Effects of Non-Nutritive Sweetener Mixers compared to Carbohydrate Mixers on Alcohol Pharmacokinetics and Patient-Reported Outcomes: A Systematic Review and Meta-Analysis

Authors

  • Shwetha Shenod PSGIMSR
  • Dhanikha SV
  • Hari Sudhan S

DOI:

https://doi.org/10.5195/ijms.2025.4011

Keywords:

Ethanol, Non-Nutritive Sweeteners, Nutritive Sweeteners, Gastric Emptying, Blood Alcohol Content

Abstract

Background: Alcohol-associated accidents pose a major global health burden, accounting for 4.7% of all deaths and 4.6% of total disability-adjusted life years. Alcohol impairs psychomotor performance, driving ability, and risk perception. These acute outcomes are largely determined by alcohol absorption and metabolism, which in turn is influenced by gender, body composition, enzyme polymorphisms, drinking state, and co-consumed mixers. While carbonation and caffeinated mixers have shown to alter the pharmacodynamics of alcohol, the effects of non-nutritive sweetener (NNS) mixers remain underexplored. Given the increasing prevalence in the use of NNS mixers, clarifying their impact on alcohol pharmacokinetics and subjective intoxication and related outcomes is critical.

 

Methods: A systematic review and meta-analysis of studies obtained from three databases (PubMed, EMBASE, Scopus) was conducted in accordance with PRISMA guidelines. Primary outcomes assessed were breath or blood alcohol concentration (BrAC/BAC) and gastric emptying (t1/2, tlag). Secondary outcomes included subjective ratings of intoxication and related psychomotor tests. Risk of bias was assessed using the RoB2 tool. Standardized mean differences (SMD) was calculated for BrAC Cmax. Subgroup analysis were performed separately for the breathalyzer used, standardized ethanol dosing, and non-nutritive sweetener composition. Heterogeneity was quantified using I² statistic, and sensitivity and publication bias analyses were performed when required adjusting for the small sample size.

 

Results: Five studies were reviewed, of which four (34 NNS vs. 34 carbohydrate (CHO)) contributed to meta-analysis. All included studies were rated as having an overall risk of bias of “some concerns”. NNS mixers were associated with higher not statistically significant peak BrAC (SMD = +1.01, 95% CI = -0.44 to 2.46, p = 0.097; I² = 53%). Subgroup analyses done for the type of breathalyzer used (p=0.1), standardized ethanol dose (p=0.80), non-nutritive sweetener content (p= 0.17) were not significant. Sensitivity analysis showed that the study by Akca et al. had a strong influence on the overall results. Gastric half-emptying time (t½) with NNS mixers were observed to be shorter than with CHO mixers in two studies. Marczinski & Stamates found that alcohol with NNS mixers slowed reaction times and increased inhibition failures, indicating impaired cognitive control. Despite Brickley et al. observing no significant subjective differences between NNS and CHO mixers, there was a trend toward poorer vehicle control and greater risk-taking in men. Acka et al. reported expected alcohol-related changes in intoxication and alertness with no significant differences between mixer types.

 

Conclusion: Current evidence suggests that NNS mixers may accelerate gastric emptying and raise peak alcohol levels compared to CHO mixers, without proportionally increasing subjective patient-reported or similarly reported intoxication levels. This mismatch between physiological and perceived impairment highlights potential safety risks and underscores the need for further research on diet mixer use.

Downloads

Published

2025-12-31

How to Cite

Shenod, S., Dhanikha SV, & Hari Sudhan S. (2025). Effects of Non-Nutritive Sweetener Mixers compared to Carbohydrate Mixers on Alcohol Pharmacokinetics and Patient-Reported Outcomes: A Systematic Review and Meta-Analysis. International Journal of Medical Students, 13, S245. https://doi.org/10.5195/ijms.2025.4011

Issue

Vol 13. (2025): Supplement 1

Section

Abstracts of the WCMSR

Categories

License

Copyright (c) 2025 Shwetha Shenod, Dhanikha SV, Hari Sudhan S

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

  1. The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
  2. Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
  3. The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
    1. Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
    2. The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
    3. Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
    4. Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
    5. The Author represents and warrants that:
      1. the Work is the Author’s original work;
      2. the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
      3. the Work is not pending review or under consideration by another publisher;
      4. the Work has not previously been published;
      5. the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
      6. the Work contains no libel, invasion of privacy, or other unlawful matter.
    6. The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.

Enforcement of copyright

The IJMS takes the protection of copyright very seriously.

If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.

If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org

 

Infringing material

If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org