AHA/ADA Give Cautious Nod to Sweeteners

July 10, 2012

July 10, 2012 (Dallas, Texas) — The American Heart Association and the American Diabetes Association have issued a joint scientific statement giving a cautious recommendation to the use of nonnutritive sweeteners to help people maintain a healthy body weight and for diabetics to aid glucose control [1].

The statement, published online in both Circulation and Diabetes Care on July 9, 2012, warns, however, that sweeteners will be helpful only as long as people don't eat additional calories later as compensation. It adds that scientific evidence is limited and inconclusive about whether this strategy is effective in the long run for reducing calorie and added-sugars consumption.

The statement reminds that limiting added sugars is an important strategy for supporting optimal nutrition and healthy weight and achieving glycemic control. It says: "There are some data to suggest that nonnutritive sweeteners may be used in a structured diet to replace sources of added sugars and that this substitution may result in modest energy-intake reductions, weight loss, and beneficial effects on related metabolic parameters."

First author Dr Christopher Gardner (Stanford University, CA) explained to heartwire that the term nonnutritive sweeteners was settled on to cover the six sweeteners included in the review--aspartame, acesulfame K, neotame, saccharin, sucralose, and plant-derived stevia. "We used the term nonnutritive because all these substances have zero calories, and that distinguishes them from other sugar substitutes that do have calories but are better for the teeth than sugar itself."

Not Addressing Safety

Gardner further noted that the statement is limited to these six sweeteners, as these have all had some form of acceptance from the FDA, which allowed the review committee to stay away from the thorny issue of safety. Acknowledging that there have been safety question marks over some of these substances in the past, Gardner commented: "We are not passing any judgment on the safety of these substances in this statement. That was not our mandate. We have left that to the FDA, and they have either approved or given some form of acceptance to all of these six substances. We just looked at human data on whether intake of these sweeteners results in a reduction of sugar intake."

Gardner stressed that the key to the success in this process is lack of compensation. He explained that compensation can take two forms: physiological, where the body might be expecting more calories and so the individual may be hungrier and therefore may eat more; and psychological, where the individual thinks they are allowed to eat more sugar-rich food because they had a diet soda instead of a full-sugar soda.

Better to Drink Them Than to Eat Them

"We found that when real people use sweeteners there is compensation. The key is how much? If there is only partial compensation, then the balance is still in favor of fewer calories, but people could also completely compensate or even overcompensate, so these sweeteners have to be used smartly to be successful."

One intriguing finding was that compensation seems less of a problem when these sweeteners are consumed in beverages as opposed to food. Gardner noted: "We found that people don't really notice the lack of calories in a diet soda and so don't tend to eat more, whereas if they consume a low-calorie yogurt or other foodstuff, they do tend to eat more as compensation. So it appears that there is more room for beneficial effects of these sweeteners when used in beverages, which is good, because that is where they are mostly consumed."

"Better Than Sugar But Not Optimal Diet"

Asked to comment on the statement and the safety of the substances included for heartwire , Dr Walter Willett (Harvard School of Public Health, Boston, MA) said: "We cannot be completely sure about the safety of these products, because their long-term use in humans has not been studied fully, in part because of the time that they have been on the market. Many products initially approved by the FDA have later been found to have side effects and withdrawn, so approval is not a definitive indication of safety."

We should consider these products to be like a nicotine patch; they are appreciably better than the real product (sugar), but not part of an optimal diet.

He added: "However, the artificial sweeteners on the market are almost certainly safer than consuming large amounts of sugar, which has definite harm when consumed in large amounts, as [it is] by many in the US and UK. This harm, particularly when consumed in beverage form such as soda, includes increases in risks of obesity, diabetes, cardiovascular disease, and gout. We have looked in detail at consumption of artificial sweeteners (in beverages) in relation to weight gain and diabetes and do not see the same increases of diabetes and weight gain as for sugar. A real concern, though, is that just replacing sugar with artificial sweeteners leaves a person, especially children, conditioned to high levels of sweetness, which is likely to influence their food choices adversely. Thus, I think we should consider these products to be like a nicotine patch; they are appreciably better than the real product (sugar), but not part of an optimal diet."

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