New Delhi: Non-sugar sweeteners do little to help lose weight or reduce body fat, and may in fact increase the risk of Type 2 diabetes and cardiovascular diseases. Nutritionists, researchers, and doctors have been sounding warning bells for years, and now, the World Health Organization (WHO) has lent its weight to the argument.
In guidelines released Monday, the global health body recommended against the use of such products.
Synthetic or naturally derived non-nutritive sweeteners like aspartame, saccharin, and stevia extracts have been touted by companies as the ‘healthy’ substitute to sugar— especially for people watching their weight.
After reviewing the existing evidence, an international committee of experts from universities around the world led by WHO concluded that non-sugar sweeteners do not confer any long-term benefit in reducing body fat in adults or children. Not only that, these may put people at potential risk of Type 2 diabetes and cardiovascular diseases, and mortality in adults, in the long term.
“Replacing free sugars with NSS (non-sugar sweeteners) does not help with weight control in the long term. 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,” Francesco Branca, WHO director for Nutrition and Food Safety, said in a statement.
“NSS 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,” Branca said.
The recommendation does not apply to individuals who already suffer from diabetes.
Common non-sugar sweeteners include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia, and stevia derivatives. These may be sold on their own to be added to foods and beverages, or found in packaged foods and beverages.
The recommendation does not apply to personal care and hygiene products containing NSS, such as toothpaste, skin cream, and medications, or to low-calorie sugars and sugar alcohols or polyols (often found in food products labeled ‘sugar-free’, including hard candies, cookies, chewing gums, soft drinks), which are sugars or sugar derivatives containing calories and are therefore not considered NSS.
The WHO acknowledges that evidence between NSS and disease outcomes may be influenced by other factors affecting study participants. Therefore, these recommendations are conditional.
“This signals that policy decisions based on this recommendation may require substantive discussion in specific country contexts, linked for example to the extent of consumption in different age groups,” the WHO statement said.
The WHO guidelines on NSS are part of a suite of existing and forthcoming advisories on healthy diets that aim to establish lifelong healthy eating habits, improve dietary quality, and decrease the risk of noncommunicable diseases worldwide.
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Higher NSS intake in long-term
The expert body found that non-sugar sweeteners used in any manner resulted in reduced sugars and energy intake, lower body weight and lower body-mass index in short-term clinical trials — the majority of which lasted three months or less.
However, their use did not significantly affect other measures of body fatness or intermediate markers of cardiometabolic health, including glucose, insulin or blood lipids.
Evidence from a small number of longer-term trials — lasting six to 18 months — did not suggest an effect on body weight, the guidelines said.
When the intake of NSS was directly compared with the intake of free sugars — that is when one group in a trial received NSS, and another group received free sugars — those receiving NSS had lower body weight and BMI.
However, most of these trials provided foods and beverages containing NSS or free sugars in addition to existing diets and, therefore, did not directly measure the effects of replacing free sugars with NSS.
When NSS were compared with nothing/placebo or water, no effects on body weight or BMI were observed.
Evidence from prospective observational studies, with up to 10 years of follow-up, showed that higher intakes of NSS were associated with higher BMI and increased risk of incident obesity.
Higher intake of NSS in the long term was also found to be associated with increased risk of Type 2 diabetes, cardiovascular diseases and death.
The use of NSS — predominantly saccharin — was also associated with an increased risk of bladder cancer in some studies.
In children, one trial did show reduction in several measures of body fatness when sugar-sweetened beverages were replaced with those containing NSS. However, when results for BMI were combined with those from a second trial, no effect was observed.
Observational studies also did not suggest any significant link between NSS use and measures of body fatness.
Meta-analysis (statistical) of three observational studies among pregnant women also found an increased risk of preterm birth with higher NSS use during pregnancy. Other observational studies reported a link between NSS use during pregnancy and increased risk of asthma and allergies, and poorer cognitive function in offspring.
(Edited by Anumeha Saxena)
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