The International Sweeteners Association (ISA) Conference 2018

“The science behind low calorie sweeteners: where evidence meets policy”

Tuesday, 6 November 2018
Royal Society of Medicine, 1 Wimpole street, London, UK

The International Sweeteners Association (ISA) organised its 3rd Conference in 2018, themed “The science behind low calorie sweeteners: where evidence meets policy”. More information about the ISA Conference 2018, the scientific programme and practical details is available below.

The ISA Conference 2018 was endorsed by the Association for Nutrition (AfN) and the British Dietetic Association (BDA). Please note that BDA endorsement applies only to the educational content of the learning activity.

About the International Sweeteners Association (ISA) Conference 2018

Committed to its mission to inform about and to enhance understanding of the most up-to-date nutritional and scientific information in relation to low calorie sweeteners’ use, role and benefits, the International Sweeteners Association (ISA) organised its first scientific conference in Brussels in 2011, followed by a second ISA Conference in 2014.

In 2018, the third ISA Conference moved to London and was held at the Royal Society of Medicine (RSM), one of London’s premier conference venues located in the city centre, and home of the RSM since 1912.

Since the previous ISA Conference in 2014, a wealth of new scientific research was conducted providing further evidence about low calorie sweeteners’ use, benefits and role in the diet, and new recommendations and nutrition policies regarding sugar reduction have been developed in Europe and around the world. Therefore, in times when these subjects are of high relevance to public health, we believed that the theme of the ISA Conference in 2018, which was “The science behind low calorie sweeteners: where evidence meets policy”, was of high scientific interest.

The ISA Conference 2018 brought together leading international scientific experts on low calorie sweeteners who presented latest research and evidence-based information and discussed recent public health and nutrition policies related to sugar reduction. Hence, the scientific programme covered subject areas around the use, safety and benefits of low calorie sweeteners in weight management and glucose control, as well as their role in today’s dietary recommendations.

If you would like to know more about the outcomes of the 3rd ISA Conference, please read the ISA Conference Review part 1 and part 2. Video recordings of all presentations are also available in the ISA Video Library here, together with the Highlights from the ISA Conference 2018.

The ISA Conference 2018 programme covered a wide range of scientific and nutrition policy subjects around low calorie sweeteners. To set the scene, the conference opened with a keynote speech by Prof Adam Drewnowski (USA) on the current setting regarding low calorie sweeteners’ role in the context of public health. This was followed by three sessions with the participation of international scientific experts on low calorie sweeteners who presented latest evidence and research around low calorie sweeteners’ use and intake, as well as their role in weight management and diabetes control. The conference concluded with a panel discussion session around sugar reduction and the use of low calorie sweeteners from a public health perspective.

Please find below the final scientific programme of the ISA Conference 2018, which was moderated by Stefan Gates (UK) or download the ISA Conference 2018 Brochure by clicking here. The full list of speakers is included in the below programme.

Conference programme: “The science behind low calorie sweeteners: where evidence meets policy”

Registration, tea and coffee
Welcome and Introduction Robert Peterson, ISA Chairman
Love, hate and confusion: sweeteners in the media Stefan Gates, Conference Moderator
Keynote speech Chair: Prof Alison Gallagher (UK)
Keynote speech: Low calorie sweeteners in the current public health discussion Prof Adam Drewnowski (USA)
Session 1 (10.00-11.25) Setting the scene: An introduction to low calorie sweeteners
Chair: Prof Carlo La Vecchia (Italy)
Regulation and approval of low calorie sweeteners by international authorities Dr Rebeca López-García (Mexico)
Evaluating research by understanding the metabolic fate of different low calorie sweeteners Dr Berna Magnuson (Canada)
Low calorie sweeteners’ use: a review of recent dietary intake assessment data Dr Séverine Goscinny (Belgium)
Tea and coffee break
Session 2 (11.50-13.20) Does evidence support a role for low calorie sweeteners in weight management?
Chair: Dr France Bellisle (France)
Sweet taste, appetite and obesity: Is there a link? Prof Kees de Graaf (Netherlands)
Latest evidence on low calorie sweeteners’ role in weight management in children and adults Dr John Sievenpiper (Canada)
How does consumer perception about low calorie sweeteners affect food behaviour and energy intake? Dr Charlotte Hardman (UK)
Lunch break
Session 3 (14.10-15.40) Low calorie sweeteners and glucose control: can they be an aid in diabetes management?
Chairs: Dr Marc Fantino (France); Prof Wendy Russell (UK)
Do low calorie sweeteners affect glycaemic control and insulin sensitivity? Dr Hugo Laviada-Molina (Mexico)
Low calorie sweeteners and gut microbiota: Why is there a debate? Prof Ian Rowland (UK)
Low calorie sweeteners’ role in the dietary recommendations for people with diabetes Dr Duane Mellor (UK)
Tea and coffee break
Panel discussion session (16.00-17.00) Sugar reduction and low calorie sweeteners’ use from a public health perspective
Chair: Prof Peter Rogers (UK)
The use of low calorie sweeteners in sugar reduction: challenges and opportunities Prof Judith Buttriss (UK)
Panel discussion: Prof Peter Rogers (chair)
Panel speakers: Prof Judith Buttriss, Prof Adam Drewnowski, Prof Alison Gallagher, Prof Carlo La Vecchia, Dr France Bellisle, Dr Marc Fantino, Prof Wendy Russell
Closing remarks

Conference speakers (listed in alphabetical order)

