Who Should Avoid Eating Artificial Sweeteners?

October 12, 2025 •

4 min read

According to the FDA, certain approved artificial sweeteners are generally recognized as safe for the general population when consumed within acceptable daily intake levels, but specific groups should exercise caution. Understanding who should avoid eating artificial sweeteners is vital for managing specific health conditions and preventing potential side effects.

Quick Summary

This guide examines specific populations, including those with PKU, IBS, and certain chronic conditions, who should limit or avoid artificial sweeteners due to health risks. It also provides a comparison of common sweeteners and outlines safer alternatives.

Key Points

Phenylketonuria (PKU): Individuals with PKU must avoid aspartame completely due to its phenylalanine content, which can be toxic for them.
Irritable Bowel Syndrome (IBS): Many IBS patients find sugar alcohols like sorbitol and mannitol, as well as sucralose, can trigger gas, bloating, and diarrhea.
Pregnancy and Breastfeeding: While most approved sweeteners are considered safe in moderation, some, like saccharin, should be avoided. Overall, experts advise caution and moderate consumption.
Cardiovascular Risk: The sugar alcohol erythritol has been linked to increased blood clot risk in some studies, prompting caution for those with existing heart issues.
Migraine Sufferers: Aspartame and other artificial sweeteners can be a trigger for migraines in some susceptible individuals, who should monitor their intake.
General Caution: Focusing on naturally sweet whole foods and reducing overall sweetness in the diet can be a healthy strategy for anyone concerned about potential side effects.
Chronic Conditions: Individuals with kidney or liver disease should consult a doctor before consuming artificial sweeteners, as some studies suggest potential complications.

Key Groups Who Should Avoid Artificial Sweeteners

While artificial sweeteners offer a low-calorie alternative to sugar, they are not suitable for everyone. Certain individuals may experience adverse health effects due to underlying conditions or sensitivities. Knowing your own health profile is key to making an informed decision about consumption.

Individuals with Phenylketonuria (PKU)

People with the rare genetic disorder Phenylketonuria (PKU) must completely avoid aspartame. Aspartame is made from two amino acids, one of which is phenylalanine. Individuals with PKU cannot properly metabolize phenylalanine, leading to a dangerous buildup in the body that can cause serious neurological problems and brain damage. For this reason, products containing aspartame must legally carry a warning label for phenylketonurics.

People with Irritable Bowel Syndrome (IBS)

Many individuals with IBS find that certain artificial sweeteners trigger or worsen their symptoms, such as bloating, gas, cramping, and diarrhea. Sugar alcohols (polyols) like sorbitol, xylitol, and mannitol are a common culprit. These are not fully absorbed by the small intestine and can ferment in the large intestine, leading to significant gastrointestinal distress. While some non-nutritive sweeteners like sucralose have also been linked to gut dysbiosis in some studies, sugar alcohols are the most well-documented issue for IBS patients.

Pregnant and Breastfeeding Individuals

While some sweeteners like aspartame and sucralose are generally considered safe in moderation during pregnancy by regulatory bodies, caution is advised. Some research suggests potential links between maternal sweetener consumption and higher infant weight gain or altered taste preferences. Moreover, the sweetener saccharin has been shown to cross the placenta and potentially accumulate in fetal tissue, making it an option to avoid. The best approach is to limit overall intake and consult a healthcare provider.

Those at High Risk for Cardiovascular Disease

Recent research has raised concerns about the potential link between some artificial sweeteners and increased cardiovascular risk. Specifically, a 2023 Cleveland Clinic study found a link between the sugar alcohol erythritol and a potentially higher risk of cardiovascular events like strokes or heart attacks. While more research is needed, individuals with existing risk factors, such as obesity, diabetes, or high blood pressure, may want to exercise caution with sweeteners, especially sugar alcohols.

Individuals with Migraine

For some susceptible individuals, certain artificial sweeteners have been identified as potential migraine triggers. Aspartame, sucralose, and saccharin are among those commonly cited. The exact mechanism is not fully understood but may involve effects on neurotransmitters or changes in blood flow. Keeping a headache diary and undergoing an elimination diet can help identify if a specific sweetener is a trigger.

People with Chronic Kidney Disease

There is conflicting information regarding the impact of artificial sweeteners on kidney health. An older observational study found an association between artificially sweetened soda consumption and an increased decline in kidney function among nurses. Conversely, more recent research does not support a causal link. However, some doctors advise kidney disease patients to be cautious, especially with dark-colored diet sodas due to phosphorus content.

