Low calorie sweeteners in diabetes: updated reports from Diabetes UK, the Latin-American Association for Diabetes (ALAD) and the American Diabetes Association (ADA)


Posted: 27 May 2019

A summary of recent position statements and consensus by diabetes organisations globally

Highlights:

  • Low calorie sweeteners are safe for people with diabetes with current intake levels being within the Acceptable Daily Intakes.
  • Low calorie sweeteners have a neutral effect on glucose control; they do not cause a spike in blood glucose, but they should not be expected to have magic “glucose-reduction” properties either.
  • Replacing sugars with low calorie sweeteners can be a helpful strategy to aid glucose and weight management in people with diabetes, but overall diet quality is key.

Over the last decade, numerous health-related organisations worldwide have issued position statements, consensus reports or nutritional guidelines about the use of low calorie sweeteners in diabetes. These reports aim to inform healthcare professionals in order to be able to provide evidence-based information to their patients. This is particularly important for people dealing with diabetes because low calorie sweeteners, used instead of sugar, help them to keep enjoying sweet taste without causing a spike in blood glucose levels after intake.

However, despite reassurance from regulatory authorities about the safety of low calorie sweeteners and from health organisations about their role in glucose control, people still receive confusing and conflicting information about low calorie sweeteners, and thus the frequent update of these reports is important. The current article provides a summary of recently published position statements and consensus reports from Diabetes UK and the Latin-American Association of Diabetes, as well as information about the updated nutrition recommendations by the American Diabetes Association.

Diabetes UK: “The use of low or no calorie sweeteners. Position Statement

Diabetes UK recently updated its Position Statement on low or no calorie sweeteners (LNCS), concluding overall that: “LNCS are shown to be safe and they can be used as part of a strategy for adults and children in the management of weight and diabetes”. Upon review of available evidence and research gaps on this subject, and following discussions with nutrition experts, dietitians, academics and people with diabetes as part of a consensus group, the updated position provides a set of recommendations in relation to the safety of low calorie sweeteners, their role in weight management and diabetes.

Some key recommendations of the updated position statement regarding the use of low calorie sweeteners include:

  • Low calorie sweeteners’ safety: “The use of LNCS remains safe with current intake levels within the ADIs [Acceptable Daily Intakes]. Any new safety issues arising from new research are regularly monitored.
  • Role in weight management: “Substituting LNCS for free sugars (especially in sugar sweetened beverages) may be a useful, relatively simple, strategy (or a ‘stepping stone’) to help reduce calorie intake and assist with weight management. […] The use of LNCS to aid weight loss should be in the context of an overall healthy diet and a wider weight management programme.
  • Role in diabetes management: “Replacing free sugars with LNCS can be a helpful strategy to aid glucose management.
  • Consumption in children: “LNCS are safe for children to consume up to the ADIs. LNCS (particularly substituting sugar-sweetened beverages with LNCS sweetened beverages) can be a useful strategy for children with diabetes to aid their glycaemic management.
  • Low calorie sweeteners and diet quality: “Healthcare professionals, such as dietitians, should assess overall diet quality and lifestyle in people who regularly consume sugar-sweetened beverages or LNCS sweetened beverages. LNCS can be used as a stepping stone to reduce intake of sugar in the diet as part of an overall healthy eating pattern.

You may download the full Diabetes UK Position Statement on “The use of low or no calorie sweeteners” and review all recommendations by Diabetes UK on its official website by clicking here.

Latin-American Association of Diabetes: Consensus on low calorie sweeteners in persons with diabetes

Reviewing current evidence in a wide area of subjects regarding the use of low calorie sweeteners, the recent consensus of the Latin-American Association of Diabetes (Asociación Latinoamericana de Diabetes (ALAD)) overall 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 calorie reduction, weight loss and glucose control, when used to replace sugar in the context of a structured dietary plan. In addition, the report clarifies that if their use does not lead to sugar replacement, low calorie sweeteners have neutral impact (neither beneficial nor adverse effects).

This consensus was developed by a group of academic experts from several countries of Latin America and aims to present a review of the most commonly asked questions by health professionals, people with diabetes and consumers in general about low calorie sweeteners. In relation to the role of low calorie sweeteners in diabetes and weight management, some of the key conclusions include:

  • If low calorie sweeteners are used as sugar substitutes and within a structured dietary plan, they can help consumers reduce the consumption of carbohydrates and energy (calories) intake, and thus they can help in modest weight loss and glucose control.
  • When used ad libitum, without sugar substitution and out of the context of a dietary plan, sweeteners do not seem to have any appreciable effects, neither beneficial nor adverse, on body weight or other metabolic outcomes.
  • Their use on occasions that affect cardiovascular health, such as obesity, diabetes and metabolic syndrome can be a good alternative for reducing sugars intake.

You may review and download the full ALAD Consensus on low calorie sweeteners in diabetes, which is available in Spanish, on the ALAD journal’s website by clicking here.

American Diabetes Association (ADA): Nutrition recommendations for people with diabetes or prediabetes – Is there a role for low calorie sweeteners?

In a Consensus Report by the American Diabetes Association (ADA), a group of experts concluded to evidence-based guidelines about individualizing nutrition therapy for adults with diabetes or prediabetes. With regard to low calorie sweeteners, the report states that, “Replacing added sugars with sugar substitutes could decrease daily intake of carbohydrates and calories. These dietary changes could beneficially affect glycemic, weight, and cardiometabolic control.”, however, it also stresses that “people should be counselled to avoid compensating with intake of additional calories from other food sources.” Indeed, low calorie sweeteners are not magic bullets and they do not automatically turn a food into a healthy option as this depends on the overall ingredient synthesis of a food or drink. However, as the report remarks, if they are used to replace caloric sweeteners, without caloric compensation, they may be useful in reducing caloric and carbohydrate intake.

Similarly, Diabetes UK updated its nutrition guidelines in March 2018. In these guidelines, it is concluded that “low calorie sweeteners are safe and may be recommended”. For more information, you may read the ISA article presenting a summary of nutrition guidelines from different European countries, the US and Canada in relation to the usage of low calorie sweeteners in diabetes by clicking here.

Conclusion

The key and common remark of every position statement, consensus report or nutrition guidance from health organisations is that what counts most is the overall diet quality. In the context of an overall healthy diet, low calorie sweeteners can be part of the toolbox along with other strategies in dealing with obesity and diabetes.

References

  1. Diabetes UK. The use of low or no calorie sweeteners. Position Statement (Updated December 2018). Available at: https://www.diabetes.org.uk/professionals/position-statements-reports/food-nutrition-lifestyle/use-o...
  2. Laviada-Molina H, Escobar-Duque ID, Pereyra E, Romo-Romo A, Brito-Córdova G, Carrasco-Piña E, González-Suárez R, López-García R, Molina-Seguí F, Mesa-Pérez JA. Consenso de la Asociación Latinoamericana de Diabetes sobre uso de edulcorantes no calóricos en personas con diabetes [Consensus of the Latin-American Association of Diabetes on low calorie sweeteners in persons with diabetes]. Rev ALAD. 2018;8:152-74
  3. Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KHK, MacLeod J, Mitri J, Pereira RF, Rawlings K, Robinson S, Saslow L, Uelmen A, Urbanski PB, Yancy Jr. WS. Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report. Diabetes Care. 2019 May;42(5):731-754
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