Year in review: What’s new about low/no calorie sweeteners?

A 2019 science review

Highlights:

• Diabetes associations across the world support the claim that replacing sugars with low/no calorie sweeteners can be a helpful strategy to aid glucose and weight control in diabetes.
• By enhancing meal enjoyment and control of food cravings, low/no calorie sweetened beverages can help consumers eat less, new studies show.
• There is no evidence of adverse effect of low/no calorie sweeteners on the gut microbiota at doses relevant to human use, according to new reviews.
• Paediatrics experts conclude that children with obesity and type 1 or 2 diabetes may benefit from the use of low/no calorie sweeteners if used in place of sugars and ask for more research to study long-term benefits in children.

Low/no calorie sweeteners are amongst the most studied ingredients in the world and new research published every year adds further evidence to our current knowledge. In 2019, there was a lot of scientific interest in the role of low/ no calorie sweeteners in glucose and weight control in both adults and children. New observational studies, higher quality clinical trials in humans and several systematic reviews, position statements and expert consensus have been published. The current article aims to provide a year-in-science review including a summary of key outcomes of the most important publications and presentations in key scientific congresses.

Low/no calorie sweeteners in glucose control: diabetes-related organisations support their usefulness

Diabetes-related organisations in the US, the UK and in Latin America have recently renewed their positions on the use of low/no calorie sweeteners in diabetes and re-confirmed the helpful role of sugar substitutes in weight and glucose control.

In a Consensus Report by the American Diabetes Association (ADA), it is confirmed that replacing added sugars with sugar substitutes could decrease daily intake of carbohydrates and calories (Evert et al, 2019). These dietary changes could beneficially affect glycaemic, weight, and cardiometabolic control, as long as people avoid compensating with intake of additional calories from other food sources. Similarly, Diabetes UK concluded that replacing free sugars with low/no calorie sweeteners (LNCS) can be a helpful strategy to aid glucose management and that: “LNCS are shown to be safe and they can be used as part of a strategy for adults and children in the management of weight and diabetes”. The consensus of the Latin-American Association of Diabetes (Asociación Latinoamericana de Diabetes (ALAD)) is in line with the other two reports supporting that the consumption of low/no calorie sweeteners is safe within the Acceptable Daily Intake (ADI) levels and that their use can have benefits in calorie reduction, weight loss and glucose control, when used to replace sugar in the context of a structured dietary plan.

Low/no calorie sweeteners, diet satisfaction and food intake control

Two new studies published this year by the University of Liverpool and presented at the 13th European Nutrition Conference – FENS 2019 found that low/no calorie sweetened beverages may benefit some individuals in reducing their caloric intake whilst helping to satisfy their desire for sweetness (Maloney et al, 2019). Overall, the studies suggest that low/no calorie sweetened beverages may help some people to eat less by controlling food cravings and also help them feel greater meal enjoyment, more in control and less guilty about their eating. By doing so, low/no calorie sweeteners can help individuals who are regular consumers of diet drinks in food intake control and in adhering to their weight-management plan while maintaining a greater palatability of, and pleasure from, the diet.

Emerging research: Low/no calorie sweeteners and gut microbiota

As the interest in the effect of the diet on gut microbiota increases, research on the impact of individual ingredients of our diet is progressing. However, so far, most of the published research on low/no calorie sweeteners and gut microbiota has been conducted in animals, using extremely high amounts of the tested sweetener, while there are only three low-quality studies in humans with important limitations such as very low number of participants, no control group, uncontrolled diet, etc.

Reviewing the available data from in vivo studies, Lobach et al. identified a total of 17 studies investigating the administration of low/no calorie sweeteners to animals (14 studies) or humans (3 studies) and effects on the gut microbiota (Lobach et al, 2019). The authors concluded that current studies establish no clear evidence of any adverse effect of low/no calorie sweeteners on the gut microbiota at doses relevant to human use. Future research should include well-designed and controlled trials with appropriated doses in the context of human realistic cnsumption levels and adequate subject sizes to evaluate the potential impact of low/no calorie sweeteners on the gut microbiota. Careful control of other factors known to affect the gut microflora, such as changes in food consumption and diet composition, are also necessary to avoid confounding effects.

Low/no calorie sweeteners in children: High-quality reseach indicates potential benefits

Recently, the American Academy of Pediatrics (AAP) issued a policy statement in relation to the use of low/no calorie sweeteners by children (Baker-Smith et al, 2019). While the report calls for more high-quality research on long-term use of low/no calorie sweeteners in childhood, its guidance for pediatricians states that higher quality data suggest that low/no calorie sweeteners’ use is associated with weight stabilization and/or weight loss in the short-term and that: “When substituted for caloric-sweetened foods or beverages, NNSs [non-nutritive sweeteners] can reduce weight gain or promote small amounts of weight loss (+-1 kg) in children (and adults); however, data are limited, and use of NNSs in isolation is unlikely to lead to substantial weight loss.” It also supports that, individuals affected by certain conditions (eg, obesity and type 1 or 2 diabetes mellitus) may benefit from the use of low/no calorie sweeteners if substituted for caloric sweeteners. In relation to dental health, the AAP report concludes that the use of low/no calorie sweeteners has been associated with a reduced presence of dental caries.

With the contribution of renowned scientific experts who presented the latest science on low/no calorie sweeteners, this year the ISA organised several symposia in important congresses and scientific events in Europe and in Latin America. We have selected the most important readings hereafter to remind you of the key scientific outcomes of these events that took place in 2019:

1. Science news from the ISA sessions at the 31st National Congress of the Mexican Diabetes Federation (March 2019): “Low calorie sweeteners in diabetes: Doctors explain their role in glucose control” – please click here to read the ISA article
2. Science news from the 13th European Nutrition Conference – FENS 2019 (October 2019): “Scientific evidence and recommendations about the use and benefits of low/no calorie sweeteners” – please click here to read the ISA article
3. Science news from the the 12th EFAD Conference (November, 2019): “Low/no calorie sweeteners: Safety, emerging research and recommendations” – please click here to read the ISA article

We hope you enjoy reading the 2019 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 all the best for a happy 2020!