  • Dr France Bellisle, Nutri Psy Consult, France
  • Prof Judith Buttriss British Nutrition Foundation (BNF), UK
  • Prof Kees de Graaf, Wageningen University, Netherlands
  • Prof Adam Drewnowski, University of Washington, USA
  • Dr Marc Fantino, CREABio Rhône-Alpes, France
  • Prof Alison Gallagher, Ulster University, Northern Ireland, UK
  • Dr Séverine Goscinny, Sciensano, Belgium (former Scientific Institute of Public Health (WIV-ISP), Belgium)
  • Dr Charlotte Hardman, Univeristy of Liverpool, UK
  • Prof Carlo La Vecchia, University of Milan, Italy
  • Dr Hugo Laviada-Molina, Marist University of Merida, Mexico
  • Dr Rebeca López-García, Logre International Food Science Consulting, Mexico
  • Dr Berna Magnuson, Health Science Consultants, Canada
  • Dr Duane Mellor, Coventry University, UK
  • Prof Peter Rogers, Univeristy of Bristol, UK
  • Dr Ian Rowland, University of Reading, UK
  • Prof Wendy Russell, University of Aberdeen Rowett Institute, Scotland, UK
  • Dr John Sievenpiper, University of Toronto, Canada

The conference provided a unique opportunity to network with international delegates from academia and research, public health, civil society, professional health organisations, and the medical field.

Congress Language

The official language of the congress is English. No simultaneous translation will be provided.

Conference venue

The conference was held at the building of the Royal Society of Medicine (1 Wimpole street, W1G 0AE, London, UK), home of the Royal Society of Medicine (RSM) since 1912 and one of London’s premier scientific conference and event venues located in the heart of London city centre.

For more information about the RSM venue and about you can get there, please visit the venue’s website at:


The conference venue, the Royal Society of Medicine, is centrally located near many hotels and is conveniently located between Bond Street and Oxford Circus underground lines. For an overview of the hotels available in this area, please visit the HotelMap website (external website) by clicking here.

About previous ISA Conferences

The International Sweeteners Association (ISA) organised its first scientific conference in Brussels, in 2011, on “Low calorie foods, beverages and sweeteners: Can they really contribute to a healthier future?”. More information can be accessed here. This was the starting point of the organisation of a successful scientific event around low calorie sweeteners’ science, leading to another ISA Conference in 2014 in Brussels, on “Making low calorie count: the effective use of low calorie sweeteners in the diet”. For more information about the ISA Conference in 2014 please click here.

Dr France Bellisle, Nutri Psy Consult, France
Following her Bachelor Degree (McGill University, Montreal) and a Masters Degree (Concordia University, Montreal) in experimental psychology, France Bellisle worked at the College de France in Paris in the laboratory of Jacques Le Magnen. She obtained Doctorate Degrees from the University of Paris. From 1982 until 2010, in the context of French National Research Institutes (CNRS, INRA), she developed original research in the field of human ingestive behaviours. Her research interests cover all types of determinants of food and fluid intake in human consumers, including psychological, sensory and metabolic factors as well as environmental influences. She has published over 250 articles in peer reviewed journals and contributed chapters to several books. She is now an independent consultant for scientific projects in the field of human appetite.

Prof Judith Buttriss, British Nutrition Foundation, UK
Professor Buttriss became Director General of the British Nutrition Foundation (BNF) in October 2007, having been BNF’s Science Director for almost 10 years. She has longstanding links with several universities and over 30 years of experience in providing targeted advice on nutrition and applying science to develop nutrition policy (including several UK government initiatives focusing on nutrient profiling in relation to children’s diets and healthy eating in general). She sits on a number of advisory committees considering nutrition and the food supply and has written numerous reviews, articles and book chapters on a wide range of diet and health topics, including topics as diverse as health claims, plant foods and health, child nutrition, healthy ageing, and sustainable diets.

Prof Kees de Graaf, Wageningen University, Netherlands
Kees (C) de Graaf is a Professor in Sensory Science and Eating Behaviour, Division Human Nutrition and Health, at the Wageningen University in the Netherlands. The objective of the Sensory Science and Eating Behavior group is to unravel the psychobiological mechanisms underlying eating behaviour. The mission of the group is “to make healthy choice the happy choice”. Wageningen University is responsible for the 2-year MSc program on Sensory Science, including technological, biological, psychological and sensometric approaches to sensory science. De Graaf is educated as a nutritionist. In 1988 he defended his Ph.D thesis on the perceived sweetness intensity of mixtures of sweeteners. He published about 260 papers, and his h-index is 53. His teaching focuses on the meaning of sensory signals for eating behaviour and the regulation of energy intake. His attention focuses on different groups (children, elderly, normal – overweight people), effects of properties of food on choice and intake with modern techniques of measurement (e.g. MRI). De Graaf is associate editor of Food Quality and Preference, and section editor of Physiology and Behavior.

Prof Adam Drewnowski, University of Washington, Seattle, USA
Prof. Dr. Adam Drewnowski is the Director of the Center for Public Health Nutrition and of the Nutritional Sciences Program at the University of Washington in Seattle. He obtained his MA degree in biochemistry at Balliol College, Oxford University and PhD degree in psychology at The Rockefeller University in New York. His Nutrient Rich Food Index (NRF), a measure of nutrient density, helps to identify foods that are healthy, affordable, sustainable, and appealing. His work on nutrient profiling has helped food industry to reformulate product portfolios for better alignment with national and global guidelines. His research on food and beverage consumption patterns in relation to body weight and health outcomes has focused on food prices, diet disparities, and health equity issues. Prof. Drewnowski is the author of over 300 research publications. He advises governments, foundations, NGOs, and the private sector on geopolitical strategies related to diets and health.

