In a newly released scientific statement the American Heart Association and the American Diabetes Association offer a cautious endorsement of the use of non-nutritive sweeteners in the diet. But the statement notes that the products are not “magic bullets” and that there is no strong evidence demonstrating beneficial effects of the products.
Sugar in the diet has been linked repeatedly to obesity, type 2 diabetes, and cardiovascular disease, leading to recommendations that sugar intake should be limited. However, the evidence to date is “inconclusive” that non-nutritive sweeteners (including aspartame, acesulfame-K, neotame, saccharin, sucralose, and stevia) can reduce caloric intake, lower body weight, or help prevent diabetes or cardiovascular disease.
“Determining the potential benefits from non-nutritive sweeteners is complicated and depends on where foods or drinks containing them fit within the context of everything you eat during the day,” sad Christopher Gardner, one of the authors of the report, in an AHA press release. “For example, if you choose a beverage sweetened with non-nutritive sweeteners instead of a 150-calorie soft drink, but then reward yourself with a 300-calorie slice of cake or cookies later in the day, non-nutritive sweeteners are not going to help you control your weight because you added more calories to your day than you subtracted.”
“However, if you substitute the beverage with non-nutritive sweeteners for a 150-calorie sugar-sweetened soft drink, and don’t compensate with additional calories, that substitution could help you manage your weight because you would be eating fewer calories,” said Gardner.
The following text is taken from the summary and recommendations of the report:
At this time, there are insufficient data to determine conclusively whether the use of NNS to displace caloric sweeteners in beverages and foods reduces added sugars or carbohydrate intakes, or benefits appetite, energy balance, body weight, or cardiometabolic risk factors…. There are some data to suggest that NNS may be used in a structured diet to replace sources of added sugars and that this substitution may result in modest energy intake reductions and weight loss. Successful reduction in energy intake requires that there is incomplete compensation of energy reduction from the use of NNS containing beverages and/or foods. The impact of incorporating NNS and NNS-containing beverages and foods on overall diet quality should be included in assessing the overall balance of benefits and risks.
Addressing the negative perception of non-nutritive sweeteners that many people have developed, weight loss expert and blogger Yoni Freedhoff sent the following comment to CardioBrief:
Likely consequent to the natural fallacy many readily assume that the consumption of NNS carries risk, included among them a risk towards increased consumption and weight gain. It’s refreshing then to see the analysis of actual evidence on the use of NNS in people rather than animal models concludes that if anything there’s a suggestion of benefit to weight management, rather than risk, with the consumption of NNS. Given the complexity of weight regulation and human behavior, no intervention will work in a vacuum and my clinical experience definitely suggests a synergy between their use and true caloric literacy and may help to explain the lackluster results. Hopefully future studies will shine more conclusive light on the situation.”
(Editor’s note: The publication of this statement had been embargoed until 4 PM ET today. However, the AHA appears to have published the statement ahead of schedule and then tweeted it.)
Here is the press release from the AHA:
Non-nutritive sweeteners: A potentially useful option – with caveats
- Substituting non-nutritive sweeteners for sugars added to foods and beverages may help people reach and maintain a healthy body weight – as long as the substitution doesn’t lead to eating additional calories later as “compensation.”
- For people with diabetes, non-nutritive sweeteners used alone or in foods and beverages remain an option and when used appropriately can aid in glucose control.
DALLAS, July 9, 2012 — Substituting non-nutritive sweeteners for added sugars in beverages and other foods has the potential to help people reach and maintain a healthy body weight and help people with diabetes
control, according to a new scientific statement from the American Heart Association and the American Diabetes Association.
But the statement — published in the American Heart Association journal Circulation and the American Diabetes Association’s journal Diabetes Care— said scientific evidence is limited and inconclusive about whether this strategy is effective in the long run for reducing calorie and added sugars consumption.
The American Heart Association recommends that most women eat no more than 100 calories per day and men no more than 150 calories per day of added sugars
. This recommendation is based on research that showed diets high in added sugars increase risk factors, such as obesity and triglycerides, for coronary heart disease. Additionally, foods and beverages high in added sugars tend to displace nutritious foods and are generally high in calories and low in nutritional value. Limiting intake of added sugars can help reduce calorie intake and can help people achieve or maintain a healthy body weight.
“While they are not magic bullets, smart use of non-nutritive sweeteners could help you reduce added sugars in your diet, therefore lowering the number of calories you eat. Reducing calories could help you attain and maintain a healthy body weight, and thereby lower your risk of heart disease and diabetes,” said Christopher Gardner, Ph.D., associate professor of medicine at Stanford University in California. “But there are caveats.”
Non-nutritive sweeteners include food additives aspartame, acesulfame-K, neotame, saccharin and sucralose, and plant-derived stevia.
Research, to date, is inconclusive whether using non-nutritive sweeteners to displace caloric sweeteners, such as added sugars, can reduce carbohydrate intake (important for diabetes control), calorie intake or body weight, benefit appetite or lower other risk factors associated with diabetes and heart disease in the long run, said the statement authors.
“Determining the potential benefits from non-nutritive sweeteners is complicated and depends on where foods or drinks containing them fit within the context of everything you eat during the day,” Gardner said.
“For example, if you choose a beverage sweetened with non-nutritive sweeteners instead of a 150-calorie soft drink, but then reward yourself with a 300-calorie slice of cake or cookies later in the day, non-nutritive sweeteners are not going to help you control your weight because you added more calories to your day than you subtracted.”
However, if you substitute the beverage with non-nutritive sweeteners for a 150-calorie sugar-sweetened soft drink, and don’t compensate with additional calories, that substitution could help you manage your weight because you would be eating fewer calories,” says Gardner.
Beyond calories, and focusing more specifically on added sugars, non-nutritive sweeteners have their place for people with diabetes.
“For example, soft drinks sweetened with non-nutritive sweeteners do not increase blood glucose levels, and thus can provide a sweet option for those with diabetes,” said Diane Reader, R.D., CDE, one of the statement authors on behalf of the American Diabetes Association. Yet, there still needs to be appropriate use of the non-nutritive sweeteners, just because a food product includes a non-nutritive sweetener, does not mean that it is a “free” food or a healthy food.
“The use of non-nutritive sweeteners may be used in a carbohydrate-controlled food plan, to potentially reduce carbohydrate intake which may aid in weight management and diabetes control.” said Reader, manager of professional training at the International Diabetes Center in Minneapolis, Minn.
The statement does not evaluate the safety of non-nutritive sweeteners, which is addressed by the U.S. Food and Drug Administration.
“For anyone trying to monitor or reduce their intake of calories or added sugars, the potential impact of choosing ‘diet products’ with non-nutritive sweeteners needs to be considered within the context of the overall diet
. Strategies for reducing calories and added sugars also involves choosing foods which have no added sugars or non-nutritive sweeteners – such as vegetables, fruits, high-fiber whole grains, and non or low-fat dairy,” Gardner said.
Co-authors are: Judith Wylie-Rosett, Ed.D., R.D.; Samuel S. Gidding, M.D.; Lyn M. Steffen, Ph.D., M.P.H., R.D.; Rachel K. Johnson, Ph.D., M.P.H., R.D.; and Alice H. Lichtenstein, D.Sc.
Author disclosures and sources of funding are on the manuscript.