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WHO Against Sugar Substitutes for Weight Loss

According to new guidance from the World Health Organization, the use of sugar substitutes for weight loss is not recommended.

It has been suggested by the global health body that a systematic review of the available evidence indicates that the use of non-sugar sweeteners, or NSS,

“Does not confer any long-term benefit in reducing body fat in adults or children.”

It has been stated by Francesco Branca, director of WHO’s department of nutrition and food safety, that the control of weight long-term is not aided by replacing free sugars with non-sugar sweeteners. Although there was a mild reduction in body weight in the short term, it cannot be sustained.

It has been mentioned by Branca that this guidance is applicable to all individuals except those with preexisting diabetes. The reason for this is that none of the studies in the review included people with diabetes, preventing an assessment from being made.

The review has also indicated that the long-term use of sugar substitutes may have “potential undesirable effects,” such as a mildly increased risk of type 2 diabetes and cardiovascular diseases.

However, Branca has clarified that this recommendation does not comment on the safety of consumption. The guideline emphasizes that if the goal is to reduce obesity, control weight, or mitigate noncommunicable diseases, science has been unable to demonstrate the desired positive health effects.

Non-sugar sweeteners are commonly used as ingredients in prepackaged foods and beverages and are also sometimes directly added to food and drinks by consumers. In 2015, WHO issued guidelines on sugar intake, recommending that adults and children limit their daily consumption of free sugars to less than 10% of their total energy intake. As a result of this recommendation, interest in sugar alternatives has increased, as stated in the review.

It has been stated by nutrition researcher Ian Johnson, emeritus fellow at Quadram Institute Bioscience, formerly the Institute of Food Research, in Norwich, United Kingdom, that this new guideline is based on a thorough assessment of the latest scientific literature. It is emphasized that the use of artificial sweeteners is not considered a good strategy for achieving weight loss by reducing dietary energy intake.

Johnson further mentioned,

“However, this should not be interpreted as an indication that sugar intake has no relevance to weight control.”

Instead, it is suggested to reduce the consumption of sugar-sweetened drinks and opt for “raw or lightly processed fruit as a source of sweetness,” added Johnson.

Via email, Dr. Keith Ayoob, scientific adviser for the Calorie Control Council, an international association representing the low-calorie food and beverage industry, expressed the opinion that the WHO’s focus solely on the prevention of unhealthy weight gain and non-communicable diseases is misguided.

According to Robert Rankin, president of the Calorie Control Council,

“Low- and no-calorie sweeteners are a critical tool that can help consumers manage body weight and reduce the risk of non-communicable diseases.”

The guidance is intended for government health organizations in countries that may consider utilizing the scientific analysis to implement policy changes for their citizens, as mentioned by Branca.

“It will likely depend on how sweeteners are consumed in a specific country,” he said. “For instance, in countries where consumption patterns are high, action may be taken in one way or another.”

Most up to date research

The review included a total of 283 studies, comprising both randomized controlled trials, which are considered the gold standard of research, and observational studies. Observational studies can only establish an association and do not provide direct cause-and-effect evidence.

According to the report, results from randomized trials indicated that the use of non-sugar sweeteners had a “low” impact on reducing body weight and calorie intake compared to sugar, with no change observed in intermediate markers of diabetes such as glucose and insulin.

Observational studies also showed a low impact on body weight and fat tissue, but no change in calorie intake. However, these studies revealed a slight increase in the risk of type 2 diabetes, high blood pressure, stroke, heart disease, and death from heart disease. The report also noted a very low risk of bladder cancer and premature death from any cause.

The recommendation provided by the WHO was labeled as “conditional” due to the potential confounding factors arising from complex sweetener usage patterns and the characteristics of the study participants, which could affect the identified association between sweeteners and disease outcomes.

The International Sweeteners Association, an industry association, expressed disappointment in an email statement, stating that it is a disservice to overlook the public health benefits of low/no-calorie sweeteners. They also highlighted that the WHO’s conclusions heavily rely on low-certainty evidence from observational studies, which are at high risk of reverse causality.

