Feed your kids less sugar. That’s good advice for parents, but when artificial sweeteners are the alternative, that advice gets murky. The American Academy of Pediatrics (AAP) has issued a policy statement about the use of sugar substitutes and a call for more research into their effect on children’s health.

More than a quarter of U.S. children reported consuming artificial sweeteners in the 2009-2012 National Health and Nutrition Examination Survey, and 80 percent of children said they were part of their diets daily. This is concerning because little is known about the long-term health effects of artificial sweeteners, especially on children, and there is currently no way to know how much of these chemicals a child may take in over the course of a day.

Booming Popularity, Growing Concerns
Artificial sweeteners, or nonnutritive sweeteners as they are also called, were introduced into the food supply over 60 years ago. They were created for people with diabetes to have the ability to treat their sweet tooth without increasing their blood sugar level. Later, these sugar substitutes became popular as a weight loss tool, a way to eat or drink something sweet, minus the calories from sugar.

Artificial sweeteners are now abundant in the food supply. Eight are approved by the Food and Drug Administration (FDA) as food additives. They are saccharin, aspartame, acesulfame-potassium, sucralose, neotame, and advantame. Stevia and monk fruit are approved under the GRAS designation, “generally recognized as safe."

Only 23 percent of parents in one study could identify products with artificial sweeteners, and 53 percent did not know that foods or beverages labeled “reduced sugar” contained an artificial sweetener.

The first health concern regarding artificial sweeteners was their possible connection to cancer, but research has shown that's not an issue. There are different concerns today.

The obesity epidemic has resulted in increased use of artificial sweeteners, yet questions remain as to how effective they actually are in controlling weight. According to the AAP, most short-term studies suggest they might reduce weight gain and promote a small amount of weight loss in kids, but there isn’t much evidence to support these findings.

Other studies have suggested artificial sweeteners may cause weight gain, changes in appetite and taste preferences, while also modifying the microbiome of the digestive tract. The microbiome includes all of the naturally occurring bacteria, fungi, parasites and viruses that live in harmony in our bodies. Changing the gut microbiome may affect blood sugar levels and lead to issues like metabolic syndrome, insulin resistance, diabetes and weight gain. Again, there is little consistent evidence.

Though the presence of artificial sweeteners is required in the ingredient list on a food or beverage package, the amount is not. The AAP finds this concerning and recommends that the amount be listed so parents know how much children are consuming and researchers can gain a better understanding of any long-term health effects they may have.

Parents aren’t always aware that food or beverages contain artificial sweeteners or understand that products that say they contain less sugar instead have an artificial sweetener among their ingredients. Only 23 percent of parents in one study could identify products with artificial sweeteners, and 53 percent did not know that foods or beverages labeled “reduced sugar” contained an artificial sweetener.

Artificial sweeteners are not just found in diet sodas but also in fruit-flavored drinks and other sugar-free or reduced-sugar products like ice cream, pudding, yogurt, cookies, chewing gum and candy.

The Food and Drug Administration (FDA) sets limits for safe consumption of the artificial sweeteners that are used as food additives. The limits range from 0.3 mg/kg to 50 mg/kg of body weight per day, depending on the sugar substitute. Most children stay within the acceptable levels, but studies have found that some children go over these limits.

Artificial sweeteners are not just found in diet sodas but also in other sugar-free or reduced-sugar products like ice cream, fruit flavored drinks, pudding, yogurt, cookies, crackers, chewing gum and candy. They may also be present in cereals, breads, salad dressings and other condiments. It’s easy to see how a child could consume more than what is considered a safe and acceptable amount, especially when parents have no idea of the amount of sugar substitutes in these products.

In a statement, Carissa Baker-Smith, lead author of the AAP policy statement, explained, “Looking at the evidence, we found there's still a lot to learn about the impact of nonnutritive sweeteners on children's health. We need more research into the use of nonnutritive sweeteners and the risk for obesity and Type 2 diabetes, especially in children. Considering how many children are regularly consuming these products — which have become ubiquitous — we should have a better understanding of how they impact children's long-term health.”

Parents should familiarize themselves with the names of artificial sweeteners and read ingredient lists on products that claim to be “sugar-free” or “reduced sugar.” Generally speaking, these products are not something that should be frequently eaten by a child anyway.

Yes, feed kids less sugar, but also limit the amount of artificially sweetened foods they eat. All sweets, regardless of how they are sweetened, should be used as an occasional treat. But there is one exception. Fruit is nature’s candy. If children are taught to eat fruit to satisfy their sweet tooth, parents won’t need to worry about the amount of sugar or artificial sweeteners their children eat.

The AAP policy statement, “The Use of Nonnutritive Sweeteners in Children,” is published in Pediatrics.