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Sugar Substitutes and IBD

Membership, The Microbiome

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Artificial sweeteners have been used to replace sugar to help curb weight gain, lowering a person’s chances of developing metabolic disease including type 2 diabetes and cardiovascular diseases.  We know that sugar substitutes are used in many products including sodas, baked goods, and others.  Sugar alcohols do not cause tooth decay like sugar can and do not spike your blood sugar in the same capacity as regular sugar can. For these reasons, sugar substitutes are used.

Artificial sweeteners that are commonly used

  • Aspartame (NutraSweet, Equal)
  • Acesulfame potassium
  • Advantame
  • Neotame
  • Saccharin
  • Sucralose
  • Monk Fruit
  • Stevia, Truvia, PureVia


What we know about sugar substitutes and microbiome

Artificial sweeteners are used as non-calorie sugar sweeteners at an increasing rate.  The most widely consumed sweeteners include saccharin, sucralose, and aspartame.  Studies have shown sugar substitutes contribute to an imbalance of gut bacteria.  This imbalance also known as dysbiosis can increase the release of LPS which are lipopolysaccharides, responsible for intestinal permeability.  The problem with intestinal permeability, from an IBD standpoint, is the correlation between developing a flare and even contributing to the pathogenesis of IBD.  Some research has shown sugar substitutes can cause gastrointestinal distress including gas and diarrhea.


What does the research say?

In one study, Crohn’s Disease-like ileitis (inflammation in the ileum) mouse model was compared to an ileitis-free mouse model with respect to their gut microbiome.  Supplementation of sucralose, also known as Splenda, was provided to the Crohn’s Disease mouse model for 6 weeks.  Results indicated that both mice models developed dysbiosis and the mice who had ileitis, had a significant increase in pro-inflammatory properties and unhealthy gut bacteria (1).  This study indicated the possibility of Splenda consumption, in healthy individuals, not being pro-inflammatory compared to those with IBD.  Another study reported chronic intake of sucralose or saccharin that were at safe levels (according to the FDA) changed certain components that increase inflammation in mouse gut microbiome (2).  Artificial sweeteners can either be pro-inflammatory or even in some situations, anti-inflammatory.  Short-chain fatty acids (SCFA) provide prebiotics and colonic bacteria to the gut.  They are anti-inflammatory and are lower in IBD patients.  SCFA provides energy and maintains intestinal health which can also be challenging for IBD patients.   Research has shown how artificial sweeteners can change the abundance and synthesis of SCFA production (2).  Types of SCFA include butyrate, propionate, and acetate.  Neotame (sold as Newtame), another type of artificial sweetener, decreased Firmicutes (help produce butyrate and maintains colon health) and increased Bacteroidetes (inflammatory) in the gut microbiota (2). Another artificial sweetener, Acesulfame potassium, has been shown to also change the microbial composition of the gut by decreasing the production of butyrate.  Stevia, another type of artificial sweetener, receives mixed results when it comes to having pro-inflammatory properties.


Key Takeaways

Artificial sweeteners have been shown to negatively impact the gut microbiota in patients with IBD with long-term consumption.  Following a Westernized diet that is high in fat along with sugar substitutes can greatly alter the gut microbiota.  More research within this area can be beneficial to the IBD community for better recommendations.



  1. Rodriguez-Palacios, A., Harding, A., Menghini, P., Himmelman, C., Retuerto, M., Nickerson, K. P., Lam, M., Croniger, C. M., McLean, M. H., Durum, S. K., Pizarro, T. T., Ghannoum, M. A., Ilic, S., McDonald, C., & Cominelli, F. (2018). The Artificial Sweetener Splenda Promotes Gut Proteobacteria, Dysbiosis, and Myeloperoxidase Reactivity in Crohn’s Disease-Like Ileitis. Inflammatory bowel diseases24(5), 1005–1020.


  1. Basson AR, Rodriguez-Palacios A, Cominelli F. Artificial Sweeteners: History and New Concepts on Inflammation. Front Nutr. 2021 Sep 24;8:746247. doi: 10.3389/fnut.2021.746247. PMID: 34631773; PMCID: PMC8497813.