Dr. Marc Fantino, CREABio Rhône-Alpes, France
Marc Fantino is a Medical Doctor (MD) and Doctor of biological sciences. Appointed as full professor of medicine at the Medical School / University-Hospital of Dijon-France (1982), he was the head of the Department of Human Physiology and Nutrition from 1987 to 2013. At the same time, he was Director of the Doctoral School of life sciences of the Universities of Burgundy and of Franche-Comté (1993 to 2001), expert at the French National Agency for Food Safety (1996-2006) and also Chairman of the National Nutrition and Health Program logo award committee (2004-2011). Being an honorary Professor of the Burgundy University since 2013, he co-founded and now manages a clinical research organization, CREABio Rhône-Alpes®, accredited by health authorities to conduct human studies. In this center, basic and applied research is implemented in the field of the sensorial and metabolic processes which regulate feeding behaviours and fat mass in humans. For these works, different behavioural, neurophysiologic or pharmacological approaches and models are developed.

Prof Alison Gallagher, Ulster University, UK
Alison Gallagher is Professor of Public Health Nutrition at Ulster University where she contributes to the research conducted within the Nutrition Innovation Centre for Food and Health (NICHE). Her research interests resonate within the area of obesity and include low calorie sweeteners and their potential impact on health, development of risk factors for disease and lifestyle interventions at key stages across the lifecycle particularly to enhance physical activity and health. A Registered Nutritionist (Public Health), she was the first Fellow of the Association for Nutrition (FAfN) on the island of Ireland. An active member of the Nutrition Society, she currently co-Chairs the Science Committee for the next FENS European Nutrition Conference. She is a passionate advocate for the European Nutrition Leadership Platform (ENLP), having participated in the ENLP seminar in 1997 and being involved with this international leadership programme ever since, now as Chair/President of the ENLP Board (

Mr Stefan Gates, UK
Stefan Gates is a hugely popular writer and TV presenter with a vast breadth of knowledge and a confident, sparky presenting style. He’s renowned for his love of quirky culinary quests and extraordinary food adventures. Stefan Gates has written and presented 18 TV series including food science series Harvest (BBC2), Food Factory (BBC1) and E Numbers: An Edible Adventure (BBC2), and three series of Cooking in the Danger Zone (BBC2) about global hunger and the politics of food. His programmes are shown in over 50 countries around the world. He also makes the acclaimed kids’ series Incredible Edibles and Gastronuts (CBBC). He appears as a guest on dozens of others from Newsnight to Blue Peter. He has recently finished two BBC4 documentaries: Can Eating Insects Save the World? and Calves Heads and Coffee: the Golden Age of English Food. He has won several awards for his TV series and books. Stefan gives numerous talks at Science Festivals, and has been guest director of Cheltenham Science Festival. He has written eight books, performed more than 1000 live shows and is in production on a new Channel 5’s series. His latest book, Insects: An Edible Field Guide, published in June 2017, explores the origins of insect eating, tips on finding edible bugs as well as providing some ideas for how to eat them once tracked down!

Dr Séverine Goscinny, Sciensano, Belgium (former Scientific Institute of Public Health (WIV-ISP), Belgium)
Séverine Goscinny specialized in Food sciences and technology at The Catholic University of Louvain (UCL) after graduating in agricultural engineering from the Free University of Brussels (ULB). A keen interest in analytical chemistry has driven her career towards research and method development in the field of contaminants (biogenic amines, dioxins, PCBs and HBCD, degradation products), pesticides, and food additives. Most of her activities at Sciensano are focused on dietary exposure assessments to support regulatory guidelines.

Dr Charlotte Hardman, University of Liverpool, UK
Dr Charlotte Hardman is a lecturer in Psychology at the University of Liverpool. She is interested in psychological determinants of appetite and eating behaviour and the application of this knowledge to interventions for health behaviour change. She completed her undergraduate degree in psychology at the University of Leeds and her PhD research at Bangor University. Her research portfolio encompasses experimental studies on basic mechanisms of appetite control through to interventions to increase healthy dietary behaviours in children. In current work, she is examining the effects of low-calorie sweetened beverages on appetite in a large randomized controlled trial for weight management (the SWITCH study). In the recently-awarded SWEET project grant (European Commission Horizon 2020) she will be working with 28 partners from across Europe to investigate the consequences of sugar replacement in foods and beverages. She has published more than 40 peer-reviewed articles and co-ordinates the North West Network for the Association for the Study of Obesity.

Prof Carlo La Vecchia, University of Milan, Italy
Dr. La Vecchia received his medical degree from the University of Milan and a master of science degree in Medicine (epidemiology) from Oxford University. Presently, he is Professor of Medical Statistics and Epidemiology at the Faculty of Medicine at the University of Milan. Dr. La Vecchia serves as an editor for numerous clinical and epidemiologic journals. He is among the most renowned and productive epidemiologists in the field with over 2050 peer-reviewed papers in the literature and is among the most highly cited medical researchers in the world, according to ISI, the developer and publisher of the Science Citation Index (2003, 2017, H index 154, H10 index 1571, second Italian in Clinical Medicine). Dr. La Vecchia is an Adjunct Professor of Medicine at Vanderbilt Medical Centre and the Vanderbilt-Ingram Cancer Centre (2002-18).

