The Case of Artificial Sweeteners – What Does the Current Evidence Suggest?
March 28, 2017
This blog is part of NRC’s Nutrition Month, a Dietitians of Canada initiative, blog series. This year’s Nutrition Month theme is “Take the fight out of food! Spot the problems. Get the facts. Seek support.“
By Sanaz Baradaran
Non-caloric artificial sweeteners (NAS) have gained much popularity over the years as an alternative to caloric sweeteners such as table sugar. At the same time, there is much confusion due to emerging research that at times considers NAS safe and at other times refers to adverse health effects related to NAS intake.
The World Health Organizationa and the Canadian Diabetes Association all recommend that sugar intake contribute to less that 10% of total energy intake1,2. These recommendations are based on evidence linking free sugars with increased energy intake, weight gain, dental diseases, and increased risk of other chronic diseases 1,2. Therefore, based on current evidence, it is safe to say that sugar intake should be limited.
The question that rises, however, is whether NAS should be recommended as an alternative to sugar. We need to seek the facts.
The use of NAS as a substitute for added sugar has been deemed beneficial for weight loss and weight management,34. Since NAS contain no calories, as a substitute for added sugar, NAS helps individuals reduce their total caloric intake. In addition, many individuals with diabetes benefit from these products as they have helped them manage their blood sugar4.
On the other hand, a number of studies point to harmful effects of certain NAS, indicating that they may impact glucose tolerance due to changes that they impose on the gut microbiota population6,7. Although these studies are very valuable, it should be recognized that many of them pertain to mice and further studies on human subjects is warranted. Further, human trials provide contradictory evidence and involve a number of confounding variables (e.g. adiposity), which need to be controlled8.
Overall, the use of NAS remains as a controversial topic. The current evidence does not encourage the use of NAS; however, knowing that excess intake of added sugar has harmful effects, NAS could be considered as a tool to help individuals who may benefit from it. As a dietitian, I would recommend that individuals limit their added sugar intake to less than 10% of their daily caloric intake. I would advice clients on the possible association of NAS intake on gut microbiota and glucose metabolism.
However, if clients absolutely need to use NAS as a part of their diet, I would encourage them to seek support and adhere to the acceptable daily intake (ADI). It is important to remind clients that NAS are not an anti-obesity drug, do no promote weight reduction and that artificially sweetened drinks should not substitute nutritious foods.
About Sanaz Baradaran: Sanaz is a registered dietitian and a member of the College of Dietitians of Ontario. She holds Bachelor’s degrees in Human Biology, Secondary Education, and Food and Nutrition, and a Master’s degree in Kinesiology and Health Sciences.
Sanaz is passionate about promoting health in the community through educating individuals about nutrition and empowering them to be their healthiest selves. She enjoys writing about nutrition and has previously written blog posts for the Sunnybrook Hospital. Currently, Sanaz is in private practice at the Altima Wellness Centre. She works as a nutrition counsellor and conducts community workshops on nutrition related topics.
References:
1. Guideline: Sugars intake for adults and children. Geneva: World Health Organization; 2015.
2. Canadian Diabetes Association. (2017). Canadian Diabetes Association: Sugars Position Statement. Retrieved from https://www.diabetes.ca/getmedia/9d0baffb-6268-4762-acc7-e52575c40c55/cda-position-on-sugars.pdf.aspx
3. Miller, P. E., & Perez, V. (2014). Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies. The American journal of clinical nutrition, 100(3), 765-777.
4. AZAD, M. K., & GUPTA, S. (2017). Artificial Sweeteners, Diabetic Foods & Supplements Myths & Facts [A Meta Analysis]. Indian Journal of Applied Research, 6(12).
5. Mattes RD, Popkin BM. Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. American Journal of Clinical Nutrition 2009;89(1):1-14.
6. Suez, J., Korem, T., Zeevi, D., Zilberman-Schapira, G., Thaiss, C. A., Maza, O., … & Kuperman, Y. (2014). Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature, 514(7521), 181-186.
7. Romo-Romo, A., Aguilar-Salinas, C. A., Brito-Córdova, G. X., Diaz, R. A. G., Valentín, D. V., & Almeda-Valdes, P. (2016). Effects of the Non-Nutritive Sweeteners on Glucose Metabolism and Appetite Regulating Hormones: Systematic Review of Observational Prospective Studies and Clinical Trials. PloS one, 11(8), e0161264.