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Benefits of Non-Sugar Sweeteners and Health Outcomes: Conflicting

Feb 26, 2019
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Dahlia Elimairi, Pharm D student at UC Denver Skaggs School of Pharmacy

While increased cancer risk was not found, overall study of sweeteners vs sugar remains inconclusive.

While using non-sugar sweeteners in place of sugar bears the promise of health benefits by reducing the daily caloric intake of sugars thereby reducing the risk of unhealthy weight gain, the evidence to support this is conflicting. Some studies have reported an association between the use of non-sugar sweeteners and the reduced risk of type 2 diabetes, excess weight, and obesity thereby allowing better management of diabetes and overall general health. Other studies have shown that non-sugar sweeteners can increase the risk of excess weight, diabetes, and cancer.

A recent systematic review and meta-analyses of randomized and non-randomized controlled trials and observational studies aimed to assess the association between intake of non-sugar sweeteners and important health outcomes in generally healthy or adults and children with excess weight and obesity. The main outcome measures of the study were body weight or body mass index, glycemic management, oral health, eating behavior, preference for sweet taste, cancer, cardiovascular disease, kidney disease, mood, behavior, neurocognition, and adverse effects.

In adults, evidence of very low and low certainty from a limited number of small studies indicated a small beneficial effect of non-sugar sweeteners on body mass index and fasting blood glucose. Lower doses of non-sugar sweeteners were associated with lower weight gain compared with higher doses of non-sugar sweeteners. For all other outcomes, no differences were detected between the use and non-use of non-sugar sweeteners, or between different doses of non-sugar sweeteners. No evidence of any effect of non-sugar sweeteners was seen on adults or children with excess weight and obesity who are trying to lose weight. In children, a smaller increase in body mass index score was observed with non-sugar sweeteners intake compared with sugar intake, but no significant differences were observed in body weight or between different doses of non-sugar sweeteners.

Most health outcomes did not seem to have differences between the non-sugar sweeteners’ exposed and unexposed groups. Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality were limited, therefore, confidence in the reported results is limited.

A recent editorial written by Vasanti Malik from Harvard T.H. Chan School of Public Health in Boston, MA discusses two trials by Janne C. de Ruyter and colleagues and Cara B. Ebbeling and colleagues that provide strong evidence that the replacement of sugar-sweetened beverages with diet alternatives reduces weight gain in children and adolescents after one year of follow-up. Still she agrees that more research is warranted, and policies and recommendations will need updating regularly as more evidence emerges to ensure that the best available data are used to inform the important public health debate on sugar and its alternatives.

Future studies assessing the effects of non-sugar sweeteners should have longer intervention duration, and detailed descriptions of interventions, comparators, and outcomes.

Practice Pearls:

  • There is limited evidence to support the use of non-sugar sweeteners in place of sugar sweeteners in clinical practice even though there could be some benefit with non-sugar sweeteners for weight loss and fasting glucose.
  • No study found an increased risk of cancer associated with the use of non-sugar sweeteners. Potential harms from the consumption of non-sugar sweeteners could not be excluded.
  • From the current information, we can assume that there are benefits to using non-sugar sweeteners and very few, if any, negatives.

References:

Toews I, Lohner S, Küllenberg de Gaudry D, Sommer H, Meerpohl JJ. Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies. BMJ. 2019 Jan 2;364: k4718.

Malik VS. Non-sugar sweeteners and health. BMJ. 2019 Jan 3;364: k5005.

Dahlia Elimairi, Pharm D student at UC Denver Skaggs School of Pharmacy