Low calorie sweeteners can play a beneficial role in calorie reduction and weight management

ISA statement in response to the systematic review by Toews et al.

An overwhelming body of robust scientific evidence demonstrates that low calorie sweeteners can be helpful tools in weight management, when used to replace sugar and as part of a calorie-controlled diet and a healthy lifestyle1,2.

Actually, the recent systematic review published by Toews et al3 shows that people consuming low calorie sweeteners have lower energy and sugar intakes. Importantly, the use of low calorie sweeteners was shown to lead to reduced body weight in overweight and obese consumers, i.e. those people who can benefit the most from weight loss.

As also noted in an accompanying editorial by Vasanti Malik in BMJ4, among adults, findings from the randomised controlled trials comparing low calorie sweeteners’ intake with sugar intake suggested small improvements in body mass index and fasting concentrations of blood glucose favouring low calorie sweeteners. Among children, low calorie sweeteners intake led to a smaller increase in body mass index z score than sugar intake.

Finally, while the current review by Toews et al. is an important review, it has serious limitations that are also discussed in the BMJ editorial by Vasanti Malik. The review has excluded important and well-designed trials, that have examined the longer-term effects of low calorie sweetened products (e.g. diet sodas) on weight management. For example, the year-long randomised clinical trial (RCT) by Peters et al clearly showed a beneficial effect of low calorie sweetened drink intake on both weight loss and weight loss maintenance (Peters et al, 2014; 2016)5,6. Several scientific experts provided comments on this study, emphasising that Toews et al. excluded several relevant RCTs in adults, and even inappropriately included one RCT which had a large effect on the overall result (Rogers, 2019)7. Experts noted that Toews et al. covered a unique and particularly small sub-set of existing publications (Bellisle, 2019)8 and that they omitted or disregarded many studies showing benefits from low calorie sweeteners (Winkler, 2019)9.

Overall, the wealth of scientific evidence to date demonstrates that low calorie sweeteners can be helpful tools not only in weight management, when used to replace sugar and as part of a calorie-controlled diet and a healthy lifestyle, but also a significant aid to people with diabetes, as they do not affect blood glucose control10,11. Furthermore, low calorie sweeteners have the added benefit of being non-fermentable by oral bacteria and thus are non-cariogenic and tooth-friendly ingredients12.

  1. Rogers PJ., Hogenkamp PS., de Graaf C., Higgs S., Lluch A., Ness AR., . . . Mela DJ. Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. Int J Obes 2016;40(3):381-94
  2. Miller PE., & Perez V. Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies. Am J Clin Nutr 2014;100(3):765-777
  3. Toews I, Lohner S, Ku?llenberg de Gaudry D, Sommer H, Meerpohl JJ. Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies. BMJ 2019;364:k4718
  4. Malik V. Non-sugar sweeteners and health. The weight of evidence hints at benefits, but the full picture has yet to emerge. BMJ 2019;364:k5005
  5. Peters, J. C., Beck, J., Cardel, M., Wyatt, H. R., Foster, G. D., Pan, Z., . . . Hill, J. O. (2016). The effects of water and non-nutritive sweetened beverages on weight loss and weight maintenance: A randomized clinical trial. Obesity (Silver Spring), 24(2), 297-304
  6. Peters, J. C., Wyatt, H. R., Foster, G. D., Pan, Z., Wojtanowski, A. C., Vander Veur, S. S., . . . Hill, J. O. (2014). The effects of water and non-nutritive sweetened beverages on weight loss during a 12-week weight loss treatment program. Obesity, 22(6), 1415–1421
  7. Rogers P. Sweeteners do help reduce weight. BMJ 2019 (online response). Available at: https://www.bmj.com/content/364/bmj.k4718/rr-4
  8. Bellisle F. Sweeteners and Health: a closer look at the totality of evidence. BMJ 2019 (online response). Available at: https://www.bmj.com/content/364/bmj.k4718/rr-3
  9. Winkler JT. Selective research makes bad policy. BMJ 2019 (online response). Available at: https://www.bmj.com/content/364/bmj.k4718/rr-2
  10. American Diabetes Association (ADA). 4. Lifestyle management: Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41(Suppl 1): S38-S50
  11. Dyson, P. A., Twenefour, D., Breen, C., Duncan, A., Elvin, E., Goff, L., . . . Watson, K.. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes (2018). Diabetic Medicine 2018 May;35(5):541-547
  12. EFSA Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA 2011 Journal 9: 2229