Expert consensus on low-calorie sweeteners: facts, research gaps and suggested actions

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Author(s): Ashwell MA, Gibson S, Bellisle F, Buttriss J, Drewnowski A, Fantino M, Gallagher AM, de Graaf K, Goscinny S, Hardman CA, Laviada-Molina H, López-García R, Magnuson B, Mellor D, Rogers P, Rowland I, Russell W, Sievenpiper J, La Vecchia C
Publication name: Nutr Res Rev. 2020;33(1):145-154. doi: 10.1017/S0954422419000283. [Epub ahead of print]
Publication year: 2020

Abstract

A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen experts (the panel) discussed three themes identified as key to the science and policy of LCS: (1) weight management and glucose control; (2) consumption, safety and perception; (3) nutrition policy. The aims were to identify the reliable facts on LCS, suggest research gaps and propose future actions. The panel agreed that the safety of LCS is demonstrated by a substantial body of evidence reviewed by regulatory experts and current levels of consumption, even for high users, are within agreed safety margins. However, better risk communication is needed. More emphasis is required on the role of LCS in helping individuals reduce their sugar and energy intake, which is a public health priority. Based on reviews of clinical evidence to date, the panel concluded that LCS can be beneficial for weight management when they are used to replace sugar in products consumed in the diet (without energy substitution). The available evidence suggests no grounds for concerns about adverse effects of LCS on sweet preference, appetite or glucose control; indeed, LCS may improve diabetic control and dietary compliance. Regarding effects on the human gut microbiota, data are limited and do not provide adequate evidence that LCS affect gut health at doses relevant to human use. The panel identified research priorities, including collation of the totality of evidence on LCS and body weight control, monitoring and modelling of LCS intakes, impacts on sugar reduction and diet quality and developing effective communication strategies to foster informed choice. There is also a need to reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede low-energy product development and reformulation.

Summary

Seventeen academic and scientific experts participated in a workshop in London on 7 November 2018 to discuss, via consensus-forming techniques, the reliable facts, gaps and actions and reach consensus on statements relating to three themes: 1) Role of low/no calorie sweeteners (LNCS) in weight management and glucose control; 2) Consumption and safety of low/no calorie sweeteners and consumer perception, and 3) Role of low/no calorie sweeteners in relation to nutrition policy.

The panel reminded that the safety of LNCS is demonstrated by a substantial body of evidence that is reviewed and evaluated by regulatory food safety agencies around the world. Continual monitoring and modelling of LNCS exposures is undertaken and this demonstrates that intakes are within the Acceptable Daily Intakes (ADIs). Despite repeated and consistent reassurances from food safety authorities, there is still some distrust of LNCS among consumers, health professionals and policy makers. There is a need to research and develop evidence-based strategies to communicate facts to consumers, health professionals and policy makers. The extensive body of scientific evidence that backs regulatory approval and the on-going safety assessment of LNCS can then encourage better informed public health decisions.

The panel agreed that when used in place of sugars to reduce energy density of foods and drinks, LNCS can help reduce net energy (calorie) intake and assist weight and diabetes control. LNCS have no adverse effect on blood glucose and insulin regulation (HbA1c, fasting and post-prandial glucose and insulin levels) in people with, and without, diabetes. However, benefits will depend on how foods and beverages containing LNCS are used and substituted, as well as on the overall quality of the diet and the total energy provision. Their potential value in the dietary management of diabetes derives from their role as substitutes for sugars and, hence, carbohydrates. More high-quality, well-designed human studies are needed to confirm long term benefits and effects of different sweeteners.

Finally, the experts agreed that reduction in the intake of sugars is being recommended globally to lower the risk and prevalence of obesity, which is a major public health concern and that the use of LNCS is one of the strategies to consider. Policies relating to sugar reduction and LNCS from different countries should be reviewed to compare their remit, priorities, evidence base and interpretation. Efforts should be made to understand and, where possible, reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede product development and reformulation designed to reduce sugars and/or calories.

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