Dr Hugo Laviada Molina, Marist University of Mérida, Mexico
Dr Hugo Laviada Molina is a clinical endocrinologist who obtained his medical degree from the University of Yucatan, in Merida, Mexico, and graduated from the postgraduate unit of the Faculty of Medicine of the National Autonomous University of Mexico. He received a master’s degree in Medical Sciences (in endocrinology) from the University of Sheffield, UK. He is also a graduate in clinical nutrition and obesity at the Institute of Technology and Higher Education of Monterrey, (Campus Guadalajara), in Mexico. Currently, he is a professor-researcher in Metabolism and Human Nutrition at the Marist University of Mérida, Mexico. He belongs to the national system of researchers of the National Council of Science and Technology of Mexico (CONACyT). He is titular member of the Mexican Society of Nutrition and Endocrinology and of the Latin American Diabetes Society being coordinator of their position papers on low calorie sweeteners.

Dr Rebeca López-García, Logre International Food Science Consulting, Mexico
Dr Rebeca López-García has been an independent consultant in the areas of food safety, toxicology, regulations and crisis management for almost 20 years. She has worked with organizations such as the United States Agency for International Development (USAID), the United Nations Food and Agriculture Organization (FAO); universities such as the University of Arizona, Michigan State University, New Mexico State University and Universidad La Salle; and companies around the world. Rebeca is a guest lecturer on Latin American Food Regulations for Michigan State University since 2002. Dr. López-García belongs to the scientific advisory board of food and beverage companies. She has been instrumental in the regulatory approval of several food additives and novel ingredients in Latin American countries. In 1998, she received a Ph.D. in Food Science and Toxicology from Louisiana State University.

Dr Berna Magnuson, Health Science Consultants Inc., Mississauga, ON Canada
Berna Magnuson is Vice President of Health Science Consultants, Inc. in Mississauga, Canada. Dr. Magnuson obtained a BSc (Honors) in Foods and Nutrition and worked in the food industry in quality assurance and product development. She then completed a MSc in Toxicology, a PhD in Nutritional Sciences, and postdoctoral research in pathology and biochemistry of colon cancer in Canada. Dr. Magnuson was a university professor for over 15 years in the US, conducting research in diet and colon cancer, and teaching food, nutrition and toxicology courses. Dr. Magnuson now works as a consultant providing expertise in food regulations, nutrition and toxicology to food, beverage, and dietary supplement manufacturers and ingredient industries, as well as health professional and consumer associations. Dr. Magnuson has extensive expertise in ingredient safety, including low calorie sweeteners, and serves as an expert advisor and speaker globally. In additional to confidential client reports and regulatory submissions, she has published over 70 peer-reviewed articles, book chapters, and professional articles. Dr. Magnuson is also a Fellow of the Academy of Toxicological Sciences (ATS).

Dr Duane Mellor, Coventry University, UK
Duane has worked clinically as a dietitian, mainly in diabetes management and education and then as a researcher in clinical trials. However, reflecting back on the first 2 decades of his career he has begun to question a number of aspects of nutrition and dietetic practice. He is now interested in looking at evidence in nutrition, both in terms of causality and quality along with how this is communicated to the public by the media. Looking to challenge thinking in this area, to consider aspects of benefit and the risks of harm, ultimately looking at how the public can be best supported to eat food they enjoy that also supports good health.

Prof Peter Rogers, University of Bristol, UK
Peter Rogers is Professor of Biological Psychology at the University of Bristol, UK. He trained in biological sciences and experimental psychology at the University of Sussex UK. He completed his PhD and postdoctoral work at the University of Leeds UK, moving to the Institute of Food Research, Reading UK in 1990. He moved to the University of Bristol UK in 1999, where he teaches biological psychology and does research on nutrition and behavior: which includes work on human appetite and weight control, low-calorie-sweeteners, food choice, dietary effects on mood and cognitive function, and the psychopharmacology of caffeine. He is a Chartered Psychologist, a Fellow of the British Psychological Society, and a Registered Nutritionist. His publications include over 200 peer-review journal papers.

Prof Ian Rowland, University of Reading, UK
Ian graduated with a BSc (Hons, First Class) and PhD in microbiology from University College London. Prior to joining the University of Reading in 2007 as the Hugh Sinclair Professor of Human Nutrition, he was head of nutrition at the University of Ulster and Director of the Northern Ireland Centre for Food and Health. Currently, he is Editor in Chief of the European Journal of Nutrition. His main research area is the interaction of diet, gut microbiota and health with a particular focus on the metabolism of phytochemicals and impact on health. In 2005 he was awarded an honorary doctorate from the University of Gent in Belgium for his work on nutrition and cancer. He has published over 400 papers and is on the Thompson-Reuters List of Most Highly Cited Researchers 2016.

Prof Wendy Russell, University of Aberdeen Rowett Institute, Scotland, UK
Wendy is a chemist specialised in molecular nutrition researching the complex interplay between diet and health. Her research aims to establish the effect of our diet on several population groups and through dietary interventions, to understand the role of food in preventing disorders such as cardiovascular disease, type 2 diabetes and cancer. Wendy has funding from the Scottish Government to investigate the potential of novel crops, particularly in protein provision for the future and the exploitation of underutilised plant species to improve nutrition and agrobiodiversity. As well as researching new opportunities for the UK Food and Drink industry, Global Challenges funding is allowing translation of this work to benefit small-scale rural farmers and co-operatives in sub-Saharan Africa. Wendy is an associate editor for Microbiome and chairs International Life Science Institute expert groups on ‘nutritional management of postprandial glycaemia’ and ‘efficacy of intervention in those with metabolic syndrome’.

