A Review Article on Effect of Sugar Substitutes on Metabolic Health

Sugar substitutes, encompassing both artificial and natural sweeteners, have become increasingly prevalent in food, beverage, and pharmaceutical formulations as alternatives to sucrose and other caloric sugars. These compounds provide intense sweetness with minimal or zero caloric content, making them especially appealing for individuals managing conditions such as obesity, type 2 diabetes mellitus, and metabolic syndrome, as well as for the general population seeking healthier dietary choices. Sugar substitutes are not only used in consumer products but also play a vital role in the formulation of sugar-free medicinal preparations, including syrups, chewable tablets, and oral dispersible films. Despite their apparent benefits, there is growing scientific concern regarding their long-term impact on metabolic health. Emerging studies have linked certain non-nutritive sweeteners to alterations in gut microbiota composition, dysregulated insulin signaling, and appetite modulation, raising questions about their overall safety and efficacy. Furthermore, the metabolic response to sugar substitutes may vary depending on individual factors such as microbiome diversity, genetic predisposition, and habitual diet. This review provides a comprehensive analysis of sugar substitutes, including their classification, physicochemical properties, mechanisms of sweetness perception, and applications in pharmaceutical formulations. Additionally, the review evaluates the advantages and disadvantages of their use, addresses current regulatory frameworks established by agencies like the FDA, EFSA, and FSSAI, and highlights areas for future research.