May 17, 2023
Replacing sugars with non-sugar sweeteners doesn't help with long-term weight control and could cause harm, new guidance from the World Health Organization says.
Research has found that these sugar substitutes are not very effective at reducing body fat in adults or children, and their long-term use may lead to an "increased risk of type 2 diabetes, cardiovascular diseases and mortality in adults," the WHO said.
Non-sugar sweeteners include artificial and naturally occurring, non-nutritive sweeteners that are not classified as sugars. The most common are acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives. These can be found in manufactured food and beverages and are sold on their own to be added to foods and beverages.
"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," said Francesco Branca, the WHO's director for nutrition and food safety. Artificial sweeteners "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 WHO's new guidance doesn't apply to individuals with pre-existing diabetes, because there wasn't enough data on this population to make any conclusive findings.
Research on the benefits and harms of sugar substitutes is conflicting. Some studies have suggested that sugar-free sweeteners can help people with obesity, diabetes or metabolic syndrome better manage their sugar and calorie intakes, but others have found that their use leads to higher calorie consumption and higher blood sugar levels.
Dr. David Ludwig, an obesity and weight loss specialist at Boston Children's Hospital, has said people sometimes consume more calories when using artificial sweeteners because they mistakenly believe that drinking diet soda allows them to indulge in other foods – like eating an extra slice of cake.
He said artificial sweeteners can change tastebuds over time so that people crave sweet foods and drinks even more, making healthy choices like fruits and vegetable less appealing.
Research also warns that there are potential harms to using artificial sweeteners in the long term.
One study, published in February, found that erythritol, a sugar alcohol often used in low-calorie and "keto" products, was associated with a higher risk of heart attacks, stroke and death. The researchers also found erythritol increased the formation of blood clots. When clots break off and travel to the heart or brain, they can trigger a heart attack or a stroke.
Erythritol is about 70% as sweet as sugar and is produced by fermenting corn. The human body naturally creates erythritol in low amounts, but when it is consumed on a regular basis, it can accumulate in the bloodstream. Erythritol, an ingredient in the calorie-free stevia sweetener Truvia, is poorly metabolized and most of it passes through the body via urine.
Another study, published last September, found that higher artificial sweetener consumption, especially of aspartame, acesulfame potassium and sucralose, increased the risk of cardiovascular disease.
Many experts cautiously recommend the use of artificial sweeteners in place of sugar to combat obesity, metabolic syndrome and diabetes — but with the caveat that they are used in moderation and only for short durations. Eating healthy proteins and fresh fruits and vegetables should be the priority.
The safest way to cut sugar intake is to consume more unsweetened foods and beverages, experts say.