Abstract
While non-caloric sweeteners (NCS) are food additives that have been used as a tool to reduce sugar consumption and total energy intake, there is currently a scientific debate around the real benefits of its use. NCS are some of the most evaluated substances in the scientific literature. Their security has been reviewed by international health regulatory agencies. Education of consumers and health professionals on these products must be strengthened in a rigorous and objective manner, based on the best scientific evidence and regulatory processes, coupled with clinical judgment. Since they exist, NCS have been used as substitutes for sucrose, particularly for people with diabetes mellitus and obesity. The controversy about whether they could favor the development of glucose intolerance or weight gain calls for a critical review of the literature. This consensus of the Asociacio?n Latinoamericana de Diabetes presents a review of the most commonly asked questions by health professionals, people with diabetes and consumers in general. This document condenses a diversity of scientific publications under the evidence-based medicine perspective, to elucidate whether the use of NCS in nutrition plans by substituting simple sugars, may or might not, favor weight reduction and maintenance, and particularly if its use in diabetic patient control programs may or might not contribute to better glycemic control. Some other sensitive subjects such as their use in the pediatric age, and during pregnancy and lactation, are also assessed, as well as their impact on intestinal microbiota.
Summary
The current consensus of the Latin-American Association of Diabetes (Asociación Latinoamericana de Diabetes (ALAD)) concludes that the consumption of low calorie sweeteners is safe within the Acceptable Daily Intake (ADI) levels and that their use can have benefits in energy reduction, weight loss and glucose control, when used to replace sugar in the context of a structured dietary plan. If their use does not lead to sugar replacement, they have neutral impact (neither beneficial nor adverse effects).
This ALAD Consensus presents a review of the most commonly asked questions by health professionals, people with diabetes and consumers in general about low calorie sweeteners and evaluates evidence according to the GRADE system. Their main conclusions in relation to the use of low calorie sweeteners by people with diabetes are that if they are used as sugar substitutes and within a structures dietary plan, they can help consumers reduce the consumption of carbohydrates and energy, and thus they can help in modest weight loss and glucose control. As anticipated, when used ad libitum, without sugar substitution and out of the context of a dietary plan, low calorie sweeteners do not seem to have any appreciable effects, neither beneficial nor adverse, on body weight or other metabolic outcomes. It is also concluded that their use in occasions that affect cardiovascular health, such as obesity, diabetes and metabolic syndrome can be a good alternative for reducing sugars intake.