Artificial Sweetners

Objective:
To assess the association between intake of non-sugar sweeteners (NSS) and important health outcomes in generally healthy or overweight/obese adults and children.

Design:
Systematic review following standard Cochrane review methodology.
Data sources Medline (Ovid), Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and reference lists of relevant publications.

Eligibility criteria for selecting studies:
Studies including generally healthy adults or children with or without overweight or obesity were eligible. Included study designs allowed for a direct comparison of no intake or lower intake of NSS with higher NSS intake. NSSs had to be clearly named, the dose had to be within the acceptable daily intake, and the intervention duration had to be at least seven days.

Main outcome measures:
Body weight or body mass index, glycaemic control, oral health, eating behaviour, preference for sweet taste, cancer, cardiovascular disease, kidney disease, mood, behaviour, neurocognition, and adverse effects.

Results:
The search resulted in 13 941 unique records. Of 56 individual studies that provided data for this review, 35 were observational studies. In adults, evidence of very low and low certainty from a limited number of small studies indicated a small beneficial effect of NSSs on body mass index (mean difference −0.6, 95% confidence interval −1.19 to −0.01; two studies, n=174) and fasting blood glucose (−0.16 mmol/L, −0.26 to −0.06; two, n=52). Lower doses of NSSs were associated with lower weight gain (−0.09 kg, −0.13 to −0.05; one, n=17 934) compared with higher doses of NSSs (very low certainty of evidence). For all other outcomes, no differences were detected between the use and non-use of NSSs, or between different doses of NSSs. No evidence of any effect of NSSs was seen on overweight or obese adults or children actively trying to lose weight (very low to moderate certainty). In children, a smaller increase in body mass index z score was observed with NSS intake compared with sugar intake (−0.15, −0.17 to −0.12; two, n=528, moderate certainty of evidence), but no significant differences were observed in body weight (−0.60 kg, −1.33 to 0.14; two, n=467, low certainty of evidence), or between different doses of NSSs (very low to moderate certainty).

Conclusions:
Most health outcomes did not seem to have differences between the NSS exposed and unexposed groups. Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality was limited; therefore, confidence in the reported results is limited. Future studies should assess the effects of NSSs with an appropriate intervention duration. Detailed descriptions of interventions, comparators, and outcomes should be included in all reports.

Could Artificial Sweeteners Promote Diabetes and Obesity?

For those who are diabetic or dieting, you may think artificial sweeteners are your best friend.

They allow you to get the taste of sugar from foods and beverages without the elevated blood sugar levels or calories. But a new study suggests this may not be the case; artificial sweeteners could actually promote obesity and diabetes.

The research team, including Eran Elinav of the Department of Immunology at the Weizmann Institute of Science in Israel, recently published their findings in the journal Nature.

Because artificial sweeteners are low calorie and do not contain carbohydrates, they are often recommended to help with weight loss or to treat or prevent metabolic disorders, such as type 2 diabetes.

However, Elinav and colleagues note that, although some studies support such recommendations, others have indicated that artificial sweeteners actually increase weight gain and raise the risk of metabolic disorders. A study from the Washington University School of Medicine published last year claimed the artificial sweetener sucralose is linked to increased glucose and insulin levels.

“Despite the controversial data, the FDA approved six NAS (non-caloric artificial sweetener) products for use in the US,” the researchers note. These are saccharin, sucralose, aspartame, advantame, neotame and acesulfame potassium.

In this latest study, the team investigated how artificial sweeteners affected the metabolism of mice. For 11 weeks, some mice were supplied with drinking water supplemented with an artificial sweetener – either saccharin, sucralose or aspartame – and glucose, while others drank just water alone or water containing only sugar.

The team found that the mice that drank the water containing glucose and an artificial sweetener developed glucose intolerance – elevated blood sugar levels, whereas the mice that drank water alone or water containing only sugar did not.