Low/no calorie sweeteners are safe

ISA statement in response to observational study by Debras et al.

Brussels, 24th March 2022: The International Sweeteners Association (ISA) responds to a new observational study by Debras et al,1 pointing to the important limitations of this study and to the opinions of international regulatory authorities which have repeatedly and consistently confirmed that all approved low/no calorie sweeteners are safe.

In fact, low/no calorie sweeteners are amongst the most thoroughly researched ingredients worldwide. Before being approved for use on the market, all low/no calorie sweeteners have undergone a thorough safety assessment by the competent regulatory authority, such as the Joint Food and Agriculture Organisation (FAO)/World Health Organization (WHO) Expert Committee on Food Additives (JECFA), the US Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA). And these authorities have all repeatedly and consistently confirmed the safety of all approved low/no calorie sweeteners.2,3,4

The safety assessment processes are based on rigorous independent expert reviews of the collective research and the evaluation of all kinds of evidence regarding potential side effects, including carcinogenicity studies and cancer epidemiology research.5,6,7,8   

Actually, in their study and the accompanying Press Release, co-authors Charlotte Debras and Mathilde Touvier also recognise that “the study has several important limitations including self-reported dietary intakes, selection bias, residual confounding and reverse causality. All these limitations are linked to the observational nature of the study. In fact, the WHO-supported systematic review by Toews et al9 emphasised that results of observational studies on the health effects of low/no calorie sweeteners should be interpreted with caution, and attention should focus on plausible residual confounding as well as reverse causality.

Importantly also, cancer epidemiology research does not support a relationship between low/no calorie sweeteners’ intake and an increased risk of cancer. Recent systematic reviews of the literature, which consider the collective research on a dedicated topic, have indicated that there is no evidence of association between low/no calorie sweetener consumption and several forms of cancer.9,10 This is in line with the conclusions reached by food safety agencies around the world and their confirmation that low/no calorie sweeteners do not bear a carcinogenic risk, and therefore are safe.

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, low/no calorie sweeteners can be helpful in creating healthier food environments. They provide 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.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.11

  1. Debras C, Chazelas E, Srour B, DruesnePecollo N, Esseddik Y, Szabo de Edelenyi F, et al. Artificial sweeteners and cancer risk: Results from the NutriNet-Sante´ population-based cohort study. PLoS Med 2022;19(3): e1003950. https://doi.org/10.1371/journal.pmed.1003950
  2. http://www.fao.org/food/food-safety-quality/scientific-advice/jecfa/en/
  3. https://www.fda.gov/food/food-additives-petitions/high-intensity-sweeteners
  4. http://www.efsa.europa.eu/en/topics/topic/sweeteners
  5. EFSA Protocol on hazard identification and characterization of sweeteners: https://efsa.onlinelibrary.wiley.com/action/downloadSupplement?doi=10.2903%2Fsp.efsa.2020.EN-1803&file=efs31803e-sup-0001-annex.pdf
  6. EFSA opinion on aspartame: EFSA Journal 2013;11(12):3496
  7. Magnuson BA, Carakostas MC, Moore NH, Poulos SP, Renwick AG. Biological fate of low-calorie sweeteners. Nutr Rev 2016; 74(11): 670-689
  8. Serra-Majem L, Raposo A, Aranceta-Bartrina J, et al. Ibero–American Consensus on Low- and No-Calorie Sweeteners: Safety, nutritional aspects and benefits in food and beverages. Nutrients 2018; 10: 818
  9. Toews I, Lohner S, de Gaudry DK, Sommer J, 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; 363: k4718
  10. Haighton L, Roberts A, Jonaitis T, Lynch B. Evaluation of aspartame cancer epidemiology studies based on quality appraisal criteria. Regul Toxicol Pharmacol 2019 Apr;103:352-362
  11. EFSA Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA 2011 Journal 9(6): 2229, and 9(4): 2076 and Commission Regulation 432/2012/EU (OJ L 136 25.5.2012, p. 1): http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2012:136:0001:0040:en:PDF