Roughly 169 million Americans incorporate
artificial sweeteners into their regular diet. Despite the perception of these sweeteners being a healthier choice, the World Health Organization has recently warned that these sugar substitutes raise the risk of severe health conditions, such as type 2 diabetes, cardiovascular disease, and even mortality.
The announcement has sparked debates among experts who stress the importance of robust research in forming public health recommendations.
WHO Guidelines Reflect Minimal Risks
The WHO
updated a 2019 review of 283 studies, including randomized controlled trials and observational studies.
Analysis of the RCTs, considered the gold standard in research, revealed that the consumption of non-sugar sweeteners had a limited effect on weight loss and calorie reduction when compared to natural sugar. Importantly, the RCTs also showed no significant changes in markers for diabetes, such as glucose or insulin levels, blood pressure, total cholesterol, or any evidence indicating increased risk of all-cause mortality or cancer.
It’s worth noting that observational studies can establish associations but not causation, and it is these studies upon which the WHO apparently based their recommendations.
Research published in the
European Journal of Clinical Investigation has found that even rigorous observational studies can fall short in establishing causation. “At least in nutrition research, associations derived from observational studies may not be reliable indicators of causal effects, even with the most rigorous study designs achievable,” the study authors concluded.
The observational studies reviewed by the WHO, like the reviewed RCTs, demonstrated that artificial sweeteners had minimal impact on body weight and fat, and little effect on calorie intake. Only the RCT studies indicated a low or very low increased risk for:
- Type 2 diabetes
- High blood pressure
- Stroke
- Heart disease
- All cause mortality
Critically, according
to recent research, while many epidemiologic studies have been conducted to investigate whether saccharin is associated with bladder cancer incidence, given the findings in a rat model of the disease, “no clear evidence for such an association in humans has emerged.”
The
WHO emphasizes that their guideline “is not based on toxicological assessments of the safety of individual non-sugar sweeteners.” Furthermore, it is not intended to “update or replace guidance” provided by the United Nations or other authoritative bodies regarding previously established safe or maximum levels of intake.
The organization clarifies that this recommendation does not include individuals with pre-existing diabetes. It encompasses all non-nutritive sweeteners, whether synthetic, naturally occurring, or modified, that are not categorized as sugars and are present in manufactured food and beverages or sold individually for consumer use. These non-sugar sweeteners (NSS) include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia, and stevia derivatives.
The
WHO noted that the recommendation is “conditional” because the link between sweeteners and disease risk might be confounded by complicated patterns of sweetener use and the baseline characteristics of study participants. “This signals that policy decisions based on this recommendation may require substantive discussion in specific country contexts,” the WHO said
in a statement.
WHO Guidelines Contrary to Scientific Evidence
A public consultation (
pdf) on the WHO guidelines brought forth significant concerns regarding the WHO’s announcement.
“Even though it is indicated in the guideline that the recommendations may not apply to those with diabetes, the ‘headline’ is what will be looked at, not the details,” one comment pointed out. “The guideline should have included individuals with diabetes and pre-diabetes, as they represent 10% of the global population.”
A comment on the WHO’s guideline development process cautions that recommendations “should only be made on strong, high quality evidence and shouldn’t be based on low quality evidence.” The comment further suggests that the evidence supporting the WHO’s recommendation is derived from observational studies of “low to very low quality.”
A similar situation recently
occurred with research conducted by Cleveland Clinic (
pdf), which suggested a significant association between erythritol, a commonly used artificial sweetener found naturally in foods and produced in our bodies, and an increased risk of heart attack and stroke. However, the study had significant limitations. For instance, the participants were far from healthy to begin with, and the researchers did not differentiate between various sources of the compound.
Moderation is Key
Emily Feivor, a registered dietitian at Northwell Long Island Jewish Forest Hills in New York, told The Epoch Times that like everything in life, the key is moderation. “Americans need to decrease their sugar consumption,” she said. “Even low or no calorie sweeteners may be found in foods that aren’t nutritious choices [like] low sugar ice cream, cookies, etc.”
Feivor suggested that this factor could explain the lack of significant weight loss observed in the research. Nonetheless, she agrees that individuals should prioritize the consumption of whole foods that offer natural sweetness and contribute to higher fiber and nutrient levels.
Moreover, there is ample evidence supporting the safety of non-sugar sweeteners, including that:
Reducing added sugar in our diets is a “pivotal way” to decrease over all energy consumption, according to Feivor. She stressed the varying health impacts of artificial sweeteners, highlighting that certain options, such as those derived from plants, could be healthier to use because of their potential antioxidant properties.
“However, working on eating more vegetables in a whole-foods balanced diet while achieving weekly exercise recommendations are key to long term weight loss,” Feivor concluded.
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