Toews et al.’s systematic review, published in the British Medical Journal today (January 3), analyses 56 reports comparing no intake, or lower intake, of non-sugar sweeteners (NSS), with elevated consumption in both healthy adults and children.
Weight, glycaemic control, cancer, kidney disease, mood and behaviour were among the measures assessed.
According to the results, no statistically or clinically relevant differences were made obvious between subjects consuming NSS and those with a relevant intake of ‘free’ sugars, nor between those consuming varying doses of NSS.
“There was no compelling evidence to indicate important health benefits of non-sugar sweetener use on a range of health outcomes,” wrote the authors, adding that “Potential harms from the consumption of non-sugar sweeteners could not be excluded.”
Researchers emphasised that many of the studies analysed were of low quality, and that longer term studies would be required to further assess the health benefits, or harmfulness, of NSS.
European interest
The report comes as excessive sugar consumption and rising obesity rates attract increased interest across government and industry sectors.
In Europe alone, sugar taxes have been introduced in a number of countries – including in Portugal, France, the UK, Spain, Estonia, and Ireland – and just yesterday, Public Health England reported that children in the UK are exceeding the maximum recommended sugar intake for an 18 year old by the age of 10.
As health and diet concerns rise, the use of NSS as a replacement for ‘free’ sugars, particularly in sweetened beverages, should not be discounted, wrote Vasanti Malik, Harvard T.H. Chan School of Public Health in an editorial attachment.
NSS “could be a helpful strategy to reduce cardiometabolic risk among heavy consumers, with the ultimate goal of switching to water or other healthy drinks,” she said.
"Policies and recommendations will need updating regularly, as more evidence emerges to ensure that the best available data is used to inform the important public health debate on sugar and its alternatives."
‘No weight gain, no cravings’
The Calorie Control Council has responded to the report, maintaining that low- and no calorie sweeteners (LNCS) continue to be useful tool, alongside a healthy diet and regular exercise, to help support weight management and weight loss.
“Despite the authors’ claims to the contrary, the highest quality scientific evidence shows that the consumption of LNCS results in reductions in body weight, does not lead to weight gain and does not cause cravings,” according to the association.
“A large body of evidence (International Journal of Obesity) evaluating more than 100 studies suggests LNCS play a role in reducing energy intake and body weight,” the Calorie Control Council continued.
‘Low calorie sweeteners can be helpful tools’
The International Sweeteners Association (ISA) has similarly discounted the review, which it described as having “serious limitations”.
According to the ISA, an “overwhelming body of robust scientific evidence” shows that low calorie sweeteners can play a beneficial role in calorie reduction and weight management, when used to replace ‘real’ sugars as part of a healthy lifestyle.
Low calorie sweeteners can also be a “significant aid to people with diabetes, as they do not affect blood glucose control,” wrote the organisation in a statement.
“Actually, the recent systematic review published by Toews et al. shows that people consuming low calorie sweeteners have lower energy and sugar intakes. Importantly, the use of low calorie sweeteners was shown to lead to reduced body weight in overweight and obese consumers.”
In addition, the ISA noted that Toews et al. excluded trials examining the longer-term effects of low-calorie sweetened products, which it says could have affected the review’s outcome.
Source: British Medical Journal
Published online: 3 January 2019
'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'
DOI: https://doi.org/10.1136/bmj.k4718
Authors: Ingrid Toews, Szimonetta Lohner, Daniela Küllenberg de Gaudry, Harriet Sommer, Joerg J Meerpohl