— Neva Cochran, MS, RDN, LD
Posted: January 23, 2019
Over the last five years, the potential impact of low and no calorie sweeteners (LNCS) on the microbiome has been a subject of debate. A new comprehensive review, “Assessing the in vivo data on low/no-calorie sweeteners and the gut microbiota,” published in the journal, Food and Chemical Toxicology1, is the basis of the following summary of the science on this issue.
Diet and Microbiome
Both long-term observational studies of population groups and short-term human intervention studies have shown that diet can affect gut microbial content. Poorly digested food components like fiber help regulate the microbiome, acting as substrates for microbial fermentation in the colon. Higher fiber intakes have been linked to increased fecal levels of certain bacteria. Higher protein and fat intake is associated with greater amounts of others,thus plant-based vs. animal-based diets can result in different gut microbiome.
Overall, studies suggest that dietary changes can modify the composition and function of the microbiome. Because there are important differences among individuals in the response of gut microbiomes to diet, researchers caution that it is difficult to generalize about the influence of specific dietary components. In interventional studies to assess the effects of different ingredients added to the diet in small amounts, the subjects’ usual diets should be determined and the intervention diets carefully controlled.
Low and No Calorie Sweeteners and the Microbiome
Concern about the effect of LNCS on the gut microbiome was prompted by a 2014 study by Israeli researchers2. The study concluded that consuming LNCS changes the composition and function of the gut microbiome, leading to an increased risk of glucose intolerance. But an expert review questioned the conclusions of the study based on limitations in the experimental design and the analysis and reporting of the data.
The authors of the new Food and Chemical Toxicology article1 reviewed 17 relevant primary research articles that investigated the effect of LNCS intake on the gut microbiome. The majority of these were animal studies, primarily with rodents. Only three were conducted with humans. A table in the paper provides a detailed summary of the studies.
There were limitations and confounding factors common in most of the studies including
Of the three human trials, none accounted for habitual dietary intake. Therefore, any changes found in the gut microbiome were not necessarily due to the LNCS itself but could be related to dietary differences between the LNCS and non-LNCS groups.
In addition, the chemical structures and metabolism of LNCS preclude any effect they could have on the human microbiome.
Finally, because LNCS are so intensely sweet, the milligram amounts consumed will always be low and well below the levels necessary to produce a significant impact on the gut microbiome.
Conclusions and Applications for Practice
The authors of the review paper conclude that studies of LNCS to date do not establish any clear evidence of any adverse effect on the gut microbiome in amounts relevant to human use. They also assert that studies evaluating the relationship between food additive and ingredient consumption and the microbiome need to be conducted in animals or humans at relevant intakes and be carefully controlled to account for the confounding factors, including the habitual diet. Safety has been well-documented over decades for acesulfame K, aspartame, saccharin, sucralose, and steviol glycosides, indicating that these low or no-calorie sweeteners as a group, or individually, do not pose any safety concerns at their currently approved levels. Therefore, nutrition and health professionals can feel confident in recommending LNCS to patients, clients and consumers as an option for sweetening foods and beverages without the addition of sugar or calories.
Neva Cochran, MS, RDN, LD is a registered dietitian nutritionist based in Dallas. She serves as a nutrition communications consultant to a variety of food and nutrition organizations, including the Calorie Control Council. She is passionate about promoting fact-based food and nutrition information to help people enjoy nutritious eating. Follow her on Twitter @NevaRDLD and check out her blog at www.NevaCochranRD.com.