Science news from the ISA symposium at GANEPÃO 2018 nutrition conference in Brazil
- Low calorie sweeteners are amongst the most studied food ingredients worldwide; before being approved for use on the market, low calorie sweeteners are subject to stringent safety evaluations by regulatory authorities around the world that consistently confirm their safety.
- There is convincing epidemiologic evidence of the absence of association between low calorie sweeteners and the risk of several common types of cancer.
- Low calorie sweeteners seem to satiate rather than enhance the appetite for sweet tasting products and to facilitate the reduction of calorie intake.
- Existing evidence suggests that low calorie sweeteners may be a helpful strategy in the prevention and management of obesity and diabetes by helping to reduce sugar consumption while maintaining the palatability of the diet.
Low calorie sweeteners’ use and role in the diet remain a hot topic in research with several new studies published each year bringing to light new evidence around low calorie sweeteners’ benefits. The emerging scientific evidence on related topics was presented and discussed by a panel of international speakers at a symposium organised by the International Sweeteners Association (ISA) in the context of the Ganepão 2018 nutrition conference that took place in São Paulo, Brazil, on 13th June 2018.
Prof Carlo La Vecchia, University of Milan, Italy, Dr France Bellisle, Université Paris 13, France, and Dr Caomhan Logue, Ulster University, Coleraine, UK, presented the latest data in their area of expertise and scientific interest around: “Sweetness without calories: Safety, benefits and role of low calorie sweeteners in obesity and diabetes”, in an ISA symposium attended by scientists, medical and nutrition professionals.
A review of the evidence around low calorie sweeteners’ safety
Despite repeated thorough safety evaluations and consistent confirmation of the safety of low calorie sweeteners by regulatory authorities worldwide, including the Joint Food and Agriculture Organisation (FAO)/ World Health Organization (WHO) Expert Committee on Food Additives (JECFA), the US Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA), the role of low calorie sweeteners in cancer risk has been debated since the 1970s. Presenting the available published data, and in line with the scientific opinions of food safety authorities around the world, Prof Carlo La Vecchia, concluded that there is now convincing epidemiological evidence of the absence of association between low calorie sweeteners and the risk of several common neoplasms.1
To provide a review of the evidence around low calorie sweeteners and the risk of several types of cancer, Prof La Vecchia presented data of his earlier research work considering the risk of cancer at several sites, including cancers of the oral cavity, pharynx and larynx, of the oesophagus, stomach, pancreas and colon-rectum, of the breast, ovary, endometrium, prostate, and of the kidney, as well as the work of other scientists considering data on brain and hematopoietic neoplasms, among other types of cancer. Based on the available epidemiological evidence, low calorie sweeteners are not associated with increased risk of the studied types of cancer, which is in line with the wealth of existing carcinogenicity studies showing no carcinogenic effect of all approved low calorie sweeteners.2
Furthermore, current levels of global intake of the different low calorie sweeteners are well below the individual sweeteners’ Acceptable Daily Intakes (ADI), which is another reassurance that there is no concern from current levels of consumption.3
Sweetness without calories and the effect of low calorie sweeteners on appetite and energy intake
The effect of low calorie sweeteners on appetite and energy intake and the role of sweetness without calories in the diet have constituted topics of high scientific interest over the last decade, especially since low calorie sweeteners can be a useful means to help people meet the recent recommendations by the World Health Organization (WHO) to reduce excess sugar intake.4
Dr France Bellisle talked about sweet taste in the diet, our innate preference to sweetness and the role low calorie sweeteners can play in sugar and energy reduction as they provide sweetness without calories.5 Recent systematic reviews and meta-analyses have further confirmed that the use of low calorie sweeteners is associated with lower energy and sugar intake in the context of weight loss programmes, and that they may also facilitate the maintenance of the reduced weight after the end of a diet.6 Dr Bellisle presented data showing that while early hypotheses suggested that low calorie sweeteners may enhance the natural appetite for sweetness and paradoxically stimulate the consumption of other sweet (sugar-containing) products and perhaps overeating, clinical trials show that low calorie sweeteners may satiate rather than enhance the appetite for sweet tasting products and facilitate the reduction of sugar intake.5,7 In relation to future research needs, Dr Bellisle concluded that more research is needed to assess the role of low calorie sweeteners in the management of sweetness appetite over the life span and in the prevention of weight gain, particularly in individuals at risk of overweight/ obesity.
The role of low calorie sweeteners in obesity and diabetes – a public health perspective
With obesity and diabetes becoming important global health issues over recent decades, the aim of the presentation by Dr Caomhan Logue was to review and present the evidence around the role that low calorie sweeteners can play in obesity and diabetes management from a public health perspective.6,8 With intakes of sugars currently exceeding the recommendations set by health organisations, several approaches have been suggested for reducing intakes, such as the promotion of healthier choices, changes in portion sizes and product reformulation including with the use of low calorie sweeteners.9
Despite current evidence from recently published systematic reviews with meta-analyses supporting the beneficial effect of low calorie sweeteners on weight status when used to replace sugar, debate persists around the use of low calorie sweeteners in relation to effects on long-term weight management and obesity. This is mainly due to mixed findings from observational studies, some of which have found positive associations with the risk of weight gain and diabetes. However, these findings may be largely attributed to reverse causality or to the presence of confounding factors. Furthermore, limitations relating to the methods used to estimate dietary intake can also be a source of bias. Therefore, alternative approaches which generate more objective and comprehensive sweetener-intake data, such as a biomarker approach, may help address this type of important limitations in future research.10 In any case, however, observational studies, by nature, cannot establish a causal relationship and any association suggested has to be examined in well-designed controlled human trials.
As low calorie sweeteners are food additives that provide a desired sweet taste without the addition of calories, they can contribute to the reduction of sugar and calorie intake without having a glycaemic impact and while maintaining the palatability of the diet and of reformulated products. Therefore, it has been suggested that low calorie sweeteners may have a positive contribution to make towards achieving important public health goals in relation to obesity and diabetes, when integrated in an overall high-quality diet and healthy lifestyle.
For more information about the programme and the speakers of the ISA Symposium at the Ganepão 2018 nutrition conference, as well as about ISA activities on this occasion, please visit the dedicated page on the ISA website by clicking here.