Recently, I saw a patient who was diabetic, hypertensive, had high cholesterol and known heart disease, and who needed to lose weight for health reasons. As we talked about weight control, he asked me what I thought about artificial sweeteners. Based on his tone of voice, he pretty clearly expected me to say they're bad and he should refrain from using them. He acted pretty surprised when I said, "God is merciful. If it weren't for artificial sweeteners, some people would remain overweight and have to deal with the health consequences that come with obesity. And others who are diabetic would be more likely to 'cheat' and over-do it on real sweets."

As with many things in life, we have to deal with "balance." Every medicine I prescribe has a good side and a bad side to it, and it affects different people in different ways. I view artificial sweeteners as probably being the same---they have a good and bad side to them and they may affect different people in different ways. When used properly by the right people, they are fine--even "good."

If you take just enough of an anti-inflammatory medicine, you generally have a good effect---pain relief. However, if you take too much for your body or if you're weakened or super-sensitive to that particular medicine, you can get an ulcer and/or bruise or bleed too freely. Some anti-inflammatories work great on one person but don't help another. That's why we have to try different ones before we settle on one that works for each individual. Every body is different.

My point is that we must be wise in our use of artificial sweeteners just as we try to be wise in our use of other chemical substances like medicines. Just as no single medicine is "right" for everybody, neither aspartame, sucralose, or sugar alcohols are right for everybody. For example, some people appear to get headaches and other weird symptoms when they consume aspartame.

However, does that mean that aspartame is wrong for everybody? Not in my opinion. A convincing, double-blind, placebo-controlled study may come along someday to change my mind. But, for now, I'm not aware of any study that proves that aspartame is uniformly dangerous and should be taken off the market.

Likewise, if a person consumes a small amount of the sugar alcohols, he or she may not notice any negative effect. But, if he or she consumes too much, the result may be unwanted GI side effects.

What about saccharin? That one is different. The scientific data are clear that saccharin is associated with bladder cancer in lab animals, and I advise my patients to stay clear from it.

How about sucralose? So far, so good. No problems that I'm aware of.

Try to maintain a proper perspective. If a person is 50 years old, overweight, and suffers with high blood pressure, high cholesterol, diabetes, and heart disease, he is a ticking time bomb. His priority is to lose weight or he might die sooner rather than later. Why should this person worry about remote, unproven possibilities of illness from artificial sweeteners when he has a KNOWN problem (life-threatening obesity) right under his nose? Take care of first things first. Lose the weight. You can deal with the nutrition minutia later.

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