Why The WHO Is Reinforcing Its Warning About Sugar Substitutes

The World Health Organization (WHO) recently issued a draft guideline recommending against the use of non-sugar sweeteners for weight loss and management, citing long-term health effects, among other factors, per Food Navigator. Manufacturers who use the sweeteners in their products were "disappointed" by the draft and said it may "negatively impact public health."

Non-sugar or non-nutritive sweeteners are often used as sugar substitutes in diet and zero-calorie drinks and snacks. There are currently eight of these non-sugar sweeteners approved for use by the FDA. They include aspartame, acesulfame potassium, luo han guo (monk) fruit extract, neotame, saccharin, stevia, sucralose, and advantame (via Cleveland Clinic). According to Harvard Medical School, the average 12-ounce can of soda flavored with sugar or high fructose corn syrup has about 150 calories that mostly come from the drink's sugar content. Using non-nutritive sweeteners in sugar's place allows companies to reduce their calorie count and market these products as healthier options.

The Cleveland Clinic notes that these sugar substitutes can be effective for persons with type two diabetes or those hoping to manage their weight, but they also come with several drawbacks.

Food Navigator reports that the World Health Organization's (WHO) draft guideline recommends against the consumption of non-nutritive sweeteners for a number of reasons. It states that these sweeteners are often used in foods with poor nutritional profiles, and often replace more nutrient-dense options. Individuals may consume a diet soda instead of low-fat milk for example.

The Harvard Medical School notes that non-nutritive sweeteners are far more potent than sugar or high-fructose corn syrup. This potency can alter our perceptions of taste and make nutrient-dense foods like fruit taste bland by comparison.

WHO also noted that while sugar substitutes may be useful for short-term weight loss, they also come with other long-term risks. It cites systematic meta-analyses that showed non-nutritive sweeteners tended to coincide with weight gain and high BMIs over long-term periods. It also noted that while evidence was limited, some data showed an increased risk of "type two diabetes, cardiovascular diseases, and mortality in adults." The American Heart Association notes that some individuals may use diet or zero-calorie options as a means to justify eating calorie-dense foods later in the day as a "reward" for their "healthier" choices.

Dr. Rachel Cheatham, founder of food and nutrition consultancy FoodScape Group told Food Navigator that this guideline is not a condemnation of sugar substitutes. Instead, individuals should understand that these sweeteners may not be as beneficial for a healthy diet as previously perceived.

The International Sweeteners Association (ISA) sent a statement to Tasting Table in response to the WHO draft guidelines. In it, the association (which defines itself as a non-profit "with scientific aims representing suppliers and users of low/no calorie sweeteners" on its website) asserts there is "an overwhelming body of scientific evidence" showing that non-nutritive sweeteners are generally safe for consumption, can help with weight management, and are not a leading cause of tooth decay.

The statement includes a comment from ISA Chairman Robert Peterson, sharing concerns this potential new