The world’s most highly regarded global scientific and regulatory food agencies, including the Food & Drug Administration and The European Food Safety Authority maintain that low- and no-calorie sweeteners are safe for consumption.
Resources on the benefits and proven safety of low- and no- calorie sweeteners:
Abstract: Inconsistency among evidence syntheses has led to opposing guidelines and public confusion regarding low- and no-calorie sweeteners (LNCS) in noncommunicable diseases. To understand the role of different analytical approaches in assessing LNCS and cardiometabolic outcomes, an umbrella review of systematic reviews and meta-analyses was conducted. Included were six trial- and five cohort-based analyses. In trials, LNCS reduced energy, body weight, and body fat in both analyses and body mass index and systolic blood pressure in bias-adjusted only, while glycosylated hemoglobin showed smaller reductions than water in bias-adjusted only. In analyses of cohorts, LNCS was associated with higher obesity, diabetes, stroke, and cardiovascular and all-cause mortality in naïve analyses but lower body weight, waist circumference, obesity, coronary heart disease, and cardiovascular and all-cause mortality in bias-adjusted analyses. The certainty of evidence was generally moderate for trials and very low for cohorts. LNCS show benefits across analytical approaches in both analyses of trials. These results agree with bias-adjusted analyses of cohorts, in which LNCS are associated benefits across cardiometabolic outcomes, but not naïve analyses of cohorts. Systematic reviews and meta-analyses using bias-reduction methods support the use of LNCS as a sugar-reduction strategy.
Key Findings:
Take home message:
A systematic review, sponsored by the American Beverage Association entitled, “A Systematic Review of Non-Sugar Sweeteners and Cancer Epidemiology Studies“, has been published in Advances in Nutrition. Epidemiology studies of sweetener intake (all types in aggregate and individually) and the risks of all types of cancer published through Fall 2024 (90 total included (30 cohort studies and 60 case-control studies) were included. Prior to evidence synthesis, the quality of each study was assessed across several domains including NSS intake assessment, covariate consideration and confounding, outcome assessment, and selection bias. Domains most likely to impact the interpretation of results were selected in order to identify study strengths and any threats to validity, and to determine the reliability of results.
Key Findings:
READ: Advances in Nutrition
The stated objective of the SWEET trial is to investigate the efficacy and safety of combined and prolonged use of sweeteners and sweetness enhancers (S&SEs), as part of a healthy diet, in adults and children with overweight or obesity.
Study Overview
This multi-center, randomized, controlled trial aimed to assess the effect of combined and prolonged use of sweeteners and sweetness enhancers (S&SEs), in both foods and drinks, as part of a healthy sugar-reduced ad libitum diet on weight loss maintenance, cardiometabolic risk factors and gut microbiota composition in adults who are overweight or obese. In children who are overweight or obese, the trial focused on weight control (i.e. weight stability and maintenance of BMI-for-age z-score) and cardiometabolic outcomes. Adults followed a 2-month low-energy diet for ≥5% weight loss, followed by a 10-month healthy, casual diet with <10% energy from sugars.
Primary outcomes included changes in body weight and gut microbiota composition at 1 year. Secondary outcomes included changes in risk factors for Type 2 Diabetes and cardiovascular disease, body mass index (BMI)-for-age z-score, intrahepatic lipid (IHL) content, the occurrence of (serious) adverse events (AEs), gastrointestinal symptoms and use of concomitant medication in adults with overweight or obesity.
Sugar Intake
In total, 203 adults and 22 children (60% and 58%) completed the 1-year trial. Overall, for all adults, total sugar intake was reduced by 12g/day, more in the S&SEs group than the sugar group. Both adults and children reduced their total intake of sugar-rich products by 142 g/day and 163 g/day, respectively.
Weight Loss and Maintenance
The S&SEs group, compared to the sugar group, maintained greater weight loss at 1 year.
