Statement from CCC on “Artificial Sweeteners and Risk of Cardiovascular Diseases: Results from the Prospective NutriNet-‎Santé Cohort”

Posted by & filed under Health Care Professionals, Low- and No-Calorie Sweeteners, Sugar Substitutes.

A study published in the British Medical Journal entitled, “Artificial Sweeteners and Risk of Cardiovascular Diseases: Results from the Prospective NutriNet-‎Santé Cohort” sought to evaluate the association between low- and no-calorie sweetener intake and cardiovascular ‎disease risk. The study authors report an association between sweetener intake and increased risk of cardiovascular and cerebrovascular disease. Further, they report an increased risk of cerebrovascular events with aspartame intake, as well as an association between acesulfame potassium and sucralose consumption with increased coronary heart disease risk. Like the previous study conducted by this group, which investigated associations between low- and no-calorie sweeteners and cancer, these allegations are contrary to decades of scientific research showing these sweeteners are safe, as evidenced by global regulatory permissions for their use.

Due to the sample utilized in this study, the results of this study cannot and should not be extrapolated to the general population, as ‎those who volunteer to participate in such research activities often exhibit unique ‎characteristics (i.e., lifestyle and socioeconomic factors, etc.) not typical of the broader ‎population. ‎These individuals also self-reported their intake data, which subjects the ‎current study to recall bias, misreporting and under-reporting. Lastly, the observational nature of this study inhibits the ability to establish causality and the ‎likelihood of residual confounding bias must be considered when interpreting ‎these results.‎ ‎

Consumers want options when it comes to sugar reduction and low- and no-calorie sweeteners have are a proven safe and effective choice for sugar and calorie reduction. Along with exercise and a healthy diet, low- and no-calorie sweeteners are a critical tool that can help consumers manage body weight and reduce the risk of non-communicable diseases, such as cardiovascular disease and diabetes.

CCC Statement: “Health effects of the use of non-sugar sweeteners – A systematic review and meta-analysis”

Posted by & filed under Featured, Health Care Professionals, Health Professionals, Healthy Lifestyle, Healthy Substitutions, Low- and No-Calorie Sweeteners, Uncategorized.

The recent publication by Rios-Leyvraz and Montez, entitled “Health effects of the use of non-sugar sweeteners – a systemic review and met-analysis,” serves as an update to the 2019 systematic review by Toews, et al. and attempts to address inherent health effects of non-sugar sweeteners (NSS) as well as those effects compared to sugar or water, when consumed at safe levels as established by authoritative bodies.

The review reports favorable findings regarding NSS intake and weight management outcomes, without significant effects on other measures of adiposity or cardiometabolic health, including ‎fasting glucose, insulin, blood lipids and blood ‎pressure (very low to high certainty evidence).‎

Although long-term cohort studies suggested less favorable outcomes, the evidence certainty is very low to low. The authors note that these findings may be due to reverse causation and/or residual confounding.

Based on the lack of significant data from studies involving children, as well as largely inconclusive results in those that exist, and very low to low certainty of evidence regarding pregnant women, it is recommended more research is necessary to investigate consumption among these two population groups.

The review concluded that NSS consumption may be associated with short-term weight loss when used to reduce total energy intake. These results are largely in agreement with the findings of other systemic reviews and the current body of evidence. 

Additionally, numerous health and regulatory organizations from around the world maintain their confirmation of the safety of low- and no-calorie sweeteners for consumption by the general population. The unified position of worldwide food safety authorities is supported by robust evidence and extensive research, which contradict the recent review’s conclusions regarding long-term effects.

Given the totality of evidence and official assessments in support of low- and no-calorie sweeteners, CCC maintains that these ingredients are safe and valuable tools to aid in sugar reduction, weight management, blood glucose management and other positive outcomes.

Weaknesses of “Artificial sweeteners and cancer risk: Results from the NutriNet-Sante’ ‎population-based cohort study”

Posted by & filed under Acesulfame K, Aspartame, Cyclamate, Featured, Health Care Professionals, Health Professionals, Low- and No-Calorie Sweeteners, Saccharin, Sucralose, Sugar Substitutes.

