano J, Smith KR, Crouch AL, Sharma V, Yi F, Vargova V, et al. High-dose saccharin supplementation does not induce gut microbiota changes or glucose intolerance in healthy humans and mice. Microbiome. 2021;9(1):11. doi:10.1186/s40168-020-00976-w. PMID:33431052
20. Pepino MY, Tiemann CD, Patterson BW, Wice BM, Klein S. Sucralose affects glycemic and hormonal responses to an oral glucose load. Diabetes Care. 2013;36(9):2530-5. doi:10.2337/dc12-2221. PMID:23633524
21. Roberts A, Renwick AG, Sims J, Snodin DJ. Sucralose metabolism and pharmacokinetics in man. Food Chem Toxicol. 2000;38 Suppl 2:S31-41. doi:10.1016/s0278-6915(00)00026-0. PMID:10882816
22. Axe J. Healthy Weight & Metabolic Reset: The 90-Day Healing Protocol. DrAxe.com protocol. 2026. "TCM says ... Avoid cold, sweet and greasy" and the TCM patterns (Spleen Qi deficiency, Damp accumulation), p. 10.
23. Debras C, Chazelas E, Srour B, Druesne-Pecollo N, Esseddik Y, Szabo de Edelenyi F, et al. Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study. PLoS Med. 2022;19(3):e1003950. doi:10.1371/journal.pmed.1003950. PMID:35324894
24. Lenoir M, Serre F, Cantin L, Ahmed SH. Intense sweetness surpasses cocaine reward. PLoS One. 2007;2(8):e698. doi:10.1371/journal.pone.0000698. PMID:17668074
25. Čad EM, Mars M, Pretorius L, van der Kruijssen M, Tang CS, de Jong HB, et al. The Sweet Tooth Trial: A Parallel Randomized Controlled Trial Investigating the Effects of A 6-Month Low, Regular, or High Dietary Sweet Taste Exposure on Sweet Taste Liking, and Various Outcomes Related to Food Intake and Weight Status. Am J Clin Nutr. 2026;123(1):101073. doi:10.1016/j.ajcnut.2025.09.041. PMID:41485871
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Dr. Josh Axe, DC, DNM, CNS

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