Gut Microbiota Composition
The S&SEs group, compared to the sugar group, exhibited distinct gut microbiota shifts, with increased short-chain fatty acid and methane-producing taxa.
Other Outcomes
No significant differences were observed in risk factors for Type 2 Diabetes and cardiovascular disease, or in children. While the S&SE diet led to significantly larger decreases in BMI, total cholesterol, LDL-C, HDL-C and non-HDL-C at 6 months, only hip circumference was significantly more reduced in the S&SEs group than the sugar group at the one year mark.
Overall, these findings indicate that, compared to adults consuming drinks and foods without S&SEs, those who included S&SEs in a healthy, sugar-reduced diet exhibited improved 1-year weight loss maintenance and gut microbiota composition without affecting cardiometabolic health markers.
READ: Full-Text Commentary
Lyle D. Burgoon and Matthew Von Hendy
Summary: Erythritol is a sweetener that is found naturally in many foods and is produced within our own bodies. Recently, there have been questions raised about the safety of erythritol, and whether it might lead to adverse cardiovascular events.
With that in mind, we sought to critically evaluate the literature through a systematic review to answer specific questions:
1) What is the current state of the science regarding the absorption, distribution, metabolism, and excretion (ADME) of erythritol?
2) What is the current state of the science with respect to the toxicological profile of erythritol?
3) What are the mechanisms that endogenous and exogenous erythritol may play in blood clotting?
4) What is the expected exposure that people may have to endogenous erythritol?
We found in our review that 60%–88.5% of exogenous erythritol is rapidly absorbed into the body, and blood levels peak around 60–90 minutes following administration. There is insufficient data to accurately estimate the elimination half-life. It also appears that erythritol is not substantially metabolized once it is absorbed.
Based on our analysis of the existing literature, there is no reliable scientific evidence to conclude that erythritol causes adverse health outcomes in humans when used at human exposure levels found in food and beverages. Upon synthesis of the evidence, it appears that the association widely reported in the press of erythritol being associated with major adverse cardiovascular events (MACE) is actually a case of a shared upstream biological state/event (e.g., metabolic disorder, increased glycemia, increased central adiposity) driving the increase in erythritol and MACE.
Highlights:
Describes the current state of the science on erythritol safety.
60%–88.5% of exogenous erythritol is absorbed by the body.
There is a general lack of consistent and coherent evidence suggesting adverse effects of erythritol at human relevant doses/concentrations
Observations that erythritol leads to major adverse coronary events (MACE) are likely due to the constellation of diseases that drive the pentose phosphate pathway also drive MACE occurrence and has nothing to do with erythritol.
Mattes, Richard D. PhD, MPH, RD; Rivera, Brianna N. PhD; Rutigliani, Giorgia; Rogers, Sarah MS; Mendoza, Ivan D. MPH; Wang, Lucheng; Beckemeier, Katheryn; Wikoff, Daniele PhD
Abstract: The objective of this narrative review is to provide a critical consideration of the safety and efficacy of weight management evidence for low and no calorie sweeteners (LNCS) that have been reviewed/approved by the US Food and Drug Administration and have the highest frequency of use: acesulfame potassium, allulose, aspartame, erythritol, monk fruit, saccharin, stevia, sucralose, and xylitol. Safety assessments by the authoritative bodies for the World Health Organization, European Union, and United States were reviewed. Additionally, emerging topics of interest regarding the safety of these sweeteners commonly cited in the recent literature or highlighted in the media are discussed.
Conclusion: Authoritative and regulatory bodies have evaluated—and continually reevaluate—the safety of LNCSs and have consistently supported a view that they are safe for use. Taken together, and consistent with the current Dietary Guidelines for Americans, this review suggests that LNCSs, when used alone, are safe and most may aid weight management.
