Low calorie sweeteners not associated with increased risk of diabetes

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ISA statement in response to new study by Drouin-Chartier et al.

Brussels, 4th October 2019: Following the publication of a study by Drouin-Chartier et al. regarding a hypothetical effect of the consumption of low/no calorie sweetened beverages on the risk of type 2 diabetes,1 the International Sweeteners Association (ISA) would point to the observational nature and thereby limitations of this study, as also acknowledged by the authors, and to the wealth of robust scientific evidence that confirms low/no calorie sweeteners’ consumption doesn’t increase the risk of diabetes.

At a time when obesity and non-communicable diseases including diabetes remain major global health challenges, and public health authorities are encouraging food manufacturers to replace sugar and reduce calories as part of their reformulation goals, it is critical that the public is provided with reliable science-based information regarding the safety and the utility of low/no calorie sweeteners including in the management of blood glucose and diabetes, which is supported by food safety authorities and health organisations worldwide. 2,3,4,5

Observational studies, by their nature, cannot prove a causal relationship and must be critically interpreted, as residual confounding and reverse causation may affect the observed associations.6 This is also recognised by the authors in the paper by Drouin-Chartier et al., who state that these findings need to be interpreted with caution, as reverse causation or surveillance bias may affect the association suggested between the consumption of low/no calorie sweetened beverages and the risk of diabetes. Indeed, individuals at higher risk of diabetes are likely to switch to low/no calorie sweetened beverages as a strategy to control their body weight, and the presence of this confounding may also overestimate the strength of the reported association.

In fact, the WHO-supported systematic review by Toews et al. also pointed to the need for interpreting with caution the results of observational studies around the health effects of low/no calorie sweeteners, and the need for being mindful of the plausible residual confounding as well as reverse causality in this type of studies.7

On the other hand, results of controlled intervention studies in humans provide the most robust data for evaluation of potential benefits and effects of low/no calorie sweeteners on measurable outcomes such as body weight and glycaemic control and therefore, are considered as evidence of higher quality. The collective data from controlled studies in both animals and humans consistently supports the assertion that low/no calorie sweeteners do not cause weight gain nor disrupt glucose control or have any other adverse health impact.8,9

Used in foods, beverages and tabletop sweeteners, low calorie sweeteners can provide people, including those with, or at risk of diabetes, 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 intake, as well as in managing blood glucose levels. Low calorie sweeteners are also non-cariogenic, which means that they do not contribute to tooth decay.5

  1. Drouin-Chartier et al. Changes in Consumption of Sugary Beverages and Artificially Sweetened Beverages and Subsequent Risk of Type 2 Diabetes: Results From Three Large Prospective U.S. Cohorts of Women and Men. Diabetes Care 2019;42:1-9
  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. The European Food Safety Authority (EFSA) has concluded that: “Consumption of foods/drinks containing intense sweeteners instead of sugar induces a lower blood glucose rise after their consumption compared to sugar-containing foods/drinks”. EFSA Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA 2011 Journal 9(6): 2229, and 9(4): 2076
  6. Pyrogianni V and La Vecchia C. Letter by Pyrogianni and La Vecchia Regarding Article, “Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women’s Health Initiative”. Stroke 2019; 50(6): e169
  7. Toews et al. 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
  8. Rogers PJ, Hogenkamp PS, De Graaf C, Higgs S, Lluch A, Ness AR, Penfold C, Perry R, Putz P, Yeomans MR, 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;40:381–94
  9. Nichol AD, Holle MJ, An R. Glycemic impact of non-nutritive sweeteners: a systematic review and meta-analysis of randomized controlled trials. Eur J Clin Nutr 2018; 72: 796-804