However, Branca emphasized the importance of long-term observational studies that track individuals over time. He stated,

“To demonstrate that overweight individuals can reduce their body weight, a study of extended duration is required. Unfortunately, we have not observed such an impact in the available research.”

All sweeteners included

The recommendation encompassed synthetic sweeteners with low or no calories, as well as natural extracts that may or may not undergo chemical modification. These include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives, and monkfruit, as stated in the report.

According to Branca,

“Stevia and monkfruit are newer sweeteners, so there is less published research in the scientific literature. However, they likely function in the body through a similar physiological mechanism as other sweeteners. Based on the available data, we cannot distinguish them from the others as they play the same role.”

Stevia products are often regarded as more “natural” since they are derived from the stevia plant. Some natural and artificial sweeteners incorporate bulking sugars in their products to reduce sweetness and add volume for baking purposes.

A recent study conducted by researchers at the US-based Cleveland Clinic discovered a potential link between erythritol, commonly used to add bulk or sweeten stevia, monkfruit, and reduced-sugar keto products, and blood clotting, stroke, heart attack, and premature death.

The study revealed that individuals with existing risk factors for heart disease, such as diabetes, were twice as likely to experience a heart attack or stroke if they had elevated levels of erythritol in their bloodstream.

Sugar and sweeteners can be reduced

Just as many people have learned to eat and cook without salt, a reduction in dependence on free sugars and non-nutritive sweeteners can be achieved, according to Branca.

“In early life, we need to target children,” he stated. “For example, sweeteners are often used by parents as a reward for children and after almost every meal. We need to advise parents to avoid cultivating that interest in sweetness among young children. This is a crucial action to take.”

Even if one considers themselves a true sugar “addict,” the good news is that the sweet tooth can be tamed, as noted by registered dietitian Lisa Drayer in an article for CNN. She provides the following steps:

Taste buds can be trained. Gradually reducing sugar, including artificial sweeteners, and incorporating more protein and fiber-rich foods into the diet can help decrease cravings for sugar, according to Drayer.

“When we consume protein and fiber with a sugar-containing food, it slows down the rise in blood sugar. This can help satisfy us and reduce our sugar intake as well,” she explained.

Opt for no-sugar-added foods and avoid sugar-sweetened drinks. For instance, choose whole-grain cereal or unsweetened Greek yogurt. Eliminate sodas, energy drinks, sports drinks, and fruit punch from the grocery list and choose water instead.

“If you enjoy sweet carbonated beverages, try adding a splash of cranberry or orange juice to seltzer or opt for flavored seltzers. You can also infuse your water with fruit slices for natural sweetness or try herbal fruit teas,” suggested Drayer.

Limit or eliminate sugars in coffee and tea. Exercise caution at coffee shops, as many lattes and flavored coffees contain as much sugar as a can of soda, if not more.

Opt for fruit as a dessert. Instead of cookies, cakes, ice cream, pastries, and other sweet treats, try enjoying cinnamon baked apples, berries, or grilled peaches, recommended Drayer.

Beware of hidden sugars. Added sugars often lurk in foods that may not seem “sweet,” such as sauces, breads, condiments, and salad dressings, warned Drayer.

“Pre-packaged sauces like ketchup, BBQ sauce, and tomato sauce tend to be some of the main culprits of hidden added sugars in the diet,” shared Kristi King, senior pediatric dietitian at Texas Children’s Hospital and a national spokesperson for the Academy of Nutrition and Dietetics.

Read nutrition facts labels. All food and beverage products must disclose the amount and type of sugar on the label.

Added sugars can go by various names, including “agave, brown sugar, corn sweetener, corn syrup, dextrose, evaporated cane juice, fructose, fruit juice concentrate, fruit nectar, glucose, high-fructose corn syrup, honey, invert sugar, lactose, malt syrup, maltose, molasses, maple syrups, raw sugar, sucrose, trehalose, and turbinado sugar,” according to Drayer.

“The higher up these added sugars appear on the ingredients list, the greater the amount of added sugar in the product.” –  she explained.