Low calorie sweeteners in the current public health discussion

A presentation by Prof Adam Drewnowski at the ISA Conference 2018
Consumers use low calorie sweeteners (LCS) to reduce dietary sugar calories and manage body weight. Their efficacy has been confirmed repeatedly both in short-term laboratory studies, observational studies, and in longer-term randomized and placebo controlled clinical trials (RCT). Laboratory studies have consistently shown that LCS beverages do not enhance appetite, suppress satiety, or lead to overeating at the next meal or the next day. Rather LCS beverages promote a feeling of fullness in the short term. Observational studies of populations have shown that LCS use was associated with higher education and incomes and, importantly, with the intent to lose weight during the preceding 12 months. Any association with obesity or diabetes was most likely due to reverse causality. Users of LCS beverages, tabletop sweeteners and foods had higher-quality diets, engaged in more health behaviors, and lived in more affluent neighborhoods. Whereas earlier RCTs used to compare LCS beverages to regular sugar-sweetened beverages (SSB), the latest RCTs have compared LCS beverages to plain drinking water. Acute and long-term consumption of LCS beverages, compared to water, did not alter appetite, energy intakes, or macronutrient selection at multiple meals in a recent French study. Given the importance of adequate hydration and the established links between short term manipulations of hunger and satiety and the management of body weight in the long term, LCS beverages can be viewed as a useful tool for managing issues of public health concern, notably obesity and overweight.