READ: Nutrition Today
Study Design Overview:
A single-center, open label, multiple-crossover RCT of the effect of replacing sugar-sweetened beverages (SSBs) with low-and no-calorie sweetened beverages (LNCBs) or water on glucose tolerance, gut microbiome diversity, and intermediate cardiometabolic outcomes over 4-weeks in at-risk overweight/obese individuals assessing 3 comparisons of clinical/public health importance:
Although there are concerns that LNCSs may induce changes in glucose tolerance through the microbiome, the STOP Sugars NOW trial does not show an effect of LNCSBs (sweetened predominantly with a blend of aspartame and ace-k) in substitution for SSBs (the “intended substitution” with caloric displacement) similar to water (the “standard of care” without caloric displacement) on either of the two primary outcomes, change in gut microbiome beta-diversity or glucose tolerance in ITT analyses.
Adherence appears to be a determinant of any effects. Completers and per protocol analyses showed that the substitution of LNCSBs for SSBS (the “intended substitution” with caloric displacement) and water for SSBs (the “standard of care” without caloric displacement) improve fasting plasma glucose and liver fat (sub-study) with water showing greater reductions.
This data is consistent with the available RCTs which have failed to show any effect on microbiome and glucose tolerance and support clinical practice guidelines recommending LNCSBs as an alternative strategy to the “standard of care” water for SSBs reduction.
READ: Published rationale, design and baseline characteristics.
READ: Study Findings
A new study, “Non-Nutritive Sweetened Beverages Versus Water After a 52-week Weight Management Program: A Randomized Controlled Trial,” set out to compare the effects of non-nutritive sweetened (NNS) beverages and water on body weight. As part of the larger SWITCH study, the current study was published in the Obesity Journal, and reports results following both the 12-week active weight loss and 40-week weight maintenance phases. The results were recently presented at The Obesity Society’s Obesity Week conference.
Key findings from the 52-week and 104-week studies:
Following a description of the rationale and design of the SWITCH trial, Dr. Halford shared 52- and 104-week results, which including the following:
52-Weeks (Active Weight Loss Phase + Assisted Weight Maintenance Phase)
104-Weeks (Active Weight Loss Phase + Assisted Weight Maintenance Phase + Follow-Up)
In terms of implications, the SWITCH Trial adds to the body of data available on the effects of sweeteners. Following the trial, participants maintained a significant weight loss over one year, saw improvements in various health markers and had reduced sugar consumption. The findings suggest that both water and NNS beverages can successfully be used as aids in weight loss, with no detriment, after one year.
Low- and no-calorie sweeteners (LNCS) are safe and can be a helpful tool to cut back on sugar and support healthy blood sugar and weight management along with an overall balanced diet.
LNCS can be useful for reducing sugary drinks, especially if you regularly enjoy soda or other sweetened beverages.
Further research and monitoring are needed to better understand how LNCS can fit into healthy diets and inform public guidance.
Business for Impact at Georgetown University’s McDonough School of Business developed this whitepaper to evaluate the role low- and no-calorie sweeteners (LNCS) can play in achieving public health recommendations to reduce added sugars in the diet. This new paper increases understanding about the use, purpose, safety and benefits of LNCS in the food supply, demonstrates LNCS are a beneficial tool to help individuals achieve public health recommendations, and will help guide more effective policy decisions, better dietary guidance, and enlightened industry actions to enhance consumer health.
LNCS are commonly used in the food supply to help reduce caloric and sugar intake. This whitepaper sponsored by the Calorie Control Council examines the current state of LNCS usage, the benefits and safety of LNCS consumption, consumer perspectives regarding the utilization and labeling of sugar and LNCS, and projections for how much sugar and calories can be removed from the food supply by increasing the incorporation of LNCS into foods and beverages.
Among the key findings of this paper are:
According to the current analyses, increasing the incorporation of LNCS within permitted regulatory limits can contribute to the potential reduction of seventy billion grams of added sugar and two hundred twenty-five billion calories in the diet. Government and public health officials are urged to prioritize consumer and media education about the benefits of LNCS in mitigating the obesity crisis.
Watch the on-demand panel discussion:
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.
