Low calorie sweeteners in breast milk do not enhance its sweetness nor encourage a liking for sweet taste and overconsumption

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ISA comments in response to study by Rother et al.

Contrary to the claims made by Rother et al. in their recent study1the International Sweeteners Association (ISA) would like to point out the lack of evidence to support any effect of low calorie sweeteners in breast milk on enhancing its sweetness and thus encouraging a liking for sweet taste and overconsumption.

In fact, this experimental study by Rother et al. only intended to examine the pharmacokinetics of two low calorie sweeteners in breast milk after ingestion of a low calorie sweetened beverage. This study does not therefore investigate nor provide any evidence about the hypothesis that addition of low calorie sweeteners to breast milk would possibly encourage a liking for sweet taste and overconsumption, or that early exposure would influence the child’s metabolism and future health.

More importantly, for a low calorie sweetener to be approved for use on the market, it must first undergo a thorough safety assessment by the competent food safety authority. At an international level, the responsibility of evaluating the safety of all additives including low calorie sweeteners rests with the Joint Expert Scientific Committee on Food Additives (JECFA)2 of the United Nations Food & Agriculture Organization (FAO) and the World Health Organization (WHO). All regulatory bodies around the world including the JECFA2, the US Food and Drug Administration (FDA)3 and the European Food Safety Authority (EFSA)4 consistently confirmed the safety of low calorie sweeteners, including for nursing or pregnant women.

The scientific evidence required for the safety evaluation of any low calorie sweetener must include rigorous analysis of the potential for the low calorie sweetener to affect overall health in the long term, including studies investigating the safety of low calorie sweeteners’ intake in pregnancy and lactation, as well as an analysis of the potential for chronic ingestion of a low calorie sweetener to affect growth, development and overall child’s health status. These studies provide strong evidence that all approved low calorie sweeteners are safe food ingredients including for consumption by pregnant and lactating women.5,6

Furthermore, current evidence doesn’t support the hypothesis that low calorie sweeteners would encourage a “sweet tooth”7. In contrast, clinical studies have shown that the replacement of sugary products with their low calorie sweetened alternatives can help reduce weight gain and fat accumulation in children and adolescents.8,9

Following an overall balanced diet during pregnancy and lactation as well as encouraging healthy eating behaviours early in childhood are recognised as some of the most critical aspects of reducing an individual’s risk of overweight or obesity and lifestyle-related diseases. Being mindful of the special nutritional needs in childhood, the use of low calorie sweetened foods and drinks within the context of an overall balanced diet can be helpful in managing a “sweet tooth” while providing fewer calories to the diet. Women who are pregnant or breast-feeding should talk to their doctors or dieticians about their special nutritional needs.

  1. Rother KI, Sylvetsky AC, Walter PJ, Garraffo HM and Fields DA. Pharmacokinetics of Sucralose and Acesulfame Potassium in Breast Milk Following Ingestion of Diet Soda. Journal of Pediatric Gastroenterology and Nutrition 2018; 66(3): 466-70
  2. http://www.fao.org/food/food-safety-quality/scientific-advice/jecfa/en
  3. http://www.fda.gov
  4. http://www.efsa.europa.eu/en/topics/topic/sweeteners
  5. Magnuson, B. A., Carakostas, M. C., Moore, N. H., Poulos, S. P., & Renwick, A. G. (2016). Biological fate of low-calorie sweeteners. Nutr Rev, 74(11), 670-689
  6. Magnuson BA, Roberts A, Nestmann ER. Critical review of the current literature on the safety of sucralose. Food Chem Toxicol 2017 Aug;106(Pt A): 324-355
  7. Bellisle F. Intense Sweeteners, Appetite for the Sweet Taste, and Relationship to Weight Management. Curr Obes Rep 2015; 4(1): 106-110
  8. Rogers P. et al. 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
  9. de Ruyter JC, et al. A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children. N Engl J Med 2012; 367: 1397–1406