Dr John Sievenpiper, University of Toronto, Canada
Dr. Sievenpiper is a Clinician Scientist, who holds appointments as an Associate Professor in the Department of Nutritional Sciences and the Lifestyle Medicine Lead in the MD Program at the University of Toronto. He also holds appointments as a Staff Physician in the Division of Endocrinology & Metabolism and Scientist in the La Ka Shing Knowledge Institute at St. Michael’s Hospital. Dr. Sievenpiper completed his MSc, PhD and Postdoctoral Fellowship training in the Department of Nutritional Sciences at the University of Toronto. He completed his MD at St. Matthew’s University followed by Residency training in Medical Biochemistry at McMaster University leading to his certification as a Fellow of the Royal College of Physicians of Canada (FRCPC). His research is focused on using randomized controlled trials and systematic reviews and meta-analyses to address questions of clinical and public health importance in relation to diet and chronic disease prevention. He currently holds a Diabetes Canada Clinician Scientist Award and Banting & Best Diabetes Centre Sun Life Financial New Investigator Award. He has authored more than 150 scientific papers and 13 book chapters. Dr. Sievenpiper is directly involved in knowledge translation with appointments to the nutrition guidelines’ committees of Diabetes Canada, European Association for the study of Diabetes (EASD), Canadian Cardiovascular Society (CCS), and the Canadian Obesity Network.

Keynote speech

Prof Adam Drewnowski – Low calorie sweeteners in the current public health discussion
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.

  1. Drewnowski A, Rehm CD. The use of low-calorie sweeteners is associated with self-reported prior intent to lose weight in a representative sample of US adults. Nutr Diabetes. 2016 Mar 7;6:e202. doi: 10.1038/nutd.2016.9.
  2. Fantino M, Fantino A, Matray M, Mistretta F. Beverages containing low energy sweeteners do not differ from water in their effects on appetite, energy intake and food choices in healthy, non-obese French adults. Appetite. 2018 Jun 1;125:557-565. doi: 10.1016/j.appet.2018.03.007. Epub 2018 Mar 9.
  3. Bellisle F. Intense Sweeteners, Appetite for the Sweet Taste, and Relationship to Weight Management. Curr Obes Rep. 2015 Mar;4(1):106-10. doi: 10.1007/s13679-014-0133-8.


Session 1 – Setting the scene: An introduction to low calorie sweeteners

Dr Rebeca López-García – Regulation and approval of low calorie sweeteners by international authorities
Low-caloric sweeteners (LCS) are legally considered food additives by international authorities. According to the Codex Alimentarius, “a food additive is any substance not normally consumed as a food by itself and not normally used as a typical ingredient of the food, whether or not it has nutritive value, the intentional addition of which to food for a technological purpose in the manufacture, processing, preparation, treatment, packing packaging, transport or holding of such food results, or may be reasonably expected to result, in it or its by-products becoming a component of or otherwise affecting the characteristics of such foods.” Since food additives such as LCS are added intentionally to foods, their safety must be carefully studied before introduction to the food supply. As opposed to drugs, foods can be consumed by any family member at any given time throughout a lifetime. Therefore, clear understanding of the metabolic fate of each compound and its potential physiological effects is needed to consider a specific compound for approval. Risk assessment of substances to be added to food must consider the safety throughout a lifetime of exposure. The safety of these compounds is studied through internationally recognized methods to answer specific questions and to show that under the intended conditions of use, these compounds can be safely added to foods. At the national level, each country may have their own approval processes and requisites, but the scientific basis of risk assessment and approval has a lot in common. This presentation will cover the basic process that ensures the safety of NCS prior to market introduction.

  1. Joint FAO/WHO Expert Committee of Food Additives (JECFA). Toxicological Evaluation of Certain Food Additives with a Review of General Principles and Specifications. Geneva.
  2. International Programme on Chemical Safety (IPCHS). Principles for the safety assessment of food additives and contaminants in food. [Online]. Available from:
  3. Pressman P., Clemens R., Hayes W. and Reddy C. Food additive safety: A review of toxicologic and regulatory issues. Toxicology Research and Application (I) 2017: 1-22


Dr Berna Magnuson – Evaluating research by understanding the metabolic fate of different sweeteners
With continued efforts to find solutions to rising rates of obesity and diabetes, there is increased interest in the potential benefits of the use of low- and no calorie sweeteners (LNCSs) as a replacement for added sugars. Concerns about safety often deter the use of LNCSs as a tool in helping control caloric intake, even though the safety of LNCS use has been affirmed by regulatory agencies worldwide. In many cases, an understanding of the biological fate of the different LNSCs can help health professionals to address safety concerns and better interpret research study findings. This presentation will discuss the similarities and differences in the chemistry, regulatory status, and biological fate (including absorption, body distribution, metabolism, and excretion) of the commonly used LNCSs: acesulfame potassium, aspartame, cyclamate, saccharin, stevia leaf extract (steviol glycoside), and sucralose. Understanding the biological fate of the different LNCSs is critical to assess whether reports of biological effects in animal studies or in humans are truly indicative of possible safety concerns. Illustrations will include use of biological fate data to determine actual systemic exposure to LNCS; to assess appropriateness and/or flaws of various research study designs; and the safety of use of sweetener combinations. Thus greater awareness of the extensive data on biological fate of sweeteners is needed, as when utilized to critically evaluate research studies, can lead to increased confidence in the safety of use of LNCS.

