Are there any negative health effects from zero sugar drinks?

November 16, 2025 •

3 min read

A 2023 review published in PMC identified mounting evidence linking excessive consumption of artificially sweetened beverages to various health consequences, including metabolic dysfunction and other systemic issues. So, are there any negative health effects from zero sugar drinks beyond simple calorie reduction?

Quick Summary

Despite zero calories, zero-sugar drinks may have various health impacts due to artificial sweeteners, affecting metabolic function, gut health, and appetite signals. Experts recommend moderation.

Key Points

Gut Microbiome Disruption: Artificial sweeteners in zero-sugar drinks can alter the balance of gut bacteria, potentially leading to inflammation and metabolic issues.
Weight Management Paradox: Despite being calorie-free, zero-sugar drinks are linked to weight gain in some studies, possibly by confusing hunger signals and increasing cravings for sweet foods.
Cardiovascular Risks: Frequent zero-sugar consumption is associated with a higher risk of heart disease, stroke, and high blood pressure in observational studies.
Metabolic Syndrome and Diabetes: Research indicates a potential link between zero-sugar beverages and an increased risk of type 2 diabetes and metabolic syndrome, possibly due to altered insulin response.
Dental Erosion: The high acidity from ingredients like phosphoric acid can erode tooth enamel over time, increasing the risk of cavities and dental sensitivity.
Mental Health and Bone Density: Aspartame has been linked to mood changes in some individuals, while some cola varieties may reduce bone mineral density due to their acid content.
Moderation is Recommended: While possibly better than sugary drinks, zero-sugar versions are not a perfect substitute. Health experts advise reducing overall reliance on sweetened beverages.

The Surprising Truth Behind Zero Sugar

Zero-sugar drinks are a popular low-calorie choice, but research suggests they might not be as harmless as they seem. The primary concern lies with the artificial and non-nutritive sweeteners they contain, which can trigger physiological responses despite having no calories.

Potential Health Impacts

Studies indicate that artificial sweeteners can affect the body in several ways:

Gut Microbiome: Sweeteners like saccharin and sucralose may alter gut bacteria balance, potentially leading to dysbiosis, which is linked to various health issues.
Weight Management: Despite zero calories, some observational studies connect frequent consumption to weight gain. This might be due to the sweet taste confusing the brain's hunger signals and potentially increasing cravings.
Cardiovascular Health: Frequent consumers may face a higher risk of heart attack, stroke, and hypertension, although the exact mechanisms are still being studied.
Kidney Function: High consumption has been linked to a higher risk of chronic kidney disease, potentially due to ingredients like phosphoric acid.
Dental Health: Zero-sugar drinks are acidic and can erode tooth enamel, increasing the risk of cavities.
Bone Density: Some cola-based diet sodas have been associated with lower bone mineral density, possibly due to phosphoric acid interfering with calcium absorption.
Mental Health: While inconclusive, some individuals report headaches or mood changes after consuming certain artificial sweeteners like aspartame.

Zero-Sugar vs. Sugary Drinks vs. Water


Feature	Zero-Sugar Drink	Sugary Drink	Water
Calories	Zero or very low	High	Zero
Sweeteners	Artificial (e.g., aspartame, sucralose) or Natural (e.g., stevia)	Sugar (sucrose, high-fructose corn syrup)	None
Dental Impact	High acidity can cause enamel erosion	Sugar feeds bacteria, high acidity causes erosion	None, protects teeth
Nutritional Value	None	None (empty calories)	High (hydration, mineral content)
Metabolic Impact	Potential metabolic confusion, insulin resistance link	Rapid blood sugar spikes, insulin resistance risk	None, supports healthy metabolism
Weight Impact	Conflicting evidence, some links to weight gain	Contributes to weight gain and obesity	None, supports healthy weight

A Broader Perspective on Sweeteners

Different sweeteners have varying effects, and research on their long-term impact is ongoing. The World Health Organization (WHO) has noted associations between non-sugar sweetener use and various health problems, emphasizing the need for further study. Artificial sweeteners have been shown to alter the gut microbiome in ways that may influence metabolism and glucose tolerance.

Expert Recommendations

Experts often suggest that zero-sugar drinks are not ideal long-term solutions, though they can help reduce sugar intake initially. The aim should be to decrease reliance on all sweetened beverages. Many studies linking zero-sugar drinks to negative outcomes are observational, showing correlation rather than direct causation, but the consistent findings on metabolic and gut changes warrant caution.

For more information on the chronic use of artificial sweeteners and their effects, one authoritative source is a review article available through the National Institutes of Health Chronic Use of Artificial Sweeteners: Pros and Cons.

Conclusion

While zero-sugar drinks offer a way to cut calories, research suggests potential downsides. They may negatively impact gut health, disrupt metabolic signals, and increase the risk of conditions like cardiovascular disease and type 2 diabetes. Their acidity can also harm dental health. Prioritizing unsweetened options like water is the best approach for long-term health. If you choose zero-sugar drinks, consume them in moderation and be aware of the potential risks identified by ongoing research.

Frequently Asked Questions

While they contain zero calories, some studies suggest they may increase appetite and cravings for other sweet or calorie-dense foods, potentially contributing to weight gain over time. Other factors, like the drinker's baseline health and diet, also play a significant role.

Some artificial sweeteners, such as sucralose and saccharin, can negatively impact the gut microbiome by altering the balance of intestinal bacteria. This can lead to digestive issues, inflammation, and potential metabolic problems.

Several large observational studies have linked frequent consumption of artificially sweetened beverages with a higher risk of cardiovascular events, including heart attack, stroke, and hypertension.

Zero-sugar drinks do not cause a blood sugar spike like regular sugary drinks. However, some research suggests they could decrease insulin sensitivity over time. Health professionals generally recommend drinking them in moderation while prioritizing water.

The link between artificial sweeteners and cancer is a common misconception. Regulatory bodies and cancer research organizations state there is no strong evidence linking approved sweeteners to cancer risk at normal consumption levels.

Yes, even without sugar, the high acidity from ingredients like citric and phosphoric acid can erode tooth enamel over time, increasing the risk of cavities and dental sensitivity.

The healthiest alternative is plain water. Other options include sparkling water with natural fruit juice, fruit-infused water, or unsweetened herbal tea. These choices provide flavor without the potential health risks associated with artificial sweeteners.

Some research suggests that the sweet taste without calories can disrupt the body's natural metabolic responses. This can potentially alter insulin and hunger hormone levels, impacting how the body processes glucose and fat.