WHO’s Advice on Non-nutritive Sweeteners

From saccharine to stevia, artificial sweeteners (AKA non-nutritive sweeteners-NNS) have been around for decades and used by many to control calorie intake or blood sugar. For the most part, artificial sweeteners are on the FDA’s GRAS (generally recognized as safe) list.

The World Health Organization (WHO) recently released new guidelines that advise against using non-sugar sweeteners; they state, “It does not confer any long-term benefits in reducing body fat in adults or children.” In fact, they believe the opposite is true. WHO suggests avoiding non-nutritive sweeteners to reduce the risk of chronic conditions like diabetes and heart disease. 1

Not So Sweet

While non-nutritive sweeteners (NNS) reduce the caloric load of food, they have ironically been linked with weight gain, not loss. A meta-analysis of 30 cohort studies discovered that people with a higher intake of NNS had higher risks for metabolic syndrome, obesity classification, cardiovascular events, and diabetes.2

A similar meta-analysis of 36 observational studies in nearly 18,000 people found that compared to higher intakes of NNS, lower intakes were linked with reduced weight gain. This was observed in people who were not purposely trying to lose weight. 3

While soda sweetened with NNS may seem better for those trying to lose weight, one study found that both types of soft drink consumption were linked with metabolic syndrome. 4 However, compared to sweetened beverages, NNS drink intake shows a reduced link with diabetes. 5

Non-nutritive Sweeteners and Gut Health

A robust microbiome aids in weight management and prevention of type 2 diabetes, non-alcoholic liver disease, cardio-metabolic diseases, and malnutrition. 6 studies on the impact of NNS and the gut microbiome have been mixed at best. One small study on 17 healthy volunteers found no alterations in gut microbiota with the regular use of aspartame or sucralose in high amounts. 7

The research on NNS and gut microbiota is complex and varies depending on animal versus human subjects. A repeated finding in studies on NNS, particularly saccharin, Acesulfame K, and sucralose, is the depletion of Akkermansia muciniphilia , a bacteria associated with glucose intolerance. Further variations occur, given gut composition differences among people. NNS may impact some but not everyone’s gut microbiomes. More research is needed here. 8

What Should Consumers Do?

I’ve heard clients say they’ll “just go back to regular soda” instead of drinking diet. Please don’t. I believe added sugar consumption has far more negative health consequences than NNS.

The WHO advises those seeking weight reduction to avoid NNS but does not extend the recommendation to individuals with diabetes. Reducing sugar and processed food with NNS is the most optimal route over the long run and is what I always choose to do personally. Here are a few tasty ideas:

• Swap out seltzer water in place of soda. It’s fizzy without added color or artificial sweeteners. And it costs less!

• Add frozen or fresh fruit to plain yogurt and skip the stuff with fruit on the bottom or NNS.

• Use citrus or other juice to flavor or freshen the water. Cucumbers, berries, or watermelon juice are tasty, too.

• Drink iced tea with lemon instead of diet soda. Green tea is light and delicious.

• Enjoy seasonal, frozen, or dried fruit in place of sugary treats.

• Try unsweetened iced coffee instead of sugary soda and energy drinks.

Lisa Andrews, MEd, RD, LD

Here is a handout you can use to help folks eat less sugar and NNS.

References:

1.    https://www.who.int/publications/i/item/9789240046429.

2.    Azad MB, Abou-Setta AM, Chauhan BF, Rabbani R, Lys J, Copstein L, et al. Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies. CMAJ 2017;189:E929-39.

3.    Toews I, Küllenberg de Gaudry D, Lohner S, Sommer H, Meerpohl JJ. Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomized and non-randomized controlled trials and observational studies. BMJ 2019;364:k4718.

4.    Dhingra R, Sullivan L, Jacques PF, Wang TJ, Fox CS, Meigs JB, et al. Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middleaged adults in the community. Circulation 2007;116:480-8.

5.    Imamura F, O'Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathiraju SN, et al. Consumption of sugar-sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. Br J Sports Med 2016;50:496-504.

6.    Fan Y, Pedersen O. Gut microbiota in human metabolic health and disease. Nat Rev Microbiol. 2021 Jan;19(1):55-71. doi: 10.1038/s41579-020-0433-9. Epub 2020 Sep 4. PMID: 32887946.

7.    Ahmad SY, Friel J, Mackay D. The Effects of Non-Nutritive Artificial Sweeteners, Aspartame and Sucralose, on the Gut Microbiome in Healthy Adults: Secondary Outcomes of a Randomized Double-Blinded Crossover Clinical Trial. Nutrients. 2020 Nov 6;12(11):3408. doi: 10.3390/nu12113408. PMID: 33171964; PMCID: PMC7694690.

8.    Richardson IL, Frese SA. Non-nutritive sweeteners and their impacts on the gut microbiome and host physiology. Front Nutr. 2022 Aug 25;9:988144. doi: 10.3389/fnut.2022.988144. PMID: 36091255; PMCID: PMC9453245.