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.