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However, this might be happening in their attempt to and as a strategy to reduce their calorie and sugar intake, which is a common dietary recommendation in such health conditions. About as harmless as water, right?

In addition, many people start using artificial sweeteners because they are already overweight and may already have developed diabetes.

But new Canadian research published Monday suggests that artificial sweeteners, such as aspartame, sucralose and stevia, may be doing more harm than good. "So a reasonable assumption is, 'OK, I'll use a sugar substitute.' This says maybe don't make that immediate substitution before we have evidence".

Azad suggests that consumers who turn to artificial sweeteners on the assumption that they're a healthier choice should to be cautious.

"However, consumption of non-nutritive sweeteners has been paradoxically associated with weight gain and incident obesity". As well, artificial sweeteners could cause people to crave sweet foods more often.

"Over 40 per cent of adults are reporting using artificial sweeteners on a regular basis", said Azad. Her own work on animals has shown these sweeteners can alter the composition of gut microbiota, which she says could play a role in long-term changes in metabolism. The more often that people reach for sweet foods, the more likely they will take in more calories than someone who avoids sweet treats. If you choose a no-sugar-added ice cream, for instance, you may eat more of it.

Another possibility is that our bodies have evolved to metabolize sugars in a way that's triggered not by calories or the sugar molecule but by the perception of sweet taste. These days aspartame and sucralose aren't just in diet sodas and chewing gum but English muffins and toothpaste as well. Do the potential risks of sweeteners outweigh the risks of sugar itself?

There has also been research that shows artificial sweeteners can actually have an impact on the bacteria in people's intestines. Seven of them were randomized trials, covering about 1,000 people, and the rest were observational studies that tracked the health and habits of nearly 406,000 people over time. These contain around 10 years' worth of information collected from over 400,000 participants. She would like to see randomized controlled trials that focus on health markers besides body weight, including lipids, insulin levels, and inflammatory markers. Observational studies can track far more people for a much longer period, and they better reflect how people actually live.

These results are "kind of the opposite of what these products are intended for", Azad said.

Diabetes Canada includes nonnutritive sweeteners in its guidelines, citing Health Canada's acceptable daily intake values.

"Given the widespread and increasing use of artificial sweeteners and the current epidemic of obesity and related diseases, more research is needed to determine the long-term risks and benefits of these products", she said.


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