Sugar-free cold drinks and other low-calorie products are often picked as the healthier option, especially by people trying to reduce their sugar intake. But a new study has raised questions about what some of these sugar substitutes may mean for brain health over the long term. Research published in Neurology, the medical journal of the American Academy of Neurology, found that people who consumed higher amounts of certain artificial sweeteners experienced a faster decline in thinking and memory skills over an eight-year period.The study, however, does not prove that artificial sweeteners cause cognitive decline. It found an association between higher consumption and changes in cognitive performance. The research was supported by Brazil’s Ministry of Health, Ministry of Science, Technology, and Innovation, and the National Council for Scientific and Technological Development.
Study followed nearly 13,000 adults
Researchers from the University of São Paulo in Brazil studied 12,772 adults with an average age of 52. The participants were followed for about eight years and were divided into three groups based on how much low- and no-calorie sweetener they reported consuming.The lowest-consumption group had an average intake of about 20 milligrams per day, while those in the highest group consumed around 191 milligrams daily. For aspartame, the amount consumed by people in the highest group was roughly equivalent to the amount found in one can of diet soda.The researchers looked at seven sweeteners: aspartame, saccharin, acesulfame K, erythritol, xylitol, sorbitol and tagatose.These ingredients are commonly found in products such as diet soft drinks, flavoured water, energy drinks, low-calorie desserts and yogurt. Some are also sold separately for use in tea, coffee and cooking.
Highest consumers showed faster decline
People who consumed the most sweeteners had a 62% faster decline in overall cognitive abilities compared with those who consumed the least. Researchers said the difference was roughly equal to 1.6 additional years of cognitive ageing.The middle-intake group also showed a faster decline, at 35% compared with the lowest-intake group, which researchers estimated to be similar to about 1.3 additional years of ageing.The cognitive tests assessed areas including verbal fluency, working memory, word recall and processing speed.The researchers also found that six of the seven sweeteners were associated with faster declines, particularly in memory. These were aspartame, saccharin, acesulfame K, erythritol, sorbitol and xylitol. Tagatose was the only sweetener examined that was not linked to faster cognitive decline.
People under 60 and those with diabetes saw stronger link
The association was more noticeable among participants younger than 60. The researchers did not find the same pattern among people older than 60.A stronger association was also seen among people with diabetes. Researchers noted that people with diabetes may use sugar substitutes more often because they are commonly advised to reduce foods and drinks that can cause blood sugar spikes.”Low- and no-calorie sweeteners are often seen as a healthy alternative to sugar, however our findings suggest certain sweeteners may have negative effects on brain health over time,” said study author Claudia Kimie Suemoto, MD, PhD, of the University of São Paulo in Brazil.
Researchers caution against drawing firm conclusions
The study has several limitations. Participants reported their own food and drink consumption, so the dietary information may not have been completely accurate. The researchers also did not examine every sugar substitute available.Most importantly, this was an observational study. That means it can identify a relationship but cannot establish that sweeteners themselves caused the cognitive changes.”While we found links to cognitive decline for middle-aged people both with and without diabetes, people with diabetes are more likely to use artificial sweeteners as sugar substitutes,” Suemoto said.”More research is needed to confirm our findings and to investigate if other refined sugar alternatives, such as applesauce, honey, maple syrup or coconut sugar, may be effective alternatives,” Suemoto added.Add 
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