The present review of noncaloric sweeteners (NCSs) by the Asociación Mexicana de Gastroenterología was carried out to analyze and answer some of the most frequent questions and concerns about NCS consumption in patients with gastrointestinal disorders, through a thorough review of the medical literature. A group of gastroenterologists and experts on nutrition, toxicology, microbiology, and endocrinology reviewed and analyzed the published literature on the topic. The working group formulated conclusions, based on the scientific evidence published, to give an opinion with respect to NCS ingestion. Current evidence does not confirm the carcinogenic potential of NCSs. However, the studies analyzed showed that saccharin could have a proinflammatory effect and that polyols can cause gastrointestinal symptoms and manifestations, depending on the dose and type of compound. The ingestion of xylitol, erythritol, sucralose, aspartame, acesulfame K, and saccharin could increase the secretion of the gastrointestinal hormones that regulate intestinal motility, and stevia and its derivatives could have a favorable effect on the percentage of liver fat. Caution should be taken in recommending aspartame consumption in patients with chronic liver disease because it reduces the ratio of branched-chain amino acids to aromatic amino acids. In addition, NCS ingestion could modify the composition of the intestinal microbiota, having an effect on gastrointestinal symptoms and manifestations. It is important to continue conducting causality studies on humans to be able to establish recommendations on NSC consumption.
The present review by a group of experts from the Mexican Association of Gastroenterology reviewed the current scientific literature about the consumption of low/no calorie sweeteners in patients with gastrointestinal disorders and concluded that, while limited cell experiments and animal studies have reported some potential impact on gut of sweeteners tested in very high doses, none of the claimed effects of low/no calorie sweeteners on gastrointestinal health have been confirmed in humans.
A summary of the conclusions of this paper about low/no calorie sweeteners is presented hereafter:
- Current evidence does not confirm a carcinogenic potential of low/no calorie sweeteners.
- There is little evidence about the effect of low/no calorie sweeteners on Nonalcoholic Fatty Liver Disease (NAFDL) and Nonalcoholic Steatohepatitis (NASH). Studies in animal models have shown no association of aspartame with the pathophysiology of NASH, while stevia derivatives may have a favorable effect on the percentage of liver fat.
- At experimental level, there is little evidence of the potential proinflammatory effect of saccharin, however no human study has shown any such effect. The review also suggests that steviol glycosides may have anti-inflammatory effects.
- Cell or tissue (in vitro) experiments that typically test sweetener concentrations that are extraordinary high have suggested that low/no calorie sweeteners could increase the secretion of the gastrointestinal hormones that regulate intestinal motility. However, contrary to findings of some in vitro studies, most clinical human trials have found no effects of low/no calorie sweeteners on circulating incretin levels. Collectively, the evidence from in vivo animal and human studies do not support the notion that low/no calorie sweeteners induce the release of clinically meaningful quantities of gut hormones.
- Limited animal and human studies have suggested the notion that low/no calorie sweeteners could modify the composition of gut microbiota. However, a recent thorough review of the literature on in-vivo data concluded that current studies investigating the impact of LCSs on gut microbiota show no evidence of any adverse effect on the gut microbiota at doses relevant to human consumption (Lobach et al, 2019). The authors call for more weel-designed future research in humans.