Despite intense scrutiny of artificial sweeteners for years, the product continues to be popular with dieters, diabetics and many just looking for a sweet fix. Even in the face of declining soda sales, the market share of diet soda continues to expand, with the second most popular soda being a diet variety.

At the same time, the global market for non-sugar sweeteners has had impressive sales in recent years. In 2010, over 9 million dollars were spent on non-sugar sweeteners, with the industry anticipating continued growth in coming years.

The key to managing diabetes is tight regulation of sugar intake, so indulgences in sweets can be very difficult.  Many diabetics find that products with artificial sweeteners help curb cravings as sweeteners tend to be much more intense than regular sugars and having no carbohydrate or effect on blood glucose levels. Since their original introduction, thousands of low-sugar alternatives have been introduce to the market. At the same time, the number of diabetics in the US has grown further driving sales.

Similarly, artificial sweeteners have been embraced by those seeking to lose weight. Obesity is a growing global epidemic, representing a serious public health problem. In the United States over one third of people are obese, putting them at an increased risk of high blood pressure, diabetes, heart disease and stroke. Overall, the cost of obesity exceeds 110 billion dollars annually, representing a major economic burden.

Substitution of artificial sweeteners for corn syrup or sugar dramatically decreases calorie content.  For instance, each gram of sugar contains 4 calories. While this might not sound like a lot, each teaspoon is 4 grams of sugar and a 12-ounce can of soda contains 8 teaspoons, resulting in about 130 calories from sugar alone. Cutting only one can of soda a day for a year would result in over 46,000 calories saved, the equivalent of 13 pounds in weight loss. While replacing that soda with water would be ideal, a calorie-free option would have the same calorie cutting effect.

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    Interestingly, recent studies have actually shown a relationship between weight-gain and artificial sweeteners. Researchers speculate that when we consume sugar-substitutes, the body expects to see a surge in glucose. When this expectation is not met, we continue to crave sweets, consuming food until the craving is met. The key to weight loss however is cutting the total number of calories consumed, making it essential to be a mindful eater.

    One of the main health concerns associated with artificial sweeteners is a possible increased cancer risk. In the 1970s, studies found that rats that were fed a diet high in saccharin (SweetN’Low) developed bladder cancer at an increased rate. Despite further studies demonstrating that the mechanism of cancer was limited to rodent physiology, the sweetener still carries a warning that it may be hazardous to one’s health.  However, in 2000 the sweetener was de-listed as a carcinogen by the US National Toxicology Program.  The National Cancer Institute also states that there is no sound scientific evidence that any artificial sweetener cause cancer or serious health problems in humans.

    Bladder cancer, however, is a serious health concern in the U.S., as it is the 4th leading cause of cancer death in men. The American Cancer Society estimates that 73,000 new cases of bladder cancer will be diagnosed this year.

    Bladder cancer almost exclusively occurs in people over the age of 55 and is associated with known risk factors. Smoking increases the risk of bladder cancer 2-4 fold, increasing with the duration and frequency of cigarette smoking. Fortunately, if you quit smoking your risk reduces with time.   Additionally there is a known risk associated with chemical exposures, namely aromatic amines, which are found in dyes and dry cleaner chemicals.  The most common initial symptom is painless blood in the urine which should always prompt a visit to the physician.

    Artificial sweeteners have a role in controlling carbohydrate intake by diabetics and dieters, while also decreasing ones risk of dental cavities.  Despite extensive studies, epidemiological research has failed to demonstrate any cancer risks. While diet products are a safe alternative to their full sugar counterparts, I advocate diet and exercise for weight loss. Exercising at least 3 days a week, increasing fiber and focusing on healthy choices are the best way to lose weight and stay fit.

    Dr. David B. Samadi is the Vice Chairman of the Department of Urology and Chief of Robotics and Minimally Invasive Surgery at the Mount Sinai School of Medicine in New York City. He is a board-certified urologist, specializing in the diagnosis and treatment of urological disease, with a focus on robotic prostate cancer treatments. To learn more please visit his websites RoboticOncology.com and SMART-surgery.com. Find Dr. Samadi on Facebook.