Why health officials recommend against non

Aug 18, 2023

Officials at the World Health Organization (WHO) has released new guidelines on using non-sugar sweeteners, indicating they recommend against their use to control body weight or the risk of noncommunicable diseases.

The officials said the recommendations were based on a finding from a review of evidence that suggests non-sugar sweeteners do not provide any long-term benefit for reducing body fat in adults or children.

Additionally, they said there could be adverse health effects due to long-term use, such as type 2 diabetes and cardiovascular disease.

The recommendations apply to all people except those with pre-existing diabetes and include all synthetic, naturally occurring, and modified non-nutritive sweeteners found in manufactured food and beverages or sold to be added to foods and drinks by consumers.

"I agree that it is essential to focus on reducing the sweetness of the diet overall, starting early in life," said Dr. Laura DeCesaris, the founder of Heartroot Health, a wellness center in Scottsdale, Arizona.

"Rather than looking for ‘better’ sweet swaps, the focus can be to emphasize a more balanced diet full of a variety of whole foods – lean meats, healthy fat, vegetables, fruits, etc. – versus swapping sugar for a non-calorie version," she told Medical News Today.

Common non-sugar sweeteners include:

"It's important to note that weight loss cannot be achieved simply by replacing high-calorie foods with low-calorie alternatives," said Caroline Thomason RD, CDCES, a registered dietitian based in Virginia.

"It is the cumulative effect of our habits and behaviors over time that contributes to overall health," she told Medical News Today.

The recommendation does not include personal care and hygiene products, such as:

"The [information on the] health effects of consuming non-sugar sweeteners regularly is inconclusive," said Kate Cohen, RD, a registered dietitian at the Ellison Clinic at Saint John's, part of the Ellison Institute for Transformative Medicine and Providence Saint John's Health Center in California.

"Most of them are classified as ‘gras’ – generally regarded as safe – but that doesn't mean there aren't negative health effects," she told Medical News Today. "A study published a few years ago in Cell showed that saccharin and sucralose (aka Sweet n Low and Splenda) not only caused blood sugar to rise like sugar, they also caused changes in the microbiome, meaning they didn't go through the body with no effect as was previously believed."

"One of the obvious health problems that can occur from long-term use of non-sugar sweeteners is weight gain if one assumes that this eliminates the need for moderation and portion control," Cohen added. "Calories still add up and, as we’ve discussed, these sweeteners can increase the appetite for more sweet foods and create an ongoing cycle."

"There can also be negative gastrointestinal effects," she noted. "Sugar alcohols like erythritol, xylitol and sorbitol are found in a variety of snacks, gums, and candies, and while these seemingly pass through the body unabsorbed, they don't go unnoticed. Many people with more sensitive GI systems can end up with unpleasant side effects like gas, bloating, and diarrhea from consuming a little or a lot of these sweeteners."

There are guidelines on how much sugar an individual should consume daily.

However, for non-sugar sweeteners, the information isn't clear.

For sugar:

"According to the American Heart Association, men should consume no more than nine teaspoons (36 grams or 150 calories) of added sugar per day," notes Dr, Priya Jaisinghani, an endocrinologist and obesity medicine specialist at NYU Langone Health in New York. "Women should consume no more than six teaspoons (25 grams or 100 calories) daily."

"According to Dietary Guidelines for Americans, 2020-2025, a healthy dietary pattern limits added sugars to less than 10 percent daily," Jaisinghani told Medical News Today. "For a 2,000 calorie per day diet, 10 percent would be equivalent to 200 calories or 50 grams of sugar daily (~ 12 teaspoons of sugar)."

For non-sugar sweeteners:

"We don't know [how much artificial sweeteners] is too much, which is part of why these recent WHO recommendations came out," said Megan Wroe, MS, RD, the wellness manager at the St. Jude Medical Center in California.

"Long-term studies now show no real benefit [for consuming sugar] and some possible harmful effects," she told Medical News Today. "So non-sugar sweeteners are currently being treated like sugar: there is no benefit and there may be harm if consumed in high amounts, so try to minimize sugars. But what that maximum number is per day? We don't have that yet."

"When you eat sugar or artificial sweeteners, you crave more, making it difficult to stop," Cohen said. "Try using whole fruit as a sweetener when cooking, baking, or adding to cereal or yogurt. I would recommend stevia or monk fruit, but they are still 100 to 400 times sweeter than sugar so less is more."

The best advice is to minimize sugars and sweeteners from your diet.

Thomason offers these tips to help:

"The recommendation is to cut back on sugar and non-sugar sweeteners altogether, not to replace them with one another," Wroe said. "When something truly needs some added sweetness, I recommend choosing a low glycemic, non-artificial sweetener, such as coconut sugar or date syrup. Allulose and monk fruit have less research around them, but I recommend those as well since they are not artificial and have negligible impacts on blood sugar. Raw honey can also be consumed in small portions."