Effect of low-and non-calorie sweeteners on the gut microbiota: A review of clinical trials and cross-sectional studies

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2024-01, Vol.117, p.112237, Article 112237
• Main Authors: Gauthier, Ellie, Milagro, Fermin I., Navas-Carretero, Santiago
• Format: Article
• Language: English
• Subjects: Aspartame; Bacteria; Calories; Clinical trials; Composition; Consumption; Cross-Sectional Studies; Dosage; Gastrointestinal Microbiome; Glucose; Glucose tolerance; Homeostasis; Humans; Intestinal microflora; intestinal microorganisms; Metabolism; Metabolites; Microbiota; Microorganisms; Non-nutritive sweeteners; Non-Nutritive Sweeteners - adverse effects; Non-Nutritive Sweeteners - analysis; Polyols; prebiotics; Precision nutrition; Probiotics; Public health; Reviews; Saccharin; Saccharin - pharmacology; Sucralose; Sweeteners; Sweetening Agents - pharmacology; Xylitol
• ISSN: 0899-9007; 1873-1244; 1873-1244
• DOI: 10.1016/j.nut.2023.112237

•Results on the effects of low and non-calorie sweeteners on the gut microbiota are heterogeneous.•The gut microbial composition at baseline could mediate the microbial response to low and non-calorie sweeteners.•More human studies are needed to confirm the effects of sweeteners on the gut microbiota. Use of non-nutritive sweeteners (NNSs) has increased worldwide in recent decades. However, evidence from preclinical studies shows that sweetener consumption may induce glucose intolerance through changes in the gut microbiota, which raises public health concerns. As studies conducted on humans are lacking, the aim of this review was to gather and summarize the current evidence on the effects of NNSs on human gut microbiota. Only clinical trials and cross-sectional studies were included in the review. Regarding NNSs (i.e, saccharin, sucralose, aspartame, and stevia), only two of five clinical trials showed significant changes in gut microbiota composition after the intervention protocol. These studies concluded that saccharin and sucralose impair glycemic tolerance. In three of the four cross-sectional studies an association between NNSs and the microbial composition was observed. All three clinical trials on polyols (i.e, xylitol) showed prebiotic effects on gut microbiota, but these studies had multiple limitations (publication date, dosage, duration) that jeopardize their validity. The microbial response to NNSs consumption could be strongly mediated by the gut microbial composition at baseline. Further studies in which the potential personalized microbial response to NNSs consumption is acknowledged, and that include longer intervention protocols, larger cohorts, and more realistic sweetener dosage are needed to broaden these findings.