GENEVA — The World Health Organization (WHO) on May 15 released a new guideline that recommends against the use of non-sugar sweeteners to control body weight or reduce the risk of non-communicable diseases.
WHO based the recommendation on a systemic review of available evidence, which suggests the use of non-sugar sweeteners does not confer any long-term benefit in reducing body fat in adults or children. The review also suggested the long-term use of non-sugar sweeteners potentially may have undesirable effects such as an increased risk of type 2 diabetes, cardiovascular diseases and mortality in adults.
The recommendation applies to all synthetic and naturally occurring or modified non-nutritive sweeteners not classified as sugars and found in manufactured foods and beverages or sold on their own to be added to foods and beverages by consumers. Common non-sugar sweeteners include acesulfame potassium (Ace-K), aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives.
The recommendation does not apply to low-calorie sugars and polyols (sugar alcohols), which are sugars or sugar derivatives containing calories and thus not considered non-sugar sweeteners.
“Replacing free sugars with NSS (non-sugar sweeteners) does not help with weight control in the long term,” said Francesco Branco, director for nutrition and food safety at the WHO. “People need to consider other ways to reduce free sugars intake, such as consuming food with naturally occurring sugars, like fruit, or unsweetened food and beverages. NSS are not essential dietary factors and have no nutritional value. People should reduce the sweetness of the diet altogether, starting early in life, to improve their health.”
The Calorie Control Council, an international association representing the low-calorie and reduced-calorie food and beverage industry, disagreed with the recommendation.
“A substantial body of evidence shows that low- and no-calorie sweeteners provide effective and safe options to reduce sugar and calorie consumption,” said Robert Rankin, president of the Calorie Control Council. “This is supported by an abundance of scientific evidence, backed by the world’s most highly regarded health and regulatory agencies, which validate the role of these ingredients. Along with exercise and a healthy diet, low- and no-calorie sweeteners are a critical tool that can help consumers manage body weight and reduce the risk of non-communicable diseases.”
The WHO recommendation applies to everybody except individuals with pre-existing diabetes. Studies conducted exclusively in individuals with pre-existing diabetes were excluded as were studies with mixed populations.
“It is mind-boggling that persons living with diabetes, for whom non-sugar sweeteners can have an especially meaningful role in their compliance with necessary dietary requirements, were conveniently not considered when creating these guidelines,” said Keith Ayoob, EdD, scientific adviser for the Calorie Control Council. “The WHO’s insistence on focusing only on prevention of unhealthy weight gain and non-communicable diseases is at the very least, misguided. The WHO’s decision not to focus on the value of non-sugar sweeteners for persons with diabetes borders on unconscionable. Their doing so dismisses the value and usefulness of NSS for persons living with diabetes and pre-diabetes, which accounts for far in excess of 10% of the global population.”
Nearly 40% of the global adult population is overweight or obese as well as millions of children, according to the WHO.
The WHO review found non-sugar sweeteners used in any manner resulted in reduced sugar and energy intake, lower body weight and lower body mass index (BMI) in short-term randomized controlled trials, the majority of which lasted three months or less, according to the WHO. Evidence from a small number of longer trials lasting 6 to 18 months did not suggest an effect on body weight but was difficult to interpret because of the many differences in how the trials were conducted and how the results were reported.
Most of the trials provided foods and beverages containing non-sugar sweeteners or free sugars in addition to existing diets, according to the WHO. The trials therefore did not directly measure the effects of replacing free sugars with non-sugar sweeteners. When non-sugar sweeteners were compared with nothing/placebo or water, no effects on body weight or BMI were observed.
Evidence from prospective observational studies with up to 10 years of follow-up showed higher intakes of non-sugar sweeteners were associated with increased risk of type 2 diabetes, cardiovascular disease and cardiovascular disease mortality, and all-cause mortality in long-term prospective observational studies with an average follow-up of 13 years (very low to low certainty evidence).