In recent times, non-sugar sweeteners, often referred to as artificial sweeteners, low-calorie alternatives, or non-nutritive sweeteners, have garnered significant attention in the media. However, much of this coverage has been less than favorable.
In March, a study conducted in the United States discovered a potential link between elevated levels of erythritol in the bloodstream and an increased risk of cardiovascular issues. Subsequently, in June, in vivo studies raised concerns about sucralose, indicating that it might undergo metabolic processes in the gut leading to the formation of compounds that could damage DNA.
Most recently, the International Agency for Research on Cancer (IARC) categorized aspartame, a widely used non-sugar sweetener found in products like diet sodas and chewing gum, as "possibly carcinogenic" to humans. This classification places it in a group alongside items like pickled vegetables, caffeine, and aloe vera, indicating "limited evidence" in humans and "insufficient evidence" in animal experiments to support the idea that aspartame is carcinogenic.
In conjunction with the IARC's classification, the joint Food and Agriculture Organization/World Health Organization (WHO) committee responsible for assessing food additives completed an updated risk evaluation of aspartame. Their conclusion was that there was no need to alter the established acceptable daily intake (ADI) of up to 40mg per kilogram of body weight for aspartame.
However, the mixed messages surrounding aspartame's "possibly carcinogenic" label, along with conflicting information on other non-sugar sweeteners, have left many individuals bewildered about the actual risks involved.
Bridget Benelam, a nutrition scientist at the British Nutrition Foundation, emphasizes, "Sweeteners frequently grab headlines, and it's understandable that people may be concerned about their safety. However, it's crucial to assess the overall evidence for health benefits or risks, rather than relying on individual studies that may appear in the media."
Duane Mellor, a registered dietitian and senior teaching fellow at Aston Medical School, adds, "We haven't communicated risks and hazards very well. Having something that's a potential hazard doesn't mean it's a risk. Yes, a hazard means, theoretically, there might be a slight problem with it, but the risk is how much of an issue it is."
The Sweetener Dilemma:
All sweeteners available on the market undergo risk assessments by regulatory bodies such as the European Food Safety Authority (EFSA) or the US Food and Drug Administration (FDA), which establish ADIs and maximum limits for additives in food and beverages. Benelam highlights that these food safety agencies continually evaluate new evidence as our understanding of topics like the gut microbiome evolves.
Gunter Kuhnle, a nutrition and food science expert at the University of Reading, points out two sources of data suggesting potential harm associated with sweeteners, both with limitations. The first source is animal studies, which often employ exceedingly high sweetener doses beyond typical human consumption levels, and sometimes possess methodological flaws.
Kuhnle explains, "A common issue I see is when you look at gut microbiome studies in rodents. One key difference between us and rodents is that rodents consume their own feces, which we don't. Consequently, their microbiome differs significantly due to their distinct dietary habits."
The other data source comprises observational studies like the NutriNet-Santé study published in 2022, which suggested a connection between artificial sweeteners, especially aspartame and acesulfame-K, and an increased cancer risk. However, observational studies can only establish associations, not causal links, making it challenging to isolate the impact of sweeteners from other behavioral factors.
"The primary exposure to sweeteners often occurs through diet soft drinks," says Kuhnle. "People who consume diet products might be more likely to be obese, have diabetes, or exhibit other factors that are challenging to disentangle."
Long-Term Usage:
Consumption of artificial sweeteners, particularly in beverages, continues to rise as more individuals seek to reduce sugar intake and cut calories. A study in 2022 analyzing trends in per capita consumption of added sugars and non-nutritive sweeteners in beverages between 2007 and 2019 indicated a 12% decline in sales of sugar-added drinks globally, while sales of non-nutritive sweetener-containing drinks increased by 36%.
However, in May, the WHO issued new guidance cautioning against the use of non-sugar sweeteners as a means of weight control or reducing the risk of noncommunicable diseases.
Benelam clarifies, "This recommendation stemmed from a systematic review that revealed no significant benefits from using non-sugar sweeteners for weight management and raised concerns about potential long-term adverse effects, such as an increased risk of type 2 diabetes, cardiovascular diseases, and mortality in adults." She further notes that the WHO classified the evidence as "low certainty."
The WHO's guidance prompted substantial debate among health experts, with some pointing out that the review failed to consider the impact of substituting sugar-sweetened beverages with artificially sweetened ones. They argued that there is evidence supporting the role of non-sugar sweeteners as a short-term strategy for reducing calorie intake when trying to lose weight.
Mellor suggests that sweeteners can be beneficial for people pursuing sugar reduction, particularly when integrated into a balanced diet that includes a variety of fruits, vegetables, seeds, beans, and lentils. He emphasizes the importance of viewing sweeteners as a tool within a broader dietary context.
In conclusion, the sweetener discussion underscores the necessity for an open and honest conversation. While water is the ideal beverage, practicality often necessitates alternatives. Providing individuals with options to reduce sugar and calorie intake while maintaining a sweet taste can be a practical strategy. Mellor advocates for a carefully worded debate on how sweeteners can serve as a tool for healthier eating choices, considering individual preferences and dietary habits. The aim is to guide individuals toward a more balanced diet in a world where palatable, calorie-rich options are readily available.
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