A new review of studies may make you want to put down the diet soda.

<p>Bill Boch/Getty Images</p>

Nearly half of all American adults enjoy at least an occasional food or drink sweetened with artificial sweeteners like aspartame, sucralose, stevia, saccharin, and advantame. And that number is on the rise, as more people look to reduce their sugar intake for health reasons—but may not be quite ready to stop indulging their sweet tooth altogether.

Related:6 Reasons Why You’re Always Craving Sugar—Plus Expert Tips on How to Stop

A new review of studies released by the World Health Organization (WHO) may dampen the enthusiasm for a daily diet soda or sugar-free treat. Researchers looked at 283 different artificial sweetener studies, and found that using artificial sweeteners may come with some unexpected and not-so-beneficial health impacts, especially if they’re used regularly long term.

<p>Bill Boch/Getty Images</p>

In fact, in the recommendation, the WHO suggests that people—except for those with pre-existing diabetes—stop using artificial sweeteners altogether. “The WHO’s statement on the negative health effects of artificial sweeteners are consistent with the message from many other large health organizations—that any processed food, including artificial sweeteners, are not part of a heart healthy diet,” says Charles German, MD, MS, assistant professor of cardiology at the University of Chicago.

Here’s the scoop on what the studies found regarding using artificial sweeteners—and what that could mean if you’re a diet drink or sugar-free sweets fan.

Artificial sweeteners may increase your risk of developing type 2 diabetes.

Type 2 diabetes has become one of the most common health issues, where your body can’t use the insulin you produce to process glucose (AKA sugar) effectively. And it would seem like using non-sugar sweeteners like aspartame would benefit you if you’re at risk of developing type 2 diabetes by helping reduce the amount of straight-up glucose you eat.

But the WHO’s review of studies found that using more artificial sweeteners increased the risk of developing type 2 diabetes, and did nothing to help improve subjects’ glycemic control. In fact, consuming artificial sweeteners made it more likely that the subjects had a higher fasting glucose level.

Related:10 Low-Sugar Fruits That Won’t Make Your Blood Sugar Spike

Non-sugar sweeteners could increase your risk of cardiovascular issues.

The WHO’s review of studies found that eating or drinking more artificial sweeteners increased the risk of strokes, heart attacks, and other cardiovascular events by nearly one-third, and also increased the risk of dying if you have a heart attack or stroke. It was also linked with an increased risk of developing hypertension.

“I think people should be concerned about the link between artificial sweeteners and heart disease, especially if they already have existing risk factors for heart disease,” Dr. German says.

Artificial sweeteners may increase your risk of death.

One of the most troubling findings was that consuming more artificial sweeteners (the equivalent of four or more artificially sweetened beverages per day) increased the risk of death by 12 percent, even when the study results were analyzed to remove people with high blood pressure or cholesterol, type 2 diabetes, or other cardiovascular diseases.

Related:3 Healthy Ways to Sweeten Food Without Sugar

Sugar-free foods and drinks may lower your calorie intake—but not your weight.

They’re called “diet” sodas for a reason, and the study review found that eating and drinking more artificial sweeteners reduced the overall caloric intake by more than 500 calories, and the sugar intake by 39 grams per day. But even when fewer calories were consumed, it didn’t necessarily result in weight loss. Some studies reported short-term weight loss, while longer studies found that using artificial sweeteners increased the risk of weight gain.

Other studies found that eating more non-sugar sweeteners may boost your appetite—which is probably not the effect most people who eat artificial sweeteners are hoping for.

Artificial sweeteners were a mixed bag for pregnant women and their babies.

Good news: Drinking and eating artificially sweetened products had no impact on the risk of developing gestational diabetes—but it was associated with an increased risk of a preterm birth.

As for the kids of women who used artificial sweeteners, there were some mixed results on whether it impacted their kids’ BMI. One study found that using non-sugar sweeteners doubled the risk of the baby being overweight at their first birthday, another found that there was no association with BMI when the kids were assessed at seven years old.

Artificial sweeteners had little to no impact on other potential health issues.

Most of the studies included in the WHO review found no link between artificial sweeteners and cancer risk—except for an increased risk of bladder cancer, which was especially linked to the use of saccharin. There was also no impact on the risk of developing chronic kidney disease.

So what’s the bottom line?

The increased risks of developing type 2 diabetes, cardiovascular disease, and other health issues may lead you to cut back on your sugar-free sweetener habit—especially if you’re mostly using these sweeteners to help you manage your blood glucose levels or other health issues that might actually be made worse by artificial sweetener use.

“Artificial sweeteners should be limited or avoided if possible, and the focus should be on natural, whole foods without any processing,” Dr. German says. “We don’t know for sure what amount may be considered safe, and this likely depends on the individual,”

While you may not decide to step away altogether, it’s probably a good idea to limit your usage, and look for more natural ways to indulge your sweet tooth—or try to curb those sweet cravings altogether.

“People need to consider other ways to reduce free sugars intake, such as consuming food with naturally occurring sugars, like fruit, or unsweetened food and beverages,” says Francesco Branca, WHO Director for Nutrition and Food Safety. “Non-sugar sweeteners are not essential dietary factors and have no nutritional value. People should reduce the sweetness of the diet altogether, starting early in life, to improve their health.”

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