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Study on Non-Nutritive Sweeteners and Diabetes Inconclusive

(Washington, D.C.) — On May 26, 2020, Cochrane Systematic Review – Intervention published a review of the scientific evidence titled “Non-nutritive sweeteners for diabetes mellitus,” The review set out to determine the effect of long-term NNS consumption on average blood sugar levels as well as other patient-centered outcomes, including body weight, side effects, diabetes complications (such as heart attack, eye or kidney disease), and health-related quality of life.  The review showed inconclusive evidence of benefit or harm to people with diabetes who consume non-nutritive sweeteners (NNS) and the authors cautioned that the findings came with very low certainty.

Out of 1,699 scientific records in the initial search, researchers included nine randomized controlled trials for their analyses. Study results were mixed, and even found the reverse was true – that changes in NNS consumption were inversely correlated with concurrent weight gain, supporting previous findings that replacing sugar with NNS is helpful in weight management. It should be noted that this study did not look at how the incorporation of NNS in place of sugar-sweetened beverages may provide benefit.

The research suffered from other drawbacks, including:

  • The resulting data on health‐related quality of life, diabetes complications, all‐cause mortality, and socioeconomic effects is lacking and its interpretation is limited due to unspecified diagnostic criteria for diabetes in most of the nine included trials.
  • Due to the small number of trials included, the potential for publication bias could not be ruled out and the generalizability of these findings are further limited, since the vast majority of these trials were conducted in upper-middle or high-income countries.

What the Experts Say

Global health organizations around the world, including The American Heart Association, American Diabetes Association and British Dietetic Association note that the use of NNS — also known as low and no calorie sweeteners (LNCS) — can be helpful for people with diabetes as they do not raise blood glucose or insulin levels, and when used to replace sugar, can help lower carbohydrate intake.

“As a primary care physician, I frequently provide dietary counseling to my patients who are diabetic, overweight or just want to live a healthier lifestyle. Substituting sugar sweetened beverages and snacks with low-calorie sweeteners is one of my tips,” said Keri Peterson, MD and medical advisor of the Calorie Control Council.

According to Robert Rankin, president of the Calorie Control Council, “Millions of Americans are affected by diabetes and obesity,. For these individuals, nutrition plays a major role in managing disease. Low and now calorie sweeteners are not a magic bullet but they are excellent tools to help reduce sugar intake, manage blood glucose levels, and reduce overall calorie intake.”

The following organizations have utilized the most rigorous and extensive testing methods to evaluate LNCS for use in diabetes management, and have concluded:

  • For some people with diabetes who are accustomed to sugar-sweetened products, non-nutritive sweeteners may be an acceptable substitute for nutritive sweeteners when consumed in moderation. – American Diabetes Association
  • Artificial sweeteners are also safe for people with diabetes when consumed within the ADI and the EFSA Panel concluded that there is sufficient scientific information to support the claims that intense sweeteners lead to lower postprandial blood glucose concentrations if consumed instead of sugars. For people who are accustomed to sugar sweetened products, nonnutritive sweeteners (NNS) have the potential to reduce overall energy and carbohydrate intake and may be preferred to sugar when consumed in moderation and can be a useful strategy for those individuals seeking to control their calorie and manage their weight. – Diabetes UK

For a half a century, The Calorie Control Council has been reviewing science on low calorie sweeteners and diet products. Established in 1966, the Council is an international association representing the low- and reduced-calorie food and beverage industry. Council staff includes experts certified in public health, food and nutrition. More at caloriecontrol.org.

faq2Do 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.