Low/no calorie sweeteners have a useful role to play in diabetes management

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ISA statement in response to study by Lohner et al.

Brussels, 26th May 2020: Responding to a new study by Lohner et al.1 the International Sweeteners Association (ISA) points to the collective evidence which confirms that low/no calorie sweeteners can be safely consumed by people with diabetes and have a useful role to play in diabetes management.

Low/no calorie sweeteners, also referred to as intense sweeteners or non-nutritive sweeteners, are food ingredients with sweet taste and no, or virtually no, calories that are used in foods and beverages as well as in table-top sweeteners in place of sugar to provide the desired sweetness with fewer or zero calories. Importantly, low/no calorie sweeteners can offer a significant aid to people with diabetes who need to manage their carbohydrate intake. They allow them to do this, while still being able to enjoy sweet-tasting food and drinks.

In fact, comprehensive systematic reviews have examined the potential effect of low/no calorie sweeteners on glycaemic control. And the evidence from these, including from the Lohner et al. paper, demonstrates that low/no calorie sweeteners do not raise blood glucose levels or otherwise affect blood glucose control.2,3 Furthermore, based on a review of the collective evidence, the European Food Safety Authority (EFSA) concluded in a scientific opinion that: “Consumption of foods containing intense sweeteners instead of sugar induces a lower blood glucose rise after their consumption compared to sugar-containing foods”.4 This is an authorised health claim in the EU.

Post-prandial blood glucose (ie. after meal consumption) plays an important role in overall glycaemic control. It is key for blood glucose levels to stay in a healthy range throughout the day including after a meal, as hyperglycaemia can cause damage or complications to the body over the course of many years. As this study by Lohner et al. excludes a wealth of clinical studies investigating the acute effect of low/no calorie sweeteners on glucose levels, it cannot determine the effect of low/no calorie sweeteners in diabetes in post-prandial blood glucose levels in the short-term. On the other hand, the results of this study are nevertheless consistent with the collective evidence that low/no calorie sweeteners have no adverse effects and can be safely used to help control sugar intake, whether in persons with diabetes or in healthy subjects with normal blood glucose control.

Health-related organisations worldwide also support the helpful role of low/no calorie sweeteners’ consumption in diabetes, including:

  • Diabetes UK, who published in December 2018 a Position Statement on low/ no calorie sweeteners (LNCS) and concluded that: “LNCS are shown to be safe and they can be used as part of a strategy for adults and children in the management of weight and diabetes”;5
  • The American Diabetes Association (ADA), who concluded in a Consensus Report in 2019 that: “Replacing added sugars with sugar substitutes could decrease daily intake of carbohydrates and calories. These dietary changes could beneficially affect glycaemic, weight, and cardiometabolic control”;6
  • The Latin-American Association of Diabetes (Asociación Latinoamericana de Diabetes (ALAD)) concluded in 2018 that the consumption of low/no calorie sweeteners is safe within the Acceptable Daily Intake (ADI) levels and that their use can have benefits in calorie reduction, weight loss and glucose control, when used to replace sugar in the context of a structured dietary plan.7

It goes without saying that in order to be approved for use on the market, all low/no calorie sweeteners, as any food ingredient, first go through a thorough safety evaluation process by the competent regulatory body which assesses all kinds of studies examining potential side effects.8,9,10

At a time when obesity and non-communicable diseases including diabetes 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 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 intake, as well as in managing blood glucose levels. Low/no calorie sweeteners are also not fermentable by oral bacteria, which means that they do not contribute to tooth decay.7

  1. Lohner S, Kuellenberg de Gaudry D, Toews I, Ferenci T, Meerpohl JJ. Non-nutritive sweeteners for diabetes mellitus. Cochrane Database of Systematic Reviews 2020, Issue 5. Art. No.: CD012885. DOI: 10.1002/14651858.CD012885.pub2.
  2. 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
  3. Tucker RM, Tan SY. Do non-nutritive sweeteners influence acute glucose homeostasis in humans? A systematic review. Physiol Behav 2017; 182: 17-26
  4. EFSA. Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA Journal 2011; 9(6): 2229. Available online: http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2011.2229/epdf
  5. 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-o…
  6. 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
  7. Laviada-Molina H, Escobar-Duque ID, Pereyra E, Romo-Romo A, Brito-Córdova G, Carrasco-Piña E, González-Suárez R, López-García R, Molina-Seguí F, Mesa-Pérez JA. Consenso de la Asociación Latinoamericana de Diabetes sobre uso de edulcorantes no calóricos en personas con diabetes [Consensus of the Latin-American Association of Diabetes on low calorie sweeteners in persons with diabetes]. Rev ALAD. 2018;8:152-74
  8. http://www.fao.org/food/food-safety-quality/scientific-advice/jecfa/en/
  9. http://www.fda.gov
  10. http://www.efsa.europa.eu/en/topics/topic/sweeteners