  1. Magnuson BA, Carakostas MC, Moore NH, Poulos SP, Renwick AG. Biological fate of low-calorie sweeteners. Nutr Rev. 2016 Nov;74(11):670-689.
  2. Renwick AG, Thompson JP, O’Shaughnessy M, Walter EJ. The metabolism of cyclamate to cyclohexylamine in humans during long-term administration. Toxicol Appl Pharmacol. 2004 May 1;196(3):367-80. PubMed PMID: 15094307.
  3. Roberts A, Renwick AG. The pharmacokinetics and tissue concentrations of cyclohexylamine in rats and mice. Toxicol Appl Pharmacol. 1989 Apr;98(2):230-42. PubMed PMID: 2469137.


Dr Séverine Goscinny – Low calorie sweeteners’ use: a review of recent dietary intake assessment data
Obesity has increased significantly worldwide in the past decade with tangible consequences on public health such as diabetes, cardiovascular diseases and asthma. One approach to help people suffering from diabetes and obesity is to lower the amount of refined sugars consumed and sweeteners have received much attention as they provide no or little calories. Although their use as additives is strictly regulated, the need to evaluate the exposure to these compounds is a continuous process because eating habits and market availability of the products have changed since the first safety evaluation of these food additives. In this environment, dietary exposure assessment identifies possible exposure concerns and pin point specific subpopulations at risks. It is a powerful tool for setting health priorities, guide future diet guidelines, and to re-evaluate acceptable daily intake (ADI) parameters or maximum permitted levels in food. The research conducted provides a refined and up-to-date exposure estimates, high consumers and the most significant food contributors were identified. The talk will show how exposure assessment protocols can be refined step-by-step as to deliver the most accurate estimate of intense sweeteners intake. The established methodology was applied for the Italian and Irish population. The estimated exposure among consumers of low calorie sweeteners in Italy and Ireland was well below the ADIs. For both populations, drinks and table-top sweeteners were the main contributors to the exposure.

  1. Obesity update, June 2014, OCDE. Available at: Update-2014.pdf
  2. Le Donne CL., Mistura L., Goscinny S., et al. Assessment of dietary intake of 10 intense sweeteners by the Italian population. Food Chem Toxicol 2017; 102: 186-197
  3. Buffini M., Goscinny S., Van Loco J., et al. Dietary intakes of six intense sweeteners by Irish adults. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2018; 35(3): 425-438


Session 2 – Does evidence support a role for low calorie sweeteners in weight management?

Prof Kees de Graaf – Sweet taste, appetite and obesity: Is there a link?
Sweet taste is conceived to signal the energy content of foods (assumption 1). As obese people ingest more energy, there is the intuitive notion that obese people have a sweet tooth (assumption 2) or ingest more energy from sweet tasting foods (assumption 3). These ideas circled around the popular press since the 1980’s and they still have a widely spread circulation in the societal discourse today. However, data have repeatedly shown that these assumptions are wrong.
In four recent studies, using data from the Australian (n=377 foods), Dutch (n=469), Malaysian (n=423) and American food supply (n=237), it was shown that perceived sweetness intensity did not correlate with the energy content of foods (r’s resp.: -0.08, 0.11, 0.04, and 0.11). Salt, umami and fat sensation intensity were better predictors of energy content.
Since the beginning of the 1980’s various studies with increasing numbers of subjects and more advanced methodologies showed that normal weight and obese subjects have similar sweetness preferences. In one recent study, in two independent Dutch subject populations (n=1351; n=944), we showed that the average contribution of sweet tasting foods to the overall energy intake is slightly lower in obese people (23%) than in normal weight people (26%).
When it comes to the role of properties of food in the regulation of appetite and food intake, it is advised to focus on the energy density and texture/eating rate of foods, instead of focusing on sugar and fat per se. Dozens of studies have repeatedly shown that food with a lower energy density and/or a lower eating rate lead to a lower energy intake.

  1. van Langeveld AWB, Teo PS, de Vries JHM, Feskens EJM, de Graaf C, Mars M. Taste-related energy intake by gender and weight status in the Netherlands. Brit J Nutr. 2018; 118:1095-1106.
  2. Appleton KM, Tuorila H, Bertenshaw EJ, de Graaf C, Mela DJ (2018) Sweet taste exposure and the subsequent acceptance and preference for sweet taste in the diet: Systematic review of the published literature. Am J Clin Nutr 2018;107:405-419
  3. Teo PS, van Langeveld AWB, Pol K, Siebelink E, de Graaf C, Yan SW, Mars M. Similar taste-nutrient relationships in commonly consumed Dutch and Malaysian foods. Appetite 2018; 32-41.
  4. Deglaire A, Méjean C, Castetbon K, Kesse-Guyot E, Hercberg S, Schlich P. Associations between weight status and liking scores for sweet, salt and fat according to the gender in adults (The Nutrinet-Santé study). Eur J Clin Nutr 2015; 69: 40-46


