Non-Sugar Sweeteners: Friend or Foe?
Our webinar this month, Added Sugar: Not So Sweet, includes tips on how to eat and drink less added sugar. Replacing added sugar with non-sugar sweeteners like Splenda or stevia seems like a no-brainer. Approximately 25% of children and 40% of adults in the US use non-sugar sweeteners on a daily basis (1). At the same time, we often hear strong opinions against the use of these products. What’s behind this controversy?
What are non-sugar sweeteners?
Non-sugar sweeteners are substances used to sweeten foods and drinks. They differ from sugar in a few ways. First, non-sugar sweeteners have few or no calories. Second, they differ in source. For example, stevia comes from a plant while sorbitol and sucralose (the sweetener in Splenda) are synthetic. Third, the human body metabolizes non-sugar sweeteners differently than sugar (2). Lastly, non-sugar sweeteners are sweeter than sugar, in some cases hundreds of times sweeter.
The value of non-sugar sweeteners is their sweet flavor and lack of calories. Replacing sugar with non-sugar sweeteners is a strategy to reduce overall calorie intake in those who consume these foods and drinks. Consuming fewer calories may affect the risk of long-term weight gain (2).
Are non-sugar sweeteners safe to eat and drink?
Yes, the FDA and other organizations have deduced that approved non-sugar sweeteners are safe to consume (1, 2). Common misconceptions about the safety of non-sugar sweeteners exist because of past research on animals. In some animal studies in the late 1960s and early 1970s, non-sugar sweeteners were linked to adverse health outcomes like cancer. However, there are two major caveats to interpreting these results. In these studies, rats were fed amounts of non-sugar sweeteners that conceivably would not be consumed in a normal human diet. Also, there is no evidence that humans respond the same way as animals to non-sugar sweeteners. We cannot apply results of animal studies to humans (1).
Do non-sugar sweeteners have effects on weight?
Maybe.
For people who drink a lot of sugar-sweetened beverages regularly, drinking non-sugar-sweetened beverages is a better alternative because calorie intake will be reduced (3). This may have a beneficial effect on weight.
On the other hand, some researchers hypothesize that non-sugar sweeteners may be associated with weight gain. Because non-sugar sweeteners are hundreds of times sweeter than sugar, they can affect appetite. Our brain interprets a sweet taste as a reward, and this may precipitate a desire for more sweet foods, resulting in overeating. In addition, some people may overcompensate when they are consuming lower-calorie foods, which also may lead to overeating (1). Appetite is complex and individual.
At the same time, non-sugar sweeteners might have no effect on weight. Some randomized controlled trials show that there are no significant changes in body weight among adults eating non-sugar sweeteners and those eating sugar or a placebo (2).
Do non-sugar sweeteners have effects on health?
Currently there is no strong evidence to indicate that approved non-sugar sweeteners have effects on health. However, there is limited human data and potential harms cannot be ruled out (1, 3). Some studies show that drinking non-sugar sweeteners is associated with higher body weight and metabolic syndrome (1). Other studies show that non-sugar sweeteners may have an adverse effect on taste perception, hormones and the gut microbiome (1, 3).
Sugar alcohols, including sorbitol, mannitol, erythritol and xylitol, have reported benefits and potential harms for some people. As an ingredient in chewing gum, sugar alcohols are non-cariogenic, meaning that they do not increase the risk for dental cavities (1). However, in some people, consuming sugar alcohols in chewing gum or other foods and drinks may result in gastrointestinal upset (4).
Can children safely eat and drink non-sugar sweeteners?
Many organizations including the Academy of Nutrition and Dietetics and the American Academy of Pediatrics have stated that non-sugar sweeteners are safe for pregnant women and children, but we do not know the long-term effects due to limited and inconsistent evidence (1, 5).
Should I eat or drink non-sugar sweeteners?
It is important to understand what is in your foods and drinks. To learn about ingredients, look at the Nutrition Facts label and ingredients list. The front of the package may be misleading; some foods that are not marketed as sugar-free may still have non-sugar sweeteners in them (1).
Like all foods, non-sugar sweeteners may have a place in your diet, but it’s for you to decide. Whether you may benefit from reducing calorie intake by choosing non-sugar sweeteners over sugar depends on the context of your diet.
References
Serra-Majem L et al. Ibero-American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages. Nutrients 2018;10:818.
Toews I et al. 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;364:k4718.
Mozaffarian D. Dietary and Policy Priorities for Cardiovascular disease, Diabetes, and Obesity – A Comprehensive Review. Circulation 2016;133(2):187-225.
Makinen K. Gastrointestinal Disturbances Associated with the Consumption of Sugar Alcohols with Special Consideration of Xylitol: Scientific Review and Instructions for Dentists and Other Health-Care Professionals. International Journal of Dentistry 2016; 5967907.
Reid AE et al. Early Exposure to Nonnutritive Sweeteners and Long-term Metabolic Health: A Systematic Review. Pediatrics 2016;137(3):e20153603.
