This article reviews two key studies on artificial sweeteners’ health risks. A prospective study in Neurology (8-year follow-up, 12,772 adults ≥35) found higher intake of most artificial sweeteners (e.g., aspartame, sorbitol) linked to faster cognitive decline: the highest intake group had 62% faster overall cognitive aging (equivalent to 1.6 years premature aging), 32% faster memory decline, and 173% faster verbal fluency decline vs. the lowest intake group. Younger adults (<60) and diabetics were more vulnerable, while tagatose was the only sweetener with no such association. Another study in Arteriosclerosis, Thrombosis, and Vascular Biology (and a prior Nature Medicine study) showed erythritol—once deemed a “perfect sweetener”—increased platelet aggregation, thrombosis risk, and major adverse cardiovascular events (1.8–2.21x higher risk in high-level groups). The article concludes “sugar-free” does not mean “harmless,” urging reduced artificial sweetener intake and prioritizing balanced, natural diets.
Picture this: You’re standing in the coffee shop line, confidently asking for a latte with “zero-sugar syrup” instead of the regular one. Later, you grab a “low-calorie” protein bar for a snack and chug a “no-sugar” soda to quench your thirst. With every bite and sip, you pat yourself on the back—“I’m making such healthy choices today. No sugar, no extra calories, just pure wellness.” But what if that reassuring feeling is nothing more than an illusion? What if those seemingly harmless “sweet substitutes” you’re relying on are quietly chipping away at two of your body’s most vital systems: your brain and your heart?
In today’s health-conscious world, more and more people are turning to low-calorie or calorie-free sweeteners as alternatives to traditional sugar. These sweeteners are now ubiquitous in “sugar-free” or “low-sugar” foods and beverages, marketed as go-to solutions for weight management and blood sugar control. Artificial sweeteners like aspartame, saccharin, and sucralose have long been promoted as “healthy replacements” for sugar, leading many to believe they can indulge their sweet tooth without the guilt or consequences. Yet, emerging research is challenging this narrative—revealing that these “sweet traps” may be doing more harm than good, particularly to cognitive function and cardiovascular health.
Artificial Sweeteners Linked to Faster Cognitive Decline: A Decade-Long Study Speaks Up
A recent prospective study published in the journal Neurology—spanning an impressive 8 years—has shed troubling light on the potential impact of artificial sweeteners on cognitive function. This large-scale research effort enrolled 12,772 civil servants aged 35 and older, with an average follow-up period of 8 years, and analyzed seven common low-calorie or calorie-free sweeteners.
The findings were striking: Consumption of artificial sweeteners was associated with accelerated cognitive decline. Compared to individuals with the lowest intake, those who consumed the most artificial sweeteners experienced a 62% faster rate of overall cognitive decline—equivalent to aging approximately 1.6 years prematurely. Additionally, their verbal fluency declined 173% faster, and their memory function deteriorated 32% faster.
The study drew data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), covering three phases: 2008–2010, 2012–2014, and 2017–2019. The participants had an average age of 51.9 ± 9.0 years at enrollment. To assess sweetener intake, the research team used a Food Frequency Questionnaire (FFQ), which tracked consumption of seven sweeteners: aspartame, saccharin, acesulfame K, erythritol, xylitol, sorbitol, and tagatose. Concurrently, participants completed a series of standardized cognitive tests designed to evaluate memory, verbal fluency, and executive function—key markers of overall cognitive health.
Higher Sweetener Intake = Faster Cognitive Aging
Analysis of the data revealed that the average daily intake of artificial sweeteners among participants was 92.1 milligrams. Among the seven sweeteners, sorbitol was consumed most frequently (with an average intake of 63.8 mg/day), while erythritol was consumed the least (averaging just 0.1 mg/day). The researchers then divided participants into three groups based on their total artificial sweetener intake:
- The lowest intake group consumed an average of 20 mg per day.
- The highest intake group consumed an average of 191 mg per day—roughly the amount of aspartame found in a single can of sugar-free soda.
When comparing these groups, the differences in cognitive decline were impossible to ignore:
- Overall cognitive function: The highest intake group experienced a 62% faster rate of global cognitive decline compared to the lowest intake group—translating to 1.6 years of accelerated cognitive aging (or an extra 0.2 years of “cognitive aging” each year over the 8-year study). The middle intake group also showed significant decline, with a 35% faster rate than the lowest group—equivalent to 1.3 years of premature cognitive aging.
- Memory function: The highest intake group’s memory performance declined 32% faster than that of the lowest intake group.
- Verbal fluency: The middle intake group’s verbal fluency dropped 110% faster than the lowest group, while the highest intake group saw a staggering 173% faster decline in this critical skill.
For many people, frequent forgetfulness or struggles with verbal expression—even at a young age—might be dismissed as “normal stress” or “busy brain.” But this study suggests a more alarming possibility: These issues could be linked to regular consumption of “zero-calorie” drinks and “low-sugar” snacks loaded with artificial sweeteners, which may be quietly speeding up brain aging.
Figure 1: Association between Total Artificial Sweetener Consumption and Cognitive Decline
Are Any Artificial Sweeteners “Safe” for Cognition?
A key question raised by the study is: Do some artificial sweeteners pose less risk than others, or are all of them linked to cognitive decline? To answer this, the researchers analyzed the specific effects of each sweetener individually. The results showed that most artificial sweeteners—including aspartame, saccharin, acesulfame K, and sugar alcohols like erythritol, sorbitol, and xylitol—were associated with reduced cognitive function, particularly in memory and verbal fluency.
