In a statement, Francesco Branca, MD, PhD, director of nutrition and food safety at the World Health Organization (WHO), stated that sugar-free sweeteners "are not essential dietary factors and have no nutritional value." He recommends reducing the sweetness of the overall diet from an early age to improve health.
Obesity, related to non-communicable diseases and one of the leading causes of death worldwide, is linked to excessive sugar consumption. According to the WHO, almost 2 billion adults and more than 340 million children and adolescents are overweight or obese.
Sugar-free sweeteners, although touted as having fewer or no calories compared to sugar, it is not clear if their long-term use aids in weight loss or control. In addition, there is accumulating evidence to suggest that sugar-free sweeteners may have unfavorable effects on risk factors for chronic disease.
A study conducted in France last year linked artificial sweeteners with an increased risk of cardiovascular disease. In addition, sucralose-6-acetate, a chemical formed by ingesting sucralose, has been found to damage DNA and increase gene activity associated with inflammation and cancer.
The WHO guidance applies to artificial and natural sweeteners that are not classified as sugar, such as aspartame, saccharin, stevia, and sucralose. However, it does not apply to sugar alcohols or low calorie sugars. It also does not apply to medicines or hygiene and personal care products that sometimes contain traces of sweeteners to improve taste. Therefore, the consumption of sugar-free sweeteners implies consuming foods and beverages that contain them or adding them to such products.
In adults, consumption of non-sugar sweeteners for short periods of approximately 3 months or less was associated with lower weight and body mass index. However, its short-term use did not improve other indicators of cardiometabolic health, such as glucose or insulin levels. Long-term use, between 6 and 18 months, did not appear to affect weight, but data from related trials were difficult to interpret due to varying methodologies.
In prospective cohort studies, including those that followed participants for up to a decade, higher consumption of non-sugar sweeteners was found to be correlated with increased risk of obesity, type 2 diabetes, various cardiovascular diseases, including stroke, and death from any cause. Although the use of sugar substitutes was not associated with an overall increased risk of cancer, saccharin was associated with bladder cancer in some case-control studies.
In children, the evidence on the health effects of non-sugar sweeteners was limited. Although children lost weight when sugar-sweetened beverages were replaced with unsweetened beverages, no significant differences were observed in body mass indices. Additionally, several studies found no significant connections between the consumption of non-sugar sweeteners and improved health outcomes.
In pregnant women, data were also limited. While higher consumption of non-sugar sweeteners during pregnancy was associated with increased risk of preterm birth, it is unclear whether it affects the baby's weight at birth or later in life. Sugar substitutes did not reduce the risk of gestational diabetes, but consumption of these sweeteners during pregnancy may affect some outcomes in babies, such as increased risk of asthma and allergies, as well as reduced cognitive function.
The guideline acknowledges that most of the findings are lacking in strong evidence and that the effect size was often small. Furthermore, there is the possibility of an inverse cause-and-effect relationship that could have contributed to the observations of increased long-term use of non-sugar sweeteners associated with disease risk. Therefore, the guidance is considered a conditional recommendation, which means that the WHO is uncertain whether the benefits of avoiding sugar-free sweeteners outweigh the risks in most cases.
In short, the guide recommends opting for unsweetened foods and beverages whenever possible. It also suggests that policymakers focus on reducing the consumption of sugar and its substitutes in infants and young children, who are still developing their taste preferences.
This is a summary of the article bye Melissa Suran, PhD, MSJ llamado Sugar Substitutes Don't Help Weight Control and May Increase Risk of Heart Disease and Diabetes, WHO Warns.
Suran M. Sugar Substitutes Don't Help Weight Control and May Increase Risk of Heart Disease and Diabetes, WHO Warns. JAMA. Published online June 14, 2023. doi:10.1001/jama.2023.10967
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