Large Body of Science Points to Benefits of Low Calorie Sweeteners, Contrary to Recent Study

Calorie Control Council statement in response to the Systematic Review by Toews et al.

(January 3, 2019) The recently published systematic review and meta-analysis by Toews et al¹ reviewed existing studies evaluating the effects of low- and no-calorie sweeteners (LNCS) intake on a number of health outcomes in adults and children.  However, in contrast to the conclusions made by the study authors, the highest quality scientific evidence shows that the consumption of LNCS results in reductions in body weight, does not lead to weight gain and does not cause cravings leading to increased intake^2,3. In fact, LNCS were found to be most beneficial to those who are overweight or obese^4,5. Additionally, longer-term trials have shown consumption of LNCS to reduce weight in children and adolescents at 1-year follow-ups ^6,7. Based on two randomized controlled trials included in the Toews’ review, the preference for sweet taste was slightly lower in the group receiving LNCS than in the group that did not.

A large body of evidence (International Journal of Obesity) evaluating more than 100 studies suggests LNCS play a role in reducing energy intake and body weight. Further, authors of The BMJ-published study cited research from Drs. Vanessa Perez and Paige Miller, who conducted a meta-analysis reviewing 35 years of independent studies on the relationship between LNCS and weight status and found that randomized control trials “resulted in statistically significant reductions in body weight, BMI, fat mass, and waist circumference.” LNCS continue to be a useful tool, along with diet and exercise, in helping to support weight management and weight loss.

As mentioned in the accompanying editorial by Vasanti Malik⁸, there are a number of significant limitations within the observational studies that have shown positive associations between LNCS consumption and weight gain. These limitations include reverse causality (meaning subjects are choosing LNCS to manage their weight after they have developed overweight/obesity) and residual confounding (the inability to control for factors that may influence the health outcome being studied).

In alignment with the conclusions made by Dr. Malik, the Calorie Control Council agrees that the highest quality science supports that LNCS can be consumed as part of a balanced diet and can assist with the reduction of cardiometabolic risk through the management of body weight and reduced caloric intake.

Given the proven safety and benefits of LNCS, consumers should continue to be confident in including these ingredients as part of a healthy diet.

1. Toews I, Lohner S, Gaudry DK De, 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. 2018. doi:10.1136/bmj.k4718
2. Rogers PJ, Hogenkamp PS, De Graaf C, et al. Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. Int J Obes. 2016. doi:10.1038/ijo.2015.177
3. Miller PE, Perez V. Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies. Am J Clin Nutr. 2014. doi:10.3945/ajcn.113.082826
4. Pan A, Malik VS, Hao T, Willett WC, Mozaffarian D, Hu FB. HHS Public Access. 2014;37(10):1378-1385. doi:10.1038/ijo.2012.225.Changes
5. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men. N Engl J Med. 2011;364(25):2392-2404. doi:10.1056/NEJMoa1014296
6. De Ruyter JC, Olthof MR, Seidell JC, Katan MB. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med. 2012;367(15):1397-1406. doi:10.1159/000356352
7. Cara B. Ebbeling, Ph.D., Henry A. Feldman, Ph.D., Virginia R. Chomitz, Ph.D., Tracy A. Antonelli, M.P.H., Steven L. Gortmaker PD, Stavroula K. Osganian, M.D., Sc.D., and David S. Ludwig, M.D. PDA. A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight. N Engl J Med. 2012;367(15):1407-1416.
8. Malik VS. Non-sugar sweeteners and health. Bmj. 2019;364:k5005. doi:10.1136/BMJ.K5005