Targeting misinformation on low/no calorie sweeteners by seeking reliable scientific information

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Science news from the webinar organised by ISA and the Colombian Diabetology Federation

Highlights:

  • Scientists participating in a webinar about low/no calorie sweeteners highlighted that, in the age of misinformation, consumers must seek reliable sources of knowledge to make informed decisions about what they choose to eat.
  • All approved low/no calorie sweeteners, irrespective of their origin, have been through a thorough safety evaluation process and have been determined to be safe within acceptable intake levels.
  • A new under-publication study confirms that the estimated intakes of the six most commonly consumed low/no calorie sweeteners are below their respective Acceptable Daily Intakes (ADI) in Argentina, Chile and Peru.
  • The replacement of sugars with low/no calorie sweeteners can help us reduce our calorie intake, and thus assist in managing our body weight more effectively. The available science does not show that low/no calorie sweeteners might increase our appetite for sweet products or induce loss of control over eating.
  • Low/no calorie sweeteners have no effect on postprandial blood sugar levels, and they cause a lower blood glucose increase when compared to sugar.

 

The role of low/no calorie sweeteners in the current public health debate was the topic of a webinar organised by the International Sweeteners Association (ISA) and the Colombian Diabetology Federation (FDC). Acknowledging the misinformation around the topic of low/no calorie sweeteners, international scientific experts aimed to provide a review of the available and most recent evidence on a wide area of topics, from safety to efficacy of sweeteners.

Intake of low/no calorie sweeteners: Are these ingredients safe? And how much do we consume?

Questions around the use of low/no calorie sweeteners still arise among consumers even though their safety has been independently evaluated and repeatedly confirmed by prominent food safety agencies around the world, such as the Joint Food and Agriculture Organisation/World Health Organisation Expert Committee on Food Additives (JECFA), the European Food Safety Authority (EFSA) and the U.S. Food and Drug Administration (FDA).1

Dr. Indira Sotelo (Universidad La Sabana, Colombia) clarified that all approved low/no calorie sweeteners have gone through the same comprehensive safety assessment process, irrespective of their natural or synthetic origin.

Another consideration by public health experts is whether the intake levels of low/no calorie sweeteners remain within the Acceptable Daily Intake (ADI), which is set for each individual sweetener during the approval process by food safety and regulatory authorities. The ADI is the amount of low/no calorie sweetener that can be safely consumed on a daily basis throughout a person’s lifetime without any health problems.

Dr. Leila Barraj (Exponent, USA) presented for the first time the results of an under-publication study, which used the budget method approach as well as country specific sales data and use data to derive screening level intake estimates of six low/no calorie sweeteners (acesulfame potassium, aspartame, cyclamate, saccharin, steviol glycosides, and sucralose) for Argentina, Chile, and Peru.2 In line with previous findings for Latin American countries, the new study confirmed that the estimated intakes of the six low/no calorie sweeteners were below their respective ADIs, even when the most conservative assumptions were applied.

Moreover, Dr Barraj explained that the consumption values used in the budget method are based on conservative assumptions on the caloric needs of young children and on the range of potential beverage intakes of infants, children, and adults in hot climates. Therefore, the results of the current study for Argentina, Chile, and Peru are not only relevant to the general adult population but are also applicable to the subpopulation of children in these three countries.

What about the efficacy of low/no calorie sweeteners? Can they make a difference in weight and glucose control?

Another area of controversy is the value of using low/no calorie sweeteners. Consumers are confused by conflicting information online and want to know if sweeteners do have the intended benefit for their health.