The study entitled, “Artificial Sweeteners and Cancer Risk: Results from the NutriNet-Sante´ Population-Based Cohort ‎Study,” attempted to evaluate any association between low- and no-calorie sweetener (LNCS) intake and cancer risk. However, the reported findings of this study are in contradiction to the totality of evidence and the numerous global health organizations who have regarded each of the named sweeteners as safe, following rigorous assessments.  

Despite its longitudinal design and large sample size, the current study has several weaknesses. Self-reported intake data subjects the study to recall bias, misreporting and under-reporting. Further, given the observational nature of this study design, causal links cannot be established and the likelihood of residual confounding bias must be considered when interpreting ‎these results.‎ Lastly, the results of this study cannot and should not be extrapolated to the general population, as ‎those who volunteer to participate in such research activities often exhibit unique ‎characteristics (i.e., lifestyle and socioeconomic factors, etc.) not typical of the broader ‎population. ‎All of these considerations significantly limit the strength of the reported findings.

In conclusion, CCC emphasizes LNCS remain safe and effective tools in weight management, sugar reduction and blood glucose management.

For more information on the safety of low- and no- calorie sweeteners, review the frequently asked questions below:

Is there any evidence that low- and no-calorie sweeteners cause cancer?
The overall body of scientific evidence regarding low-and no-calorie sweeteners (LNCS) does not support an association between consumption and cancer risk. Global scientific authorities and food safety agencies have assessed the totality of available evidence and have concluded that each of the approved sweeteners are safe.
Is aspartame safe?
Regulatory agencies in more than 100 countries have all affirmed aspartame’s safety. The scientific evidence overwhelmingly supports the safety of aspartame even in amounts far greater than people typically consume.

With more than 200 studies attesting to its safety, aspartame is one of the most researched food additives in the world and has a long history of safe use. A thorough review of the research by The European Food Safety Authority released in 2013 concluded that aspartame is safe for the general population including infants, children and pregnant women. Scientists from the U.S. Food & Drug Administration (FDA) have also reviewed the scientific data regarding the safety of aspartame in food and concluded that it is safe for the general population. According to the U.S. Department of Agriculture, aspartame is one of the most exhaustively studied substances in the human food supply.

Since aspartame contains phenylalanine, aspartame is not recommended for individuals with phenylketonuria (PKU), a rare hereditary disease, who have difficulty in metabolizing phenylalanine.

In 2012 Academy of Nutrition and Dietetics (AND) stated, “Consumers can safely enjoy a range of nutritive sweeteners and nonnutritive sweeteners (NNS) when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as individual health goals and personal preference.” In reference to any adverse effects aspartame related to aspartame consumption, AND concluded, “Aspartame consumption is not associated with adverse effects in the general population.”

Does Ace-K cause cancer?
No. All substances that are intended to be added to food must undergo extensive tests to ensure their safety. At the center of these studies are tests to determine whether the substances have any carcinogenic or cancer-promoting effect. Only substances not suspected of having such an effect are approved for use in food by the relevant agencies.
What are some of the lifestyle and socioeconomic factors that make this study inapplicable to the general population?
In general, individuals who participate in volunteer-based cohorts tend to be women, have higher educational and socio-professional levels, and tend to exhibit more health-conscious lifestyle behaviors.
What is residual confounding bias, and why does it apply to the results of this study?
“Residual confounding” is a term that refers to the relationship between exposure (in this case, LNCS consumption) and an outcome (i.e., cancer risk). Whereas typically, exposure proceeds an outcome, in some cases, this is reversed. In observational studies, conclusions regarding causality are not possible.
Why should I use an low or no-calorie sweetener instead of regular sugar?
Low-calorie products provide consumers with many benefits. Whether by choice or necessity, millions of Americans restrict their intake of calories, carbohydrates and fats. According to opinion research, most people consume low-calorie products to stay in better overall health, eat or drink healthier foods and beverages, maintain weight, reduce weight or maintain an attractive physical appearance. Most people use low-calorie products as part of an overall healthy lifestyle. Research also shows that health professionals believe low-calorie sweeteners are especially beneficial to obese individuals and those with diabetes. Low-calorie sweeteners also do not promote dental cavities.