Dr John Sievenpiper – Latest evidence on low calorie sweeteners’ role in weight management in children and adults
Sugars have emerged as the dominant public health concern. Major health agencies have recommended that added/free sugars be reduced to <5-10% of calories. The use of low calorie sweeteners represent an important strategy to achieve these reductions. Although approved as safe by international regulatory agencies, there is an emerging concern that low calorie sweeteners may not have the intended benefit and may even increase the risk of obesity and its downstream cardiomeatbolic complications. Several health authorities have specifically recommended against the use of low calorie sweeteners to replace sugars. A careful review of the available evidence suggests that that a number of important methodological considerations have been overlooked such as reverse causality in prospective cohort studies and the nature of the comparator in randomized controlled trials. If one accounts for these considerations, then the concerns appear unfounded. Whereas prospective cohort studies that model low calorie sweeteners as baseline or prevalent exposures have shown an adverse association of low calorie sweeteners with weight gain and incident diabetes and cardiovascular disease, those that adjust for reverse causality by modelling the exposure as change show the opposite association with weight loss and no adverse associations with diabetes or cardiovascular disease. Network and pairwise meta-analyses of randomized controlled trials, which provide a better protection against bias, also show that low calorie sweeteners have the intended benefit when accounting for the calories available to be displaced from the comparator. Comparisons with sugars show the expected weight loss and related improvements in cardiometabolic risk factors while comparisons with water show the expected lack of difference. Overall, the available evidence supports the intended benefits of low calorie sweeteners as being similar to that of other strategies to reduce excess calories from sugars, such as water. More research remains a priority for improving the certainty of the estimates.

  1. Azad MB, Abou-Setta AM, Chauhan BF, et al. Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies. Canadian Medical Association Journal. 2017;189:E929-E39.
  2. Sievenpiper JL, Khan TA, Ha V, Viguiliouk E, AuYeung F. The importance of study design in the assessment of nonnutritive sweeteners and cardiometabolic health. CMAJ. 2017 Nov 20;189(46):E1424-E1425.
  3. Rogers PJ, Hogenkamp PS, de Graaf C, Higgs S, Lluch A, Ness AR, Penfold C, Perry R, Putz P, Yeomans MR, Mela DJ. Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. Int J Obes (Lond). 2016 Mar;40(3):381-94.DeRuyter
  4. Wang L, Khan TA, Won C, Blanco Mejia S, Sievenpiper JL. Network meta-analyses of low calorie sweetened beverages versus water and risk of obesity. Proceedings of the 36th International Symposium on Diabetes and Nutrition, Opatija, Croatia, Jun 27-29, 2018
  5. McGlynn N, Khan TA, Sievenpiper JL. Systematic review and meta-analysis of low calorie sweetened beverages versus water and glycemic control. Proceedings of the 36th International Symposium on Diabetes and Nutrition, Opatija, Croatia, Jun 27-29, 2018


Dr Charlotte Hardman – How does consumer perception about low calorie sweeteners affect food behaviour and energy intake?
Consumption of low-calorie sweetened (LCS) beverages has increased significantly. Previous research indicates that some individuals frequently consume high quantities of LCS beverages while others choose to avoid them. Little is known about the psychological factors, such as beliefs and attitudes, which influence and maintain LCS beverage intake. To address this gap in knowledge, we have developed a novel questionnaire to quantify beliefs and attitudes towards LCS beverages. Using this tool, we have found that frequent consumers (>825 ml LCS beverages per day; N=108) believe that LCS beverages are highly palatable as well as being effective in controlling appetite (hunger, cravings) and body weight. Non-consumers (N=103) did not share these beliefs. Frequent consumers also had higher levels of dietary restraint and body weight concerns than non-consumers, suggesting that they may use LCS beverages as a strategy to control food intake. To further test this idea, we conducted a laboratory study with frequent consumers (N=158) to examine food consumption when LCS beverages were available compared to when they were unavailable. Results indicated that participants ate fewer calories from sweet and savoury snack foods, felt less guilty about their food intake and more in control of their eating when LCS beverages were available compared to unavailable. Together, these findings suggest that positive beliefs about palatability and appetite control are key determinants of LCS beverage consumption. Results also indicate that LCS beverages may be used as part of a successful strategy to control food intake and reduce negative psychological states associated with eating.

  1. Rogers PJ, Hogenkamp PS, de Graaf C, Higgs S, Lluch A, Ness AR, Penfold C, Perry R, Putz P, Yeomans MR, Mela DJ. Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. International Journal of Obesity 2016; 40(3):381-94.
  2. Appleton KM, Conner MT. Body weight, body-weight concerns and eating styles in habitual heavy users and non-users of artificially sweetened beverages Appetite 2001; 37: 225-230
  3. Appleton KM, Tuorila H, Bertenshaw EJ, de Graaf C, Mela DJ. Sweet taste exposure and the subsequent acceptance and preference for sweet taste in the diet: systematic review of the published literature. Am J Clin Nutr 2018; 107:405–419


Session 3 – Low calorie sweeteners and glucose control: can they be an aid in diabetes management?

Dr Hugo Laviada Molina – Do low calorie sweeteners affect glycaemic control and insulin sensitivity?
When only observational data are considered, several cohort studies have shown an association between type 2 diabetes (DM2) and the use of low calorie sweeteners (LCS). However, when controlled clinical trials are assessed, the vast majority of them show that LCS have a neutral effect on outcomes such as glycosylated haemoglobin (HbA1C), blood insulin, and fasting or postprandial glucose levels. Moreover, in trials where LCSs are integrated within a structured nutritional plan as a replacement for sucrose, discrete benefits can be seen on these clinical parameters. It would seem that, considered separately, observational and interventional studies report contradictory conclusions regarding LCS on metabolic impact. The positive association between LCS use and risk of DM2 found in some cohort studies seems to be mediated, at least in part, by confounding factors, in particular adiposity, and the so-called “reverse causality” effect.
Recent reviews have assessed the published controlled trials, which represent the highest level of evidence, examining the effect of LCS on the metabolism of carbohydrates. In a review conducted by Romo-Romo et al in 2016, the heterogeneity of the studies did not allowed to conduct a meta-analysis. Using Romo-Romo et al data and the studies published thereafter, we identified 30 intervention trials. All trials assessed the effect on blood glucose: 22 studies (73,3%) did not find significant changes, 5 studies (16.7%) reported a slight decrease with LCS use, and 3 studies (10%) a slight increase. In the studies reporting improvements in metabolic parameters, evidence suggests that this is due to the substitution of sugars, rather than to an intrinsic effect of LCS. Per se these additives do not seem to have an effect on carbohydrate metabolism and on blood glucose levels.

