Consensus of international experts on the safety, use and benefits of low calorie sweeteners as sugar substitutes
Low calorie sweetened foods and beverages can be included in dietary guidelines and recommendations as alternative options to products sweetened with sugar; low calorie sweeteners are safe ingredients with potential benefits for weight management, glucose control in diabetes and dental health, when used in place of sugar. These are some of the key conclusions from an international panel of more than 60 scientific experts who met in a scientific meeting in Lisbon on 2-4 July 2017 that was organised by the Spanish Nutritional Research Foundation (FIN), in collaboration with the Lusófona University of Lisbon, and with the support of 43 organisations and foundations specialised in nutrition and dietetics, medical societies, universities and research centres in Europe and Latin America, including that of the International Sweeteners Association (ISA). The conclusions of this meeting were gathered in a consensus paper which was published in June 2018.1 The goal of the document, as Prof. Lluís Serra-Majem, Professor of Preventive Medicine and Public Health, Director of the Research Institute of Biomedical and Health Sciences of the University of Las Palmas de Gran Canaria and President of the Spanish Nutritional Research Foundation (FIN) points out in a Press Release2, is: “to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations”.
- Low calorie sweeteners’ safety has been reviewed and confirmed by health regulatory agencies globally; they are amongst the most extensively evaluated ingredients in the human food chain.
- The use of low calorie sweeteners in place of sugar may provide benefits in the context of weight reduction programmes, in diabetes control and in dental health.
- It is suggested that foods and beverages sweetened with low calorie sweeteners are included in dietary guidelines as alternative options to their sugar-sweetened versions.
- Consumer education about low calorie sweeteners must be strengthened in a rigorous, objective way, based on the best scientific evidence and regulatory processes.
- Health professionals are an important source of scientific information; continuing education towards this group on the science around low calorie sweeteners is necessary.
Conclusions of the Lisbon Ibero-American Consensus meeting
Aiming to provide a useful, evidence based, point of reference to assist in efforts to reducing sugar consumption, in line with current international public health recommendations, more than 60 international scientific experts in food, nutrition, dietetics, endocrinology, toxicology and public health met in Lisbon to discuss and review the current evidence in relation to low calorie sweeteners’ use as sugar substitutes. The topics addressed during the Lisbon meeting and in a subsequently published consensus paper1 include: the safety and regulation of low calorie sweeteners, their impact on weight management, glucose control and dental health, their role in sugar reduction and in dietary guidelines, as well as other nutritional aspects of their use in foods and beverages. Furthermore, the critical role of well-informed health professionals and the need for science-based consumer education were highlighted. This ISA article provides a brief overview of the key conclusions reached in the Ibero-American Consensus meeting among this panel of international experts.
The safety of low calorie sweeteners is well established
Low calorie sweeteners are indeed amongst the most extensively researched food additives available on the market. The safety of low calorie sweeteners has been repeatedly assessed and confirmed by regulatory and scientific bodies worldwide, including the Joint Food and Agriculture Organization/ World Health Organization (FAO/WHO) Expert Committee on Food Additives (JECFA), the US Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA). In fact, their safety is continuously re-evaluated to consider new and relevant scientific safety and intake data. This Consensus paper provides information about the safety evaluation and the approval processes by regulatory bodies at international and European levels as well as by national regulatory authorities in Latin American countries.
Benefits of low calorie sweeteners when used in place of sugar
Based on the available scientific literature, the experts concluded that the use of low calorie sweeteners to replace sugar in weight reduction programmes may favour sustainable weight loss or weight loss maintenance. These programmes should consider structured diet plans – possibly monitored by healthcare professionals – as well as an active, healthy lifestyle that includes a sensible, balanced diet and regular physical activity. The ad libitum consumption of low calorie sweeteners, without replacement of sugar, seems to have no beneficial nor detrimental effect on body weight. Furthermore, the use of low calorie sweeteners in diabetes management programmes may contribute to a better glycaemic control. Contrary to sugar, low calorie sweeteners do not affect glycaemia and therefore do not cause a spike in blood glucose levels after consumption. Also, low calorie sweeteners provide dental health benefits when used in place of free sugars.
Low calorie sweeteners as alternative to sugar in dietary guidelines and nutritional recommendations
It has been proposed that foods and beverages with low calorie sweeteners could be included in dietary guidelines as alternatives to products sweetened with free sugars, and that this could encourage product reformulation by the food industry and help in achieving sugar reduction at a population basis. For example, dietary recommendations from several countries refer to foods and beverages containing low calorie sweeteners as possible alternatives to products sweetened with caloric sweeteners to promote the reduction of free sugar consumption with some advising on amounts of such beverages (Belgium, Spain, UK). Foods and beverages containing low calorie sweeteners can also be recommended to replace products with added sugars for patients with diabetes, dyslipidaemia, obesity or cardiovascular diseases.
Consumer education must be strengthened and scientifically accurate
Consumers are often faced with multiple sources of information on food and health issues, which do not always help provide reliable, high-quality information. In addition, the increasing use of new technologies and social networks favours the rapid dissemination and exchange of information, not all of which is accurate. Consumer education about the use of low calorie sweeteners, as with all health- and nutrition-related topics, should be objective and based on the most robust scientific evidence. Continued education of health professionals is also required, since they are a key source of information on issues related to food and health for both the general population and patients. Finally, it is critical to facilitate access to information that is of proven quality, evidence-based, transparent, and easy-to-understand by the general public, to support warranted recommendations for low calorie sweeteners’ use.