For more aspartame FAQs, click here.

For more Ace-K FAQs, click here.

Network Analysis Reinforces Benefits of Low- And No- Calorie Sweetened Beverages

Posted by & filed under Diabetes/Blood Sugar Management, Featured, Health Care Professionals, Health Professionals, Low- and No-Calorie Sweeteners, Sugar Reduction, Sugar Substitutes, Uncategorized.

(Download)

McGlynn ND, Khan TA, Wang L, et al.

JAMA Network Open. 2022;5(3):e222092. doi:10.1001/jamanetworkopen.2022.2092

A recent review published in JAMA Network Open examined the association of low- and no-calorie sweetened beverages (LNCSBs) with body weight and cardiometabolic risk factors in adults with and without diabetes. Recent trials and reviews have reported inconsistent findings regarding these outcomes, and methodological considerations limit the conclusions that can be drawn from their reported results. For example, the authors note that the syntheses of randomized controlled trials (RCTs) do not fully account for the calories available to be displaced by LNCSBs, leading to an underestimation of the outcome of LNCSBs. In an effort to update the recommendations of the European Association for the Study of Diabetes, the Diabetes and Nutrition Study Group commissioned this new systematic review and meta-analysis to summarize evidence regarding the association of LNCSBs with intermediate cardiometabolic outcomes, including:

  • Adiposity
  • Glycemic Control
  • Blood Lipids
  • Blood Pressure
  • Measures of Non-Alcoholic Fatty Liver Disease
  • Uric Acid

Medline, Embase and the Cochrane Central Register of Controlled Trials were utilized to search RCTs with at least 2 weeks of interventions comparing LNCSBs, sugar-sweetened beverages (SSBs), and/or water (the standard of care substitution) from inception through December 2021. In contrast with the standard pairwise approach, researchers conducted a network meta-analysis, which allowed for the simultaneous assessment of three pre-specified substitutions (i.e., LNCSBs for SSBs, water for SSBs, and LNCSBs for water). This approach leverages direct and indirect comparisons with a common comparator to increase the information size, allowing for more precise estimates and the comparison of interventions that have not been previously compared.

Seventeen RCTs with twenty-four trial comparisons were included in the network meta-analysis. In total, the sample included 1733 adults with an average age of 33 years. The majority of included individuals (77.4%) were women who were overweight or obese and at-risk for or diagnosed with diabetes. In 12 of the RCTs included, LNCSBs were a substitute for SSBs, while 3 RCTs used water was a substitute for SSBs. LNCSBs were a substitute for water in 9 RCTs.

Network analyses of the prespecified substitutions yielded the following results:

  • Substitution of LNCSBs for SSBs (intended substitution with caloric displacement) was associated with reduced body weight body mass index, percentage of body fat, and intrahepatocellular lipid.
  • Substitution of water for SSBs (standard-of-care substitution with caloric displacement) was not associated with any outcome, although the direction of association favored water for most of the outcomes.
  • Substitution of LNCSBs for water (reference substitution without caloric displacement) was associated with lower-level glycated hemoglobin A1C seen with water and decreased body weight and systolic blood pressure with LNCSBs.

Certainty of the evidence assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Network estimates of RCTs and the direct and indirect estimates that composed these network estimates started at a high certainty of evidence but were downgraded by established criteria for risk of bias, inconsistency (incoherence), indirectness, imprecision, and publication bias. As a result, for the body weight outcome, the certainty of the evidence was rated as “moderate” for the substitution of LNCSBs for SSBs, and “low” for substitutions of water for SSBs and LNCSBs for water. The certainty of evidence was generally moderate for all other outcomes across all substitutions.