Comparison of Common Artificial Sweeteners


Sweetener	Example Brand	Who Should Avoid	Potential Side Effects	Notes
Aspartame	NutraSweet, Equal	Individuals with PKU, those sensitive to potential migraines or mood swings.	Headaches, dizziness, mood changes, potential digestive upset.	Breaks down into phenylalanine; must be labeled for PKU.
Sucralose	Splenda	Individuals with IBS, those who bake with it at high temperatures, those on certain medications.	Gas, bloating, diarrhea, potential gut microbiome disruption.	When heated, can produce potentially toxic chloropropanols.
Stevia	Truvia, SweetLeaf	People with ragweed allergies, those on blood pressure or diabetes medication without supervision.	Bloating, nausea, potential impact on blood pressure/glucose.	Blends may contain sugar alcohols and cause digestive issues.
Sugar Alcohols (e.g., Sorbitol, Erythritol)	Many sugar-free products	Individuals with IBS, those at high cardiovascular risk (especially erythritol).	Bloating, gas, diarrhea, laxative effect.	Some, like erythritol, are better tolerated than others but still carry risks.

Natural Alternatives to Artificial Sweeteners

For those who need or choose to avoid artificial sweeteners, several natural options exist. It's important to remember that 'natural' doesn't always mean healthier in large quantities, but these options can be useful for reducing processed sweetener intake.

Monk Fruit Extract: A calorie-free sweetener derived from the monk fruit. It's generally recognized as safe and doesn't cause the same digestive issues as many artificial options.
Stevia (Purified Extract): For those without sensitivities, purified stevia extract is a plant-based, zero-calorie option. Look for pure extracts to avoid added sugar alcohols.
Pure Honey or Maple Syrup: These contain calories but also offer some minerals and antioxidants. Use them in moderation.
Dates: Whole, pitted dates offer natural sweetness along with fiber and nutrients. They are excellent for baking or as a snack.

Conclusion: Mindful Consumption is Key

While most regulatory agencies consider artificial sweeteners safe for the general population when used in moderation, it is clear that they are not a universal solution for everyone. People with specific health conditions such as PKU, IBS, and those at high risk for heart disease should be particularly cautious or avoid certain sweeteners entirely. Pregnant women, migraine sufferers, and individuals with chronic diseases should also consult a healthcare provider. The varied effects on gut microbiota, medication absorption, and other metabolic functions underscore the complexity of their impact. Ultimately, the healthiest approach for many is to retrain the palate to prefer less sweet flavors and focus on natural, whole foods, using sweeteners only sparingly. If you have concerns, speaking with a doctor or registered dietitian is the best course of action to create a personalized plan. Consult the FDA for detailed information on approved sweeteners.

Frequently Asked Questions

Individuals with Phenylketonuria (PKU) must avoid all products containing aspartame, as their bodies cannot metabolize the amino acid phenylalanine, one of its components. All products with aspartame are required to have a specific warning label.

Yes, some artificial sweeteners, particularly sugar alcohols like sorbitol, xylitol, and mannitol, are known to cause digestive issues. They are not fully absorbed by the body and can ferment in the gut, leading to gas, bloating, and diarrhea.

Most FDA-approved artificial sweeteners are considered safe in moderation during pregnancy, but experts advise caution. Saccharin should be avoided as it can cross the placenta. Always discuss any sweetener consumption with your healthcare provider during pregnancy.

For some susceptible people, yes. Aspartame is one artificial sweetener that has been linked to triggering headaches and migraines. If you suspect a connection, tracking your intake and monitoring symptoms can help identify a trigger.

People with Irritable Bowel Syndrome (IBS) often react negatively to sucralose, experiencing symptoms like bloating, gas, and stomach cramps. Some research suggests it can disrupt gut bacteria, so those with sensitive digestive systems may be better off avoiding it.

Some artificial sweeteners, like sucralose, can become unstable when heated to high temperatures. When combined with fats like glycerol, this can create potentially toxic compounds called chloropropanols. It is best to avoid cooking or baking with sucralose at high heat.

Good natural, non-caloric options include purified stevia extract and monk fruit extract. Both are derived from plants and are generally well-tolerated. For low-calorie options with nutritional value, honey or pure maple syrup can be used in moderation.