The World Health Organization (WHO) recently released new guidance stating that sugar substitutes, also known as non-sugar sweeteners (NSS), do not provide any long-term benefits for weight loss. According to a systematic review conducted by the WHO, replacing free sugars with non-sugar sweeteners does not help individuals control their weight in the long run. Although there may be a mild reduction in body weight in the short term, it is not sustainable. The guidance applies to all individuals except those with preexisting diabetes, as the studies reviewed did not include participants with diabetes.
Furthermore, the review suggested that the long-term use of sugar substitutes could potentially have undesirable effects, such as a slightly increased risk of type 2 diabetes and cardiovascular diseases. However, it is important to note that the recommendation does not comment on the safety of consuming sugar substitutes but rather focuses on their effectiveness in reducing obesity, controlling weight, and mitigating the risk of noncommunicable diseases.
Non-sugar sweeteners are commonly used in prepackaged foods and beverages and are also added directly by consumers. The WHO issued guidelines in 2015 recommending that adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake. Since then, there has been increased interest in sugar alternatives.
The recommendation by the WHO is intended for government health organizations in countries that may consider implementing policy changes based on the scientific analysis. The decision to take action would depend on the consumption patterns of sweeteners in a specific country.
The review included a total of 283 studies, comprising both randomized controlled trials and observational studies. The randomized trials showed a low impact of non-sugar sweeteners on body weight and calorie intake compared to sugar, with no significant change in diabetes markers. Observational studies also found a low impact on body weight and fat tissue, but a slight increase in the risk of type 2 diabetes, high blood pressure, stroke, heart disease, and death from heart disease. There was also a very low risk identified for bladder cancer and premature death from any cause.
The recommendation includes both low or no-calorie synthetic sweeteners and natural extracts, whether chemically modified or not. Examples of sweeteners mentioned in the report are acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia, stevia derivatives, and monkfruit. While stevia and monkfruit are considered newer sweeteners with less published research, they are believed to function similarly to other sweeteners based on the available data.
It is worth noting that observational studies following individuals over time play a crucial role in understanding the effects of sweeteners. The WHO emphasizes that long-term studies are necessary to demonstrate the impact of reducing body weight in overweight individuals, which has not been consistently observed in the current research.
The International Sweeteners Association, an industry association, expressed disappointment with the WHO’s conclusions, stating that the evidence relied mainly on low-certainty evidence from observational studies, which are susceptible to reverse causality.
In terms of practical advice for reducing sugar and sweetener intake, the WHO suggests gradually cutting back on sugar, including artificial sweeteners, and incorporating more protein and fiber-rich foods in the diet. Choosing no-sugar-added foods, avoiding sugar-sweetened drinks, opting for coffee and tea with fewer sugars, and enjoying fruit as a dessert are other recommendations. It is also important to be aware of hidden sugars in sauces, condiments, and pre-packaged foods, and to check nutrition labels for added sugars.
Overall, the WHO’s new guidance suggests that relying on sugar substitutes alone is not an effective strategy for long-term weight control, and reducing sugar intake from various sources is recommended for promoting better health.