  1. Serra-Majem, L., Raposo, A., Aranceta-Bartrina, J., Varela-Moreiras, G., Logue, C., Laviada, H et al. Ibero–American Consensus on Low-and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages. Nutrients 2018; 10(7): 818.
  2. Romo-Romo, A., Aguilar-Salinas, C. A., Brito-Córdova, G. X., Díaz, R. A. G., Valentín, D. V., & Almeda-Valdes, P. Effects of the non-nutritive sweeteners on glucose metabolism and appetite regulating hormones: systematic review of observational prospective studies and clinical trials. PloS One 2016; 11(8): e0161264.
  3. Johnson, R. K., Lichtenstein, A. H., Anderson, C. A., Carson, J. A., Després, J. P., Hu, F. B.. Low-Calorie Sweetened Beverages and Cardiometabolic Health: A Science Advisory From the American Heart Association. Circulation 2018; 138: 00-00.


Prof Ian Rowland – Low calorie sweeteners and gut microbiota: Why is there a debate?
The human colonic microbiota is a large and complex microbial community. Over 1000 bacterial species have been identified with about 160 being found in the gut of any individual. The size and diversity of the microbiota is reflected in extensive metabolic activities.
Observational studies comparing the faecal microbiotas of healthy subjects with those of patients, strongly suggest an association of gut microbiota composition and the aetiology and/or development of a range of gastrointestinal diseases and also a link with obesity and diabetes. However, the precise organisms involved are difficult to identify.
The interactions of low/no calorie sweeteners (LCNS) and gut microbiota has been the subject of numerous studies in laboratory animals and human subjects. LNCS are a structurally diverse group of compounds that have very different metabolic fates following consumption. Most (e.g. acesulfame K, saccharin, and sucralose) are not metabolized by gut bacteria. Stevia is a notable exception as its glycosidic forms are hydrolysed by the microbiota, releasing steviol, which is then absorbed intact without further bacterial metabolism.
LNCS are consumed at such low levels that they are unlikely to have a direct, clinically meaningful impact on the gut microbiota. Nevertheless, a few studies on saccharin have shown effects on microbiota composition or metabolism, although only at very high doses above normal human consumption. Studies with other LCNS show either no, or inconsistent, effects on the microbiota, probably as a consequence of design issues and lack of adequate controls. Overall, the evidence indicates that LCNS have minimal impact on gut microbiota.

  1. Rowland I et al. Gut microbiota functions: metabolism of nutrients and other food components. Eur J Nutr 2018 Feb; 57(1): 1-24
  2. Portune KJ et al. Gut microbiota, diet and obesity-related disorders – The good, the bad and the future challenges. Mol Nutr Food Res 2017 Jan; 61(1)
  3. Magnuson BA et al. Biological fate of low-calorie sweeteners. Nutr Rev 2016 Nov; 74 (11): 670-689


Dr Duane Mellor – Low calorie sweeteners’ role in the dietary recommendations for people with diabetes
The first recommendation of the Diabetes UK Nutritional Guidelines is to support ‘an individualised approach to diet taking into consideration the person’s personal and cultural preferences’. This is framed in recommendations based on foods rather than nutrients. There are recommendations which encourage a reduced consumption of red and processed meat along with less refined carbohydrates and sugar sweetened beverages. With respect to the latter points, low calorie sweeteners have a potential role in helping individuals to reduce their sugar and energy intake. There has been a number of reports suggesting that intakes of sweeteners may increase the risk of developing type 2 diabetes. However, this data is not consistent and relates to the development of type 2 diabetes and not its management. Therefore, it is apparent, in line with current guidelines low calorie sweeteners have the potential to be part of an individualised dietary approach. Although low calorie sweeteners are not the dietary solution on their own to manage type 2 diabetes, they can be a useful way to reduce energy and free sugars intakes. Whether the inclusion of low calorie sweeteners is likely to benefit someone living with diabetes is likely to depend on which foods and drinks they are found in and how these foods are incorporated in a dietary pattern. Consuming low calorie sweeteners as part of a diet based on vegetables, fruits, wholegrains, fish, nuts and pulses could be a way of maintaining quality of life through the addition of sweet flavours without energy or sugar. .

  1. Diabetes UK (2018) Evidence-based nutrition guidelines for the prevention and management of diabetes. Diabetes UK, London, UK
  2. BDA (2016) Policy Statement: The Use of Artificial Sweeteners. BDA, Birmingham, UK
  3. Huang M. et al. Artificially sweetened beverages, sugar-sweetened beverages, plain water, and incident diabetes mellitus in postmenopausal women: the prospective Women’s Health Initiative observational study. AJCN 2017; 106 (2): 614-622
  4. Edwards C.H. et al. The role of sugars and sweeteners in food, diet and health: Alternatives for the future. Trends in Food Science & Technology 2016; 56: 158-166