Low calorie sweeteners and diabetes: Positions of scientific, medical and patient organisations

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A webinar by the Spanish Federation of Diabetes (FEDE)

Highlights:

  • Low calorie sweeteners are safe, including for people with diabetes, and their consumption is well below the set Acceptable Daily Intake (ADI) limits.
  • Low calorie sweeteners have a favourable effect on post-prandial blood glucose levels, when consumed instead of sugars.
  • By replacing sugars, low calorie sweeteners can help reduce daily intake of carbohydrates and calories.

On 27th June 2019, the Spanish Federation of Diabetes (Federación Española de Diabetes – FEDE) organised a 45-minute webinar entitled “Low calorie sweeteners and diabetes: Scientific Evidence” that was presented by Dr Pilar Riobó, MD, PhD. The webinar, supported by the International Sweeteners Association (ISA), aimed to present the scientific evidence relating to the use of low calorie sweeteners by people with diabetes as reviewed and included in scientific opinions, position papers and experts’ consensus from scientific bodies, safety and regulatory authorities and diabetes-related medical and/ or patient organisations. The current article provides a summary of the information that was presented during this webinar by Dr Riobó, and which is still available to watch on FEDE’s YouTube channel here.

Scientific Opinions and Positions from scientific and regulatory bodies

Over the last decade, regulatory agencies, such as the European Food Safety Authority (EFSA), and scientific organisations such the American Diabetes Association (ADA) and the American Heart Association (AHA), among others, have issued scientific opinions and position papers regarding the consumption of low calorie sweeteners by all population groups including by people with diabetes.

European Food Safety Authority (EFSA)
Based on strong evidence, in a scientific opinion on low calorie sweeteners published in 2011, EFSA concluded that: “Consumption of foods containing low calorie sweeteners instead of sugar induces a lower blood glucose rise after their consumption compared to sugar-containing foods”. This is an authorised health claim in the EU Register of nutrition and health claims. Practically, this means that, compared to sugars, low calorie sweeteners have a favourable effect on post-prandial glucose, that is the levels of blood glucose after food/ drink consumption, especially for people with impaired glucose tolerance such as people with diabetes or prediabetes.

American Diabetes Association (ADA) – American Heart Association (AHA)
In 2012, ADA and AHA issued a joint Position Statement about current use and health perspectives regarding low calorie sweeteners. Among their conclusions, it was stated that: “NNS [non-nutritive sweeteners] may be used in a structured diet to replace sources of added sugars and that this substitution may result in modest energy intake reductions and weight loss.” By referring to a “structured diet”, the position aims to emphasise that in order to help in weight management, low calorie sweeteners should be consumed in the context of a calorie-reduced, healthy and balanced diet, and that benefits in weight control relate to the level of sugar and, subsequently, calorie reduction.

Expert consensus

Furthermore, consensus of experts published recently, such as the Ibero-American Consensus on low calorie sweeteners by Serra-Majem et al. (2018) and the Consensus Report on nutrition therapy for adults with diabetes and pre-diabetes by Evert et al. (2019), the latter supported by the American Diabetes Association (ADA), reviewed current evidence about low calorie sweeteners’ consumption and reiterated that low calorie sweeteners are safe for consumption within the Acceptable Daily Intake (ADI) levels. This Consensus Report concluded that, “replacing added sugars with sugar substitutes could decrease daily intake of carbohydrates and calories”, emphasising that, “people should be counselled to avoid compensating with intake of additional calories from other food sources.

Positions of diabetes-related and patient organisations

Similarly, several diabetes-related medical and/ or patient organisations have published their positions regarding the consumption of low calorie sweeteners in diabetes.

Diabetes UK
In December 2018, Diabetes UK updated its Position Statement on low calorie sweeteners in order to address confusing and conflicting information that exists online on this subject. Among a number of recommendations, it is stated that “Substituting LNCS [low or no calorie sweeteners] 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”, and importantly it is emphasised that, “The use of LNCS to aid weight loss should be in the context of an overall healthy diet and a wider weight management programme.

Latin-American Association of Diabetes (ALAD)
In 2018, a working group of the Latin-American Association of Diabetes (Asociación Latinoamericana de Diabetes – ALAD) conducted a thorough review of the current literature on the role and health effects of low calorie sweeteners. In relation to their impact on glycaemic control, the group concluded that: “the vast majority of randomised controlled clinical trials shows a neutral effect of low calorie sweeteners on glycosylated haemoglobin (Hb1Ac), insulin and glucose at fasting and post-prandial levels.” The consensus also pointed that 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.

Take-home messages

Closing the FEDE-organised webinar, Dr Riobó highlighted the following take-home messages:

  • The use of low calorie sweeteners is safe and can have benefits including for people with diabetes, when consumed in the context of a healthy diet and lifestyle.
  • The scientific evidence supporting these conclusions is strong, as confirmed by scientific and medical/ patient organisations and safety agencies.
  • When searching online for information about low calorie sweeteners, always look for reliable sources and science-based information, and/ or ask your health professionals for information.

For more information, you may watch the full FEDE-organised webinar in Spanish with Dr Pilar Riobó by clicking here. For the main opinions on low calorie sweeteners from safety and health-related organisations at a glance, please download the related infographic, developed by FEDE with the support of the ISA, which is available by clicking here.

  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. EFSA. Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA Journal 2011, 9(6), 2229. Available at: http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2011.2229/epdf
  3. Commission Regulation (EU) No 432/2012 of 16 May 2012 establishing a list of permitted health claims made on foods
  4. 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
  5. Gardner C, Wylie-Rosett J, Gidding SS, et al. Nonnutritive Sweeteners: Current Use and Health Perspectives. Diabetes Care 2012; 35(8): 1798-1808
  6. 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
  7. Serra-Majem L, Raposo A, Aranceta-Bartrina J, et al. Ibero–American Consensus on Low- and No-Calorie Sweeteners: Safety, nutritional aspects and benefits in food and beverages. Nutrients 2018; 10: 818