No evidence of sugar substitutes’ health benefits
Sweeteners may not aid weight loss, finds review, although some are querying results
Sarah Boseley Health editor, Wed 2 Jan 2019
Low-calorie and artificial sweeteners, increasingly added to drinks and food as the industry responds to pressure to cut sugar, may not help people lose weight and there is not enough evidence on their safety, according to a major new review.
The review, carried out by Cochrane – an international non-profit research group – aims to provide evidence for the World Health Organization, which is preparing guidance on what it calls “non-sugar sweeteners” or NSSs – a term that includes artificial sweeteners such as aspartame and low or no-calorie natural alternatives such as stevia.
“No evidence was seen for health benefits from NSSs and potential harms could not be excluded,” says the review, published in the British Medical Journal, which calls for better-quality research to be done.
Food and drink manufacturers have been under pressure from Public Health England (PHE) to reduce the sugar content of their products to help tackle the obesity crisis. PHE has asked for a cut of 20% by 2020. Many companies have opted to use artificial sweeteners instead of sugar, particularly in soft drinks.
WHO is aiming to produce guidance on sweeteners because, it says, “their use is widespread and they continue to be heavily promoted as healthy alternatives to sugars”.
The Cochrane review was set up to answer a set of questions posed by WHO about the effects on adult and child health of consuming sweeteners and specifically the impact on obesity.
The evidence analysed in the review was not very robust, said the reviewers. They included 56 studies but said most were small and did not last long enough to come to firm conclusions.
The studies were set up to look at different types of sweeteners, measuring weight, blood sugar (glycaemic) control, oral health, cancer, cardiovascular disease, kidney disease, mood and behaviour in consumers. For most of them, there was no statistical difference in weight loss or health benefits of adults and children using higher doses of sweeteners rather than small amounts or none.
However, sweeteners had their uses, said PHE. “Using sweeteners is one way the food and drink industry can reduce sugar in everyday products,” said Dr Alison Tedstone, the chief nutritionist at PHE. “The evidence suggests sweeteners are safe and can help consumers make healthier choices.”
I would say that there is no convincing evidence of clear health benefits in the general population. There might be a small benefit on weight, but we don’t have high quality data with long-term follow-up that definitely confirm this effect,”
“Finally, there is a good, and safe, alternative for people/people trying to loose weight: water, and non-/less-sweetened foods. In other words, there is no need to either add free additional sugar, or sweeteners in most instances.”
Tom Sanders, emeritus professor of nutrition and dietetics at King’s College London, said: “The findings of this study are not surprising and confirm the view that artificial sweeteners are not a magic bullet to prevent obesity. Replacement of sugary drinks with artificial sweeteners helps prevent weight gain in children but is not superior to the preferred alternative – water.”
Another expert said sweeteners were still preferable to sugar and pointed out that some large studies not included in the review showed they did help some people lose weight.
“This paper does not change my mind – non-sugar sweeteners remain far better than sugar-sweetened beverages given lack of calories in the former, and the well-known harms of the latter including in particular on dental health,” said Naveed Sattar, professor of metabolic medicine at the University of Glasgow.
However, she said, based on the existing evidence, replacing sugar with sweeteners, particularly in drinks, “could be a helpful strategy to reduce cardiometabolic risk [chances of having diabetes, heart disease or stroke] among heavy consumers, with the ultimate goal of switching to water or other healthy drinks.
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