The World Health Organization’s (WHO) Nutrition Guidance Expert Advisory Group (NUGAG) subgroup on Diet and Health published its final Guideline on the Use of Non-Sugar Sweeteners. The Guideline includes the following conditional recommendation: “WHO suggests that non-sugar sweeteners not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases (conditional recommendation).”
The Calorie Control Council strongly disagrees with this recommendation and reaffirms the documented health benefits and longstanding safety of non-sugar sweeteners, also known as low- and no-calorie sweeteners, for consumption by all populations, including those living with non-communicable diseases such as obesity and diabetes. Low- and no-calorie sweeteners have been proven to assist in body weight and blood glucose management, promote oral health as well as facilitate the reduction of calorie and sugar intake.
It is worth noting the recommendation is classified as “conditional,” which is used when the evidence supporting the recommendation is considered less certain. In the case of the current Guideline, most of the evidence used to support the recommendation was graded as “very low” to “moderate.” Further, the Guideline notes the use of low- and no-calorie sweeteners contributes to reductions in key outcomes such as body weight and body mass index, only to issue a recommendation against their use. This does not provide the full picture regarding the efficacy of these ingredients and has the potential to negatively impact public health.
“A substantial body of evidence shows that low- and no-calorie sweeteners provide effective and safe options to reduce sugar and calorie consumption. This is supported by rigorous reviews of this evidence by the world’s most highly regarded health and regulatory agencies, who have validated the role of these ingredients. 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,” said Robert Rankin, President, Calorie Control Council.”
Click here for CCC’s press release on the WHO Guideline on Non-Sugar Sweeteners.
Low- and No-Calorie Sweetener Benefits
Low- and no-calorie sweeteners play an important role in reducing caloric and added sugar intake. Low- and no-calorie sweeteners are:
Reducing Added Sugar Consumption: More than 60% of American adults exceed the recommended limit for added sugar intake, consuming more than 10% of their daily calories via added sugar (according to What We Eat in America, using NHANES data from 2013-2016).1-2 Replacing added sugars with low- and no-calorie sweeteners can help populations around the world adhere to the WHO recommendations for sugar reduction recommendations.
Replacing Caloric Beverages: Similar to the new WHO draft guideline, the 2020-2025 Dietary Guidelines for Americans recommends that adults limit their intake of sugar-sweetened beverages, suggesting that consumers instead choose beverage options that are calorie-free or contain no added sugars. While water is always a good choice for replacing caloric and sugar-sweetened beverages, for those who are used to consuming these beverages, making the transition may not be easy. An 2018 advisory issued by the American Heart Association noted, “LCS [low-calorie sweetened] beverages may be a useful replacement strategy to reduce intake of sugar-sweetened beverages (SSBs). This approach may be particularly helpful for persons who are habituated to a sweet-tasting beverage and for whom water, at least initially, is an undesirable option.”3 Beverages containing low- and no-calorie sweeteners (LNCSBs) are an option that provide desired sweetness and flavor without adding calories, have been shown to help manage weight and may even be equal to water when it comes to weight loss. 4-5 A recent systematic review and meta-analysis reported that when LNCSBs beverages are substituted for water, there is a decrease in body weight and systolic blood pressure seen in those who consume LNCSBs.6
Addressing Global Health Issues Like Obesity: In the global effort to prevent and control unhealthy weight gain and the development of chronic diseases, including obesity, there are different approaches and tools available.5 Low- and no-calorie sweeteners are one of many different tools that can be used.7-8 Replacing sugary foods and drinks with those containing Low- and no-calorie sweeteners can be useful in helping people to manage their weight. A recent systematic review and meta-analysis reported that substitution of beverages containing low- and no-calorie sweeteners low- and no-calorie sweetened beverage for SSBs was associated with reduced body weight and BMI, percentage of body fat, and intrahepatocellular lipid.6
Public health strategies should take into account that obesity and body weight are impacted by diet, physical activity and other biological and socioeconomic factors.9 Making foods with reduced calories is an important component of these strategies. The 2021 American Diabetes Association Standards of Medical Care states that, “The use of nonnutritive sweeteners may have the potential to reduce overall calorie and carbohydrate intake if substituted for caloric (sugar) sweeteners and without compensation by intake of additional calories from other food sources.”10
Low- and No-Calorie Sweetener Consumption in Children
The safety of low- and no-calorie sweeteners has been confirmed by many international government and regulatory agencies, including but not limited to the European Food Safety Authority, the United States Food and Drug Administration, Public Health England, Food Standards Australia and New Zealand and Health Canada.11-17
For sensitive populations like pregnant women and children, recommendations from global public health organizations should be consistent with statements18 made by regulatory authorities around the globe, as well as the hundreds of peer-reviewed scientific studies that confirm the safety of low- and no-calorie sweeteners.
