2020 year in review: What did we learn from new research on low/no calorie sweeteners?

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Highlights:

  • There is expert consensus that excessive intake of sugars should be reduced to lower the risk and prevalence of obesity, and low/no calorie sweeteners are one of the strategies to help achieve sugar reduction.
  • Two large reviews published in 2020 confirm that low/no calorie sweeteners are useful in weight loss, when replacing sugars in the diet.
  • Low/no calorie sweeteners have no impact on blood sugar levels, a WHO-supported review confirms. Sweeteners’ benefit in diabetes, when used instead of sugars, derives from causing a lower spike in blood glucose after food consumption.
  • A 2020 review confirms the beneficial role of low/no calorie sweeteners in dental health linking chewing sugar-free gum with lower rates of tooth decay.

 

Globally, the focus of research this year was undoubtedly around the COVID-19 pandemic. On nutrition research alone, more than 1500 new studies have been published in PubMed.gov since the outbreak. Studies exploring the role of diet quality and the impact of obesity on COVID-19 emerged quickly. This article aims to present new research findings on low/no calorie sweeteners’ science and to discuss these findings in the context of the current COVID-19 pandemic.

Science clarifies how low/no calorie sweeteners can help in weight loss

A scientific report aiming to inform the new Dietary Guidelines for Americans 2020-20251, two important systematic reviews2,3 and an expert consensus4 published in 2020 provided clear answers to the ongoing debate about sweeteners’ role in weight management: when used as sugar replacers, low/no calorie sweeteners can help reduce body weight by reducing calorie intake.

The scientific report1 developed by the experts of the 2020 Dietary Guidelines Advisory Committee, US, concluded that: “Limited evidence suggests that LNCSB [low/no calorie sweetened beverage] consumption is associated with reduced adiposity in adults. The studies reviewed in adults and children did not provide evidence that LNCSB promote weight gain or adiposity.” The Committee recommended low/no calorie sweeteners to be considered as an option for helping manage body weight.

This recommendation is in line with the conclusion of two new systematic reviews and meta-analyses published in 2020, the largest to date.2,3 Low/ no calorie sweeteners are shown to work favourably in weight loss when they are used to replace sugars, and hence, calories in our diet. Studies comparing low/no calorie sweeteners to placebo or water find no effect, simply because there is no calorie decrease by this substitution.

This is a clarification that many experts do when explaining the science around low/no calorie sweeteners and weight or diabetes control. In an expert consensus published this year, seventeen scientific experts concluded that, when substituted for sugars to reduce energy density of foods and drinks, low/no calorie sweeteners can help reduce net energy intake and thereby assist weight management. They further explain that their value in weight and glucose control derives from their role as substitutes for sugars.4

For more information about the outcomes of the “Expert consensus on low calorie sweeteners: facts, research gaps and suggested actions”, published in January 2020 in Nutrition Research Reviews, you may watch the video here.

New studies on low/no calorie sweeteners and diabetes confirm what we have known for decades

New systematic reviews and meta-analyses published this year, including one supported by the World Health Organization (WHO)5, confirm there is no evidence of adverse effect of low/no calorie sweeteners on glucose and insulin control, both in the short- and long-term.5,6 While sweet-tasting, low/no calorie sweeteners are not carbohydrates, and therefore they have no impact on blood sugar or insulin levels in people with, or without, diabetes.6 The potential value of low/no calorie sweeteners in the dietary management of diabetes derives from their role as substitutes for sugars, because they cause a lower blood glucose spike when used instead of sugars.7

New data on low/no calorie sweeteners and sugar-free chewing gum in dental health

It has long been established that low/no calorie sweeteners are non-fermentable ingredients, which means they are not broken down by bacteria in our mouth and thus do not contribute to dental demineralisation, which is one of the reasons for tooth decay. A new systematic review published this year found a significant reduction of caries, by up to 28%, with chewing sugar-free gum sweetened with non-fermentable sweeteners.8

Importance of new research findings on low/no calorie sweeteners in the context of COVID-19

Obesity and diabetes significantly increase chances of severe outcomes for COVID-19 patients.9,10 New data suggest that, during the national lockdowns, higher BMI was associated with lower levels of physical activity, worse diet quality, and a greater reported frequency of overeating.11 In light of these findings, dietary tools that could help individuals manage their eating behaviour and ultimately their energy balance (calorie intake vs expenditure) are very important. For example, as evidence affirms, low/no calorie sweeteners are one helpful tool, among a pool of different strategies, that can help bring down overall calorie intake and thus assist in weight management, when used to replace sugars in the diet.1-4 Some recent studies have also indicated that low/no calorie sweeteners may help some people satisfy their desire to eat something sweet or eat less by controlling food cravings.12,13 For people with diabetes, consuming a low/no calorie sweetened food or drink has the additional benefit of causing a lower rise in blood glucose levels compared to a sugar-sweetened version.6,7

Finally, at the height of the pandemic amidst national lockdowns, concerns arise from changes in snacking behaviours11 that could increase susceptibility to dental diseases. In this context, a tooth-friendly diet is recommended. Unlike carbohydrates, low/no calorie sweeteners do not contribute to tooth demineralisation7 and new evidence further supports the role of chewing sugar-free gum in helping reduce the incidence of dental caries.8