The findings in this study are in agreement with those reported in other systematic reviews and meta-analyses, which have allowed for the interpretation of results by comparator. Previous analyses have also reported reduced body weight, BMI, and body fat associated with the use LNCSBs as a substitute for SSBs with caloric displacement, which is consistent with the utility of LNCSBs in reducing net energy intake. Neutral outcomes associated with the use of LNCSBs as a substitute for water without caloric displacement were reported in previous analyses. The authors note, “Although water is considered to be the standard-of-care substitution for SSBs by authoritative bodies, with many health organizations recommending against the use of LNCSBs, the existing evidence confirms the intended benefits of LNCSBs as a substitute for SSBs over the moderate term.”

In conclusion, the authors state, “There is a need for high-quality RCTs that focus on quantifying the outcome of LNCSBs using different LNCS blends as substitutes for SSBs compared with the outcome of water (the standard-of care substitution).” They note that their findings provide a good indication of the benefits of LNCSBs as an alternative replacement strategy over the moderate term for SSBs in adults with overweight or obesity who are at risk for or have diabetes. Future research using a range of designs is warranted to confirm whether the intended benefits of using LNCSBs as a substitute for SSBs are durable and extend to hard clinical outcomes.

Recent Research Strengthens Body of Evidence for Latin American Sweetener Intake Estimates

Posted by & filed under Acesulfame K, Aspartame, Aspartame, Cyclamate, Featured, Health Care Professionals, Health Professionals, Saccharin, Stevia, Sucralose, Sugar Substitutes, Uncategorized.

A manuscript entitled, “Low- and No-Calorie Sweetener Intakes in the Brazilian Population Estimated Using Added Sugar Substitution Modelling” has been published in the Food Additives & Contaminants: Part A journal. Given the lack of data available on replacing added sugars with low- and no-calorie sweeteners (LNCS) in foods and beverages for many regions globally, the aim of this assessment was two-fold:

  • Estimating daily intakes six LNCS (acesulfame-K, aspartame, cyclamate, saccharin, steviol ‎glycosides, and sucralose) within ‎the Brazilian population; and
  • Examining alternative models for ‎assessing intakes of these sweeteners which do not involve use-level information (i.e., utilizing an added sugar substitution approach).

Each intake estimate was derived from documented added sugar intakes in the Brazilian population ‎and reported levels of added sugar in food, in conjunction with sucrose sweetness ‎equivalence data for each LNCS and usage patterns in the Brazilian market. The resulting intake estimate was then ‎compared to the sweetener’s Acceptable Daily Intake (ADI), a conservative calculation of the amount of a substance a person can consume on a daily basis for their lifetime without adverse effects established by the Joint FAO/WHO Expert Committee on Food ‎Additives (JECFA) for all population groups.‎

In both replacement models, researchers found that the intakes of all LNCS included in the study, except for cyclamate, were below the ADI by average (mean) and ‎heavy LNCS consumers (90th and 95th percentiles) for all population groups over 10 years of age.‎ However, it was noted that the assessment does not represent realistic patterns of replacement based on actual usage patterns of LNCS, which would vary by product type, and is not the most suitable for LNCS that have a high sucrose sweetness equivalence, such as cyclamate.

This work contributes to the body of evidence for intake estimates for Latin America, and Brazil specifically, which were previously quite limited. Additional research is needed for younger age groups to confirm whether these findings are applicable to the entire Brazilian population.

Combine Nutrition and Delicious, Global Flavors During National Nutrition Month and Beyond!

Posted by & filed under Featured, Healthy Diet, Healthy Lifestyle, Lifestyle Articles, National Nutrition Month, Uncategorized.

National Nutrition Month® is a nutrition education and information campaign held annually in March by the Academy of Nutrition and Dietetics. Everyone is invited to learn about making informed choices around healthy eating and physical activity habits. The campaign has been around for nearly fifty years. In the 1980s, due to the increase in public support for health and nutrition, National Nutrition Week was expanded to National Nutrition Month.

This year’s theme, “Celebrate a World of Flavors,” embraces global cultures and cuisines. Cooking tasty meals at home is one of the easiest ways to incorporate your favorite cultural foods and new and interesting flavors into a healthy diet. What’s more, preparing meals at home allows you to easily select high quality ingredients and control portion size – two hidden hazards of dining out. It is also a great strategy for eating healthy on a budget.

One of the top food trends of 2022, according to US Foods, is approachable global cuisines, particularly South Asian cuisines. The Academy recommends several simple, nutritious recipes with locally sourced ingredients from all the food groups.

For a taste, here are two of the recommended dishes, which are also gluten-free and vegan:

  • For breakfast, try a besan cheela, a savory Indian pancake made with chickpea flour and vegetables such as onions, tomatoes and spinach, then seasoned with turmeric, ginger and coriander. Mix all the ingredients to make a batter and cook on a hot griddle.
  • At dinnertime, consider bhindi masala, a popular North Indian dish made with sautéed spiced okra, onion, tomatoes and lentils, best served with warm whole grain roti bread.

Some of the common ingredients used in South Asian cuisine offer strong health benefits. These ingredients and their valuable nutrition include:

Turmeric

Turmeric is derived from the root of the plant Curcuma longa (part of the ginger family). It is widely used for culinary and medicinal purposes. Turmeric is a rich source of antioxidants, mainly contributed to a polyphenol compound called curcumin, which also gives it the signature, bright yellow color. Studies have shown the anti-inflammatory properties of turmeric may help patients at risk for or suffering from chronic diseases such as heart disease, arthritis and Alzheimer’s. Dried turmeric has a strong taste and is best cooked before consumption.

Cinnamon

Cinnamon, one of the world’s first spices to be discovered. It is harvested from the dried, inner bark of evergreen trees within the genus Cinnamomum. Cinnamon’s most studied health benefit is the possible blood sugar-lowering effect for people with diabetes. Like turmeric and many other spices, cinnamon also has antioxidant components, such as cinnamaldehyde. Of note, cinnamon supplementation is not a replacement for pharmaceutical therapy. People with liver diseases or who are taking blood-thinning medication should avoid cinnamon supplementation before consulting a healthcare professional.

Chickpeas (Garbanzo Beans)

Chickpeas are an excellent source of plant protein, folate, fiber, iron, phosphorus and, polyunsaturated and monounsaturated fatty acids. In combination with a healthy diet, chickpeas may help prevent chronic conditions such as diabetes, heart disease and obesity. The fiber in chickpeas, called raffinose, is also beneficial for the gut microflora.

Lentils

Lentils are low in sodium and saturated fat, plus high in potassium, fiber, folate and plant chemicals called polyphenols, which have antioxidant activity. Lentils can help maintain blood sugar levels because they contain resistant starch, which slows the digestive system’s absorption of carbohydrates. Studies also show that lentils may help improve cholesterol levels in people with diabetes.

Flavors from cultures around the world are a great way to nourish our bodies and appreciate our diversity. The key to cooking at home is to choose a variety of foods from each food group and to abide by portion size recommendations. This approach can help you plan a balanced meal and get a variety of nutrients that are needed for good health. And what’s better than enjoying your meals with friends or family at home?

For more information, please visit https://www.eatright.org/food/resources/national-nutrition-month.

Sources:

https://www.todaysdietitian.com/newarchives/030612p40.shtml

https://www.todaysdietitian.com/newarchives/030612p40.shtml

https://www.hsph.harvard.edu/nutritionsource/food-features/chickpeas-garbanzo-beans/

https://www.hsph.harvard.edu/nutritionsource/food-features/lentils/

https://delishably.com/spices-seasonings/Aromatic-Spices-The-basic-Ingredients-of-Indian-Cuisine

2022 Food and Restaurant Trends | US Foods

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