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

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ISA statement in response to the systematic review by Rios-Leyvraz and Montez

Brussels, 15th April 2022: The International Sweeteners Association (ISA) responds to the new  WHO-supported systematic review by Rios-Leyvraz and Montez1 on health effects of low/no calorie sweeteners.

This review acknowledges the positive role of low/no calorie sweeteners in short-term weight loss when their use leads to a reduction in total energy intake without evidence of harm on cardiometabolic health, based on evidence from randomised controlled trials, the gold standard in nutrition research.

Indeed, an overwhelming body of robust scientific evidence demonstrates that low/no 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 lifestyle.2,3,4 This has also been demonstrated in children.5 Moreover, they can also offer a significant aid to people with diabetes, as they do not affect blood glucose control.6,7

Actually, when analysing epidemiological research, which provide very low to low certainty of evidence, authors recognise that results from observational studies suggesting the possibility of long-term health effects may be linked to potential limitations of the observational study design, including reverse causation and/or residual confounding. The authors explain that reverse causation implies that individuals assessed as higher consumers of low/no calorie sweeteners (LNCS) are more frequently already in a “predisease” state or at high risk for disease (e.g. overweight), and therefore might have initiated or increased LNCS intake in response to these health issues, thus leading to a spurious association between LNCS intake and increased body weight, or diabetes. Importantly, higher quality evidence from controlled clinical studies does not confirm adverse effects of low/no calorie sweeteners’ use in cardiometabolic risk factors including glucose control, blood lipids and blood pressure.

Finally, the ISA points to the safety of low/no calorie sweeteners, including during pregnancy, that has been repeatedly and consistently confirmed by food safety authorities around the world.8,9,10

At a time when obesity and non-communicable diseases including diabetes and dental diseases remain major global health challenges, and in light of current public health recommendations to reduce overall sugar intake, all low/no calorie sweeteners can be helpful in creating healthier food environments. They provide people with a wide choice of sweet-tasting options with low or no calories, and thus can be a useful tool, when used in place of sugar and as part of a balanced diet, in helping reduce overall sugar and calorie intake3, as well as in managing blood glucose levels.11 Low/no calorie sweeteners are also not fermentable by oral bacteria, which means that they do not contribute to tooth demineralisation, which is one of the reasons for tooth decay.12

  1. World Health Organization, Rios-Leyvraz, Magali & Montez, Jason. (‎2022)‎. Health effects of the use of non-sugar sweeteners: a systematic review and meta-analysis. World Health Organization. https://apps.who.int/iris/handle/10665/353064. License: CC BY-NC-SA 3.0 IGO
  2. McGlynn ND, Khan TA, Wang L, et al. Association of Low- and No-Calorie Sweetened Beverages as a Replacement for Sugar-Sweetened Beverages With Body Weight and Cardiometabolic Risk: A Systematic Review and Meta-analysis. JAMA Network Open 2022;5(3):e222092
  3. 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.
  4. Laviada-Molina H 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.
  5. de Ruyter JC, Olthof MR, Seidell JC, et al. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med 2012;367(15):1397–1406
  6. 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; 112(4):1002-1014
  7. Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KHK, MacLeod J, Mitri J, Pereira RF, Rawlings K, Robinson S, Saslow L, Uelmen A, Urbanski PB, Yancy Jr. WS. Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report. Diabetes Care. 2019 May;42(5):731-754
  8. http://www.fao.org/food/food-safety-quality/scientific-advice/jecfa/en/
  9. https://www.fda.gov/food/food-additives-petitions/high-intensity-sweeteners
  10. http://www.efsa.europa.eu/en/topics/topic/sweeteners
  11. Diabetes UK. The use of low or no calorie sweeteners. Position Statement (Updated December 2018). Available at: https://www.diabetes.org.uk/professionals/position-statements-reports/food-nutrition-lifestyle/use-of-low-or-no-calorie-sweetners
  12. EFSA Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA 2011 Journal 9(6): 2229, and 9(4): 2076.