2020 scientific events in review

The current pandemic had also a major influence on the way new research is presented in scientific congresses with most of them turning to virtual events. In light of this new way of science communication, the ISA organised or supported several online symposia or webinars, in collaboration with nutrition-related organisations:

  • In a scientific symposium at the virtual FINUT 2020 conference, organised by the Ibero-american Nutrition Foundation (FINUT), scientists stressed that, when interpreting research on low/no calorie sweeteners’ impact on body weight, the comparator (for example, if sweeteners are compared to sugar or water) is important. For more information about the outcome of the ISA “meeting with the experts” at the FINUT 2020 conference, you may read the related article here.
  • At a webinar organised by the European Federation of Associations of Dietitians (EFAD), experts presented data supporting the notion that the substitution of sugar-sweetened beverages with low/no calorie sweetened alternatives improves cardiometabolic risk factors (reduction of body weight, body fat, triglycerides and liver fat), but also clarified that this potential benefit of sweeteners should be examined in the right context: by assessing the intended substitution of sugars with low/no calorie sweeteners. For more information about the outcome of the EFAD webinar that was supported by the ISA, you may read the related article here.
  • At a webinar organised by the International Sweeteners Association (ISA) in collaboration with the Argentine Society of Nutrition (Sociedad Argentina de Nutrición – SAN), four experts presented latest data about the dietary intake of low/no calorie sweeteners in Latin American countries (Brazil and Chile), and further discussed the role of low/no calorie sweeteners in reformulation for sugar and calorie reduction as well as in weight management. You may watch on demand the webinar in Spanish by clicking here.

 

We hope you enjoyed reading the 2020 science review. From our side, we stay committed to continue bringing you the latest and key scientific news around low/no calorie sweeteners over the next year as well, and we wish you a happy and healthy 2021!

  1. Dietary Guidelines Advisory Committee. 2020. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC.
  2. Rogers PJ and Appleton KM. The effects of low-calorie sweeteners on energy intake and body weight: a systematic review and meta-analyses of sustained intervention studies. Int J Obes 2020. https://doi.org/10.1038/s41366-020-00704-2
  3. Laviada-Molina H, Molina-Segui F, Pérez-Gaxiola G, et al.Effects of nonnutritive sweeteners on body weight and BMI in diverse clinical contexts: Systematic review and meta-analysis. Obesity Reviews 2020; 21(7): e13020
  4. Ashwell M, Gibson S, Bellisle F, Buttriss J, Drewnowski A, Fantino M, Gallagher AM, de Graaf K, Goscinny S, Hardman CA, Laviada-Molina H, López-García R, Magnuson B, Mellor D, Rogers P, Rowland I, Russell W, Sievenpiper J, la Vecchia C. Expert consensus on low-calorie sweeteners: facts, research gaps and suggested actions. Nutr Res Rev. 2020;33(1):145-154. doi: 10.1017/S0954422419000283. [Epub ahead of print]
  5. Lohner S, Kuellenberg de Gaudry D, Toews I, Ferenci T, Meerpohl JJ. Non-nutritive Sweeteners for Diabetes Mellitus. Cochrane Database of Systematic Reviews 2020 May 25;5:CD012885. Doi 10.1002/14651858.CD012885.pub2
  6. Greyling A, Appleton KM, Raben A, Mela DJ. Acute glycemic and insulinemic effects of low-energy sweeteners: a systematic review and meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition 2020; 112(4): 1002-1014. nqaa167. https://doi.org/10.1093/ajcn/nqaa167
  7. EFSA Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA 2011 Journal 9(6): 2229, and 9(4): 2076
  8. Newton JT, Awojobi O, Nasseripour M, Warburton F, Di Giorgio S, Gallagher JE, Banerjee A: A systematic review and meta-analysis of the role of sugar-free chewing gum in dental caries. JDR Clin Trans Res 2020;5(3):214-223
  9. WHO/Europe. Coronavirus disease (COVID-19) outbreak. Published 22 October 2020. Available at: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/10/obesity-significantly-increases-chances-of-severe-outcomes-for-covid-19-patients
  10. ECDC, Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK, 8 April 2020, https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-rapid-risk-assessment-coronavirus-disease-2019-eighth-update-8-april-2020.pdf
  11. Robinson E, Boyland E, Chisholm A et al.. Obesity, eating behavior and physical activity during COVID-19 lockdown: A study of UK adults. Appetite 2021;156:104853
  12. Rogers PJ, Ferriday D, Irani B, et al. Sweet satiation: Acute effects of consumption of sweet drinks on appetite for and intake of sweet and non-sweet foods. Appetite 2020 Feb 11; 149:104631. doi: 10.1016/j.appet.2020.104631. [Epub ahead of print]
  13. Maloney NG, Christiansen P, Harrold JA, Halford JCG, Hardman CA. Do low-calorie sweetened beverages help to control food cravings? Two experimental studies. Physiology & Behavior 2019; 208: 112500