The only exception was tagatose, a natural sweetener. Tagatose is a monosaccharide (a simple sugar) but is rarely used due to its complex production process and high cost. Researchers speculate that its unique metabolic pathway may explain why it did not show a link to cognitive decline, as it may affect the brain differently than other sweeteners.
Another notable finding was age-related differences in risk: Participants under 60 with high artificial sweetener intake showed particularly significant declines in verbal fluency and overall cognitive function. In contrast, no such association was observed in participants over 60. This suggests that younger people may have different metabolic traits or greater brain sensitivity to artificial sweeteners, making them more vulnerable to cognitive harm.
Figure 2: Association between Artificial Sweetener Consumption and Cognitive Decline
Diabetics Face Even Greater Cognitive Risks
The study also addressed a critical subgroup: people with diabetes. Since individuals with diabetes often choose “sugar-free” or “low-sugar” products to manage their blood sugar, the researchers wanted to explore whether artificial sweetener intake posed unique risks for this group. The results were concerning: Among diabetics, the link between sweetener intake and memory decline was stronger than in the general population, and the rate of global cognitive decline was also more pronounced.
Figure 3: Association between Artificial Sweetener Consumption and Cognitive Decline in Stratified Analysis
For many diabetics, choosing artificial sweeteners is a well-intentioned effort to prioritize health by avoiding sugar. But this study highlights a cruel irony: The “sugar-free” products they rely on may be silently undermining their cognitive health. It raises a vital question: Could eating small amounts of real sugar be a better choice for brain health than consuming large quantities of “fake sugar”?
Beyond the Brain: “Perfect” Sweetener Erythritol May Boost Cardiovascular Risk
Artificial sweeteners don’t just threaten cognitive health—they may also put your cardiovascular system at risk. A prime example is erythritol, a sugar alcohol once hailed as the “perfect sweetener” due to its lack of known health drawbacks. In recent years, it has gained widespread popularity as a replacement for traditional artificial sweeteners like aspartame. However, new research from the Cleveland Clinic, published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, warns that erythritol may increase the risk of blood clot formation, heart attacks, and other cardiovascular events.
Why Erythritol? The “Harmless” Sweetener Under Scrutiny
Erythritol was chosen as the focus of this study precisely because it was previously considered one of the safest artificial sweeteners, with no clear links to adverse health effects. Its growing popularity—among both consumers and food manufacturers—made it a critical target for investigation: If even erythritol posed risks, it would challenge the safety of artificial sweeteners more broadly.
The study included 20 healthy volunteers who participated in an intervention trial. After consuming 30 grams of erythritol, the participants’ blood erythritol levels were measured and compared to those who consumed 30 grams of glucose (a simple sugar) instead. The results were dramatic: Blood erythritol concentrations in the erythritol group were more than 1,000 times higher than in the glucose group.
It is important to clarify that the key finding of this study is not simply "elevated erythritol levels"—a natural consequence of exogenous erythritol consumption—but its specific effects on cardiovascular health. The glucose group served as a key control, eliminating the possibility that "consumption of sweeteners or caloric substances" itself caused elevated erythritol levels or changes in coagulation markers. Blood erythritol levels in the glucose group remained essentially unchanged from baseline (3.0 [2.6–4.0] μM vs. 2.9 [2.7–3.8] μM, P=0.87), and no abnormalities in coagulation-related markers were observed. This confirms that the risks observed in the erythritol group were not a general response to diet but rather a unique effect of erythritol.
Erythritol Enhances Blood Clotting: The Science Behind the Risk
To further explore erythritol’s impact, the researchers conducted in vitro (laboratory) experiments and animal model studies. These tests confirmed that erythritol levels similar to those observed in the human volunteers significantly increased platelet aggregation (the process by which blood platelets clump together to form clots) and enhanced the body’s tendency to form blood clots.
The mechanism behind this effect was also uncovered: Erythritol strengthens platelets’ response to activating factors (such as ADP and TRAP6) and promotes the release of pro-thrombotic (clot-promoting) molecules. Specifically, the erythritol group showed a highly significant increase in TRAP6-induced serotonin release (a marker of platelet dense granules) and CXCL4 release (a marker of platelet alpha granules), with both results meeting the threshold of P<0.0001 (statistically extremely significant). ADP-induced serotonin release was also significantly increased (P=0.004). In contrast, the glucose group showed no significant changes in these markers. This confirms a clear causal chain: Elevated erythritol levels → increased release of clot-promoting molecules → higher risk of blood clots.
Conclusion: “Sugar-Free” Does Not Equal “Harmless”
Together, these studies sound a clear alarm: Artificial sweeteners are not the “healthy alternatives” they are often made out to be. “Sugar-free” labels do not guarantee safety—especially when these products are consumed regularly and in large quantities over time. The hidden risks include accelerated cognitive decline (particularly in younger people and those with diabetes) and increased cardiovascular danger (even from “perfect” sweeteners like erythritol).
For individuals with diabetes and younger adults, reducing artificial sweetener intake may be a critical step in protecting cognitive health. More broadly, these findings remind us that healthy living cannot be achieved through “magic substitutes.” True wellness is built on a foundation of diverse, balanced, and natural eating habits—one that prioritizes whole foods over processed products, even if those products claim to be “sugar-free.”
The next time you reach for that sugar-free soda or low-calorie snack, take a moment to glance at the ingredient list. Then ask yourself: Do I really need this sweetness? Or am I trading short-term satisfaction for long-term harm to my brain and heart?