Dr Brian Cavagnari (Universidad Católica Argentina, Argentina) aimed to clarify the reason for this confusion. He explained that different types of studies, depending on their design, strengths and limitations might show differing results3, but healthcare professionals should base their recommendations on evidence-based nutrition, which is linked to the hierarchy of scientific evidence.4 For example, in the case of sweeteners, observational studies sometimes show a link between higher consumption of low/no calorie sweeteners and obesity, which, however, might be due to the fact that people with higher body weight turn to sweeteners in their effort to reduce sugars intake and to manage their body weight, not the other way around. This is a typical case of ‘reverse causation’. Due to limitations in the design of observational studies, this type of research ranks lower in the hierarchy of evidence, while randomised controlled trials (RCTs) provide higher level of evidence due to their more sophisticated design. So, contrary to what observational studies show, RCTs conclude that the replacement of sugars by low/no calorie sweeteners can help reduce our overall energy (calorie) intake, and thus assist in body weight loss or weight maintenance.5 In fact, the beneficial effect on body weight is greater in people living with overweight or obesity, but this also depends on the level of calorie reduction from sugar replacement.6 If low/no calorie sweeteners are compared to water or placebo, where there is no calorie reduction achieved, the effect on body weight is simply neutral.5

Similarly, to understand the potential benefit of low/no calorie sweeteners in glucose control, healthcare professionals should evaluate the totality of evidence and provide targeted recommendation to their patients according to individual eating patterns. For example, low/no calorie sweeteners do not affect blood glucose levels, and thus when compared to sugars which cause a glucose spike, sweeteners have the benefit of causing a lower blood sugar increase.7 Some studies suggest that this benefit might be more evident and important for people with diabetes.8

What about the long-term effect on sweetness preference? Do they cause a sweet tooth?

People also want to know if the short-term benefit of low/no calorie sweeteners in reducing calorie intake might exacerbate their long-term preference to sweet taste.

Dr France Bellisle (University of Paris, France) talked about what the current evidence shows on the effect of low/no calorie sweeteners on appetite and sweetness liking. While more research is needed in this field, and large RCTs are currently ongoing, increasing number of studies published up to date report no effects of sweet taste exposure on subsequent desires for and intakes of sweet foods.9 The available evidence does not confirm the hypothesis that low/no calorie sweeteners might exacerbate appetite for sweet products or induce loss of control over eating. In contrast, at least in the short-to-medium term, some clinical trials suggest that the use of low/no calorie sweeteners as part of a weight loss diet satiates the appetite for sweetness, so that less sugar is consumed.

Targeting misinformation by putting forward reliable scientific evidence

At the webinar, moderated by Dr Luisa Fernanda Bohórquez, President of the Colombian Diabetology Federation (FDC), the experts also talked about the role of media in fighting misinformation. The experts agreed that, in the current age where information is everywhere, finding credible evidence can be a challenge, yet consumers must seek reliable information to make informed decisions about what they are eating.

You may watch the webinar on demand by clicking here.

  1. Aldrete-Velasco J. et al. Análisis de la evidencia disponible para el consumo de edulcorantes no calóricos. Documento de expertos. Med. interna Méx. 2017;33(1):61-83.
  2. Barraj L, Bi X, Tran N. Screening level intake estimates of low and no-calorie sweeteners in Argentina, Chile and Peru. Food Additives & Contaminants: Part A. (Under publication)
  3. Normand M, Ritz C, Mela D, Raben A. Low-energy sweeteners and body weight: a citation network analysis. BMJ Nutrition, Prevention & Health 2021; bmjnph-2020-000210. doi: 1136/bmjnph-2020-000210
  4. Cavagnari BM. Edulcorantes no calóricos y peso corporal. (Non-caloric sweeteners and body weight). MEDICINA (Buenos Aires) 2019; 79: 115-122
  5. 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 2021; 45(3): 464-478 https://doi.org/10.1038/s41366-020-00704-2
  6. 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. doi: 10.1111/obr.13020
  7. Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA Journal 2011, 9(6), 2229. Available online: Available online: http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2011.2229/epdf
  8. 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. Am J Clin Nutr 2020; nqaa167. https://doi.org/10.1093/ajcn/nqaa167
  9. Appleton KM, Tuorila H, Bertenshaw EJ, de Graaf C and 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