![]() ![]() Only data on aspartame (4 papers), saccharin (11 papers), and sucralose (14 papers) were included. Given the limited amount of data on the AS acesulfame and neotame, these AS were excluded from our review. In the end we selected 26 original papers to be included in our systematic review. At the end of our search, we found a total of 617 eligible papers which were reviewed separately by 2 reviewers (MS and AG) and any discrepancies were resolved by a third party (SM) 591 papers were excluded because of irrelevance to the specific questions being asked, not written in English, case reports, letters to the editor, or reviews reporting data of the same original studies. We retrieved potentially relevant articles and reviewed their reference lists to identify any studies missed by our search strategy. All searches were completed by June 8, 2015. The search strategies were adapted to suit the Embase databases as well, and duplicate papers found in both databases were eliminated. The searches were then limited to full articles in the English language, and no other filters were applied. We first constructed a search strategy for PubMed which combined MeSH terms and free text terms to construct a broad discovery net for articles on individual AS and each of these terms: fermentation, absorption, and GI tract. The purpose of this review is to evaluate the available literature on the effects of AS on the GI tract in order to determine whether they could be playing a role in GI symptoms, especially those experienced by IBS patients. 9 Some anecdotal evidence exists of AS triggering gastrointestinal (GI) symptoms in humans, but little has been published in the medical literature on this topic. Other non-nutritive sweeteners, such as stevia, exist but these are not technically considered to fall under the term “artificial sweeteners.” AS are often used for assistance with weight loss by decreasing the amount of calories consumed from sugar. 9, 10 The US Food and Drug Administration (FDA) has approved 5 AS to date: acesulfame, aspartame, neotame, saccharin, and sucralose. The prevalence of these nonnutritive sweeteners in products and their resultant ingestion by consumers has been increasing over time. 7, 8 Many commercially available foods and beverages contain artificial sweeteners (AS), sometimes unbeknownst to the consumer. 3– 6 To date, the greatest attention has focused on diets excluding FODMAPs (fermentable oligo-di-monosaccharides and polyols) or gluten in treatment of IBS symptoms. 1, 2 Roughly two thirds of patients with IBS associate the onset or worsening of their symptoms with food intake. Irritable bowel syndrome (IBS), a syndrome that is characterized by recurring episodes of abdominal pain, bloating, and altered bowel habits, is a common problem that is seen in approximately 10–20% of the general population. Keywords: Gastrointestinal tract, Irritable bowel syndrome, Microbiota, Motility, Sweetening agents This is especially pertinent in patients with irritable bowel syndrome, a population in whom dietary interventions are routinely utilized as a management strategy. Further research is needed to assess whether AS could be a potential cause of GI symptoms. The specific effects of AS on the microbiome have been conflicting and the available studies have been heterogeneous in terms of the population studied and both the AS and doses evaluated. The effect on motility is mainly indirect via increased incretin secretion, though the clinical relevance of this finding is unknown as the downstream effect on motility was not studied. The 2 main areas on which there is data to suggest that AS affect the GI tract include motility and the gut microbiome, though human data is lacking, and most of the currently available data is derived from in vivo studies. ![]() Overall, there is limited medical literature available on this topic. At the end of our search, we found a total of 617 eligible papers, 26 of which were included. Standard protocols for a systematic review were followed. Utilizing the PubMed and Embase databases, we conducted a search for articles on individual AS and each of these terms: fermentation, absorption, and GI tract. Artificial sweeteners (AS) are ubiquitous in food and beverage products, yet little is known about their effects on the gastrointestinal (GI) tract, and whether they play a role in the development of GI symptoms, especially in patients with irritable bowel syndrome. ![]()
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