“The WHO recommendations are based on evidence that was assessed overall as low certainty. Their recommendations were summated as being conditional and require substantial future discussion. Weaknesses such as reverse causation may have played a role in the findings, as pre-existing risk factors such as obesity confounded the ability to determine risk of disease development. There were no identified undesirable effects seen with use of NSS. NSS play a role in replacing free sugars to reduce overall calorie intake. I will continue to recommend NSS to my patients as a tool for weight management,” Dr. Keri Peterson, MD and medical advisor of the Calorie Control Council.
“The new WHO guidelines advising against using these sweeteners for weight management and reducing disease risk totally miss the point of why people use these ingredients. Non-sugar sweeteners are safe, documented by numerous studies leading to approval by government health agencies around the world. They provide a way for people to enjoy sweetened foods and beverages with less sugar and fewer calories. Extensive research has shown they can help reduce calorie intake and promote weight loss when they replace calories from sugar in food. They also help lower added sugar, a dietary goal in many countries around the globe to reduce disease risk. In addition, they help increase the intake of foods like yogurt, milk, canned fruit and juice, which provide essential nutrients people often fall short of consuming. As a registered dietitian nutritionist I feel confident recommending low calorie and no-calorie sweetened foods and beverages as part of a nutrient-rich, health-promoting meal pattern, ” Neva Cochran, MS, RDN, LD, FAND and Nutrition Communications Consultant.
“It is mind-boggling that persons living with diabetes, for whom no-sugar sweeteners can have an especially meaningful role in their compliance with necessary dietary requirements, were conveniently not considered when creating these guidelines. NUGAG’s insistence on focusing only on prevention of unhealthy weight gain and non-communicable diseases is at the very least, misguided. NUGAG’s decision not to focus on the value of no-sugar sweeteners for persons with diabetes borders on unconscionable. Their doing so dismisses the value and usefulness of NSS for persons living with diabetes and pre-diabetes, which accounts for far in excess of 10% of the global population,” Dr. Keith Ayoob, Scientific Advisor, Calorie Control Council.
About the WHO NUGAG Guidance on Sugar Intake for Adults and Children
In 2015,19 to reduce the risk of non-communicable diseases (particularly unhealthy weight gain and tooth decay), WHO issued a Guideline on Sugar Intake for Adults and Children recommending that individuals limit consumption of “free sugars,” also known as added sugars, to less than 10% of their total daily calories. WHO further suggested that added sugars be less than 5% of total calorie intake for additional benefit.
Low- and No-Calorie Sweetener are Safe
The safety of low- and no-calorie sweeteners has been confirmed by many international government and regulatory agencies, including but not limited to the European Food Safety Authority, the United States Food and Drug Administration, Public Health England, Food Standards Australia and New Zealand and Health Canada.11-17
For sensitive populations, such as pregnant women and children, recommendations from global public health organizations should be consistent with statements18 made by regulatory authorities around the globe, as well as the hundreds of peer-reviewed scientific studies that confirm the safety of low- and no-calorie sweeteners.
For more information about the WHO NUGAG subgroup on Diet and Health, click here.
Do you have questions about low-calorie sweeteners? Want to learn more about maintaining a healthy lifestyle? You asked and we listened. Our resident Registered Dietitians answered the most popular questions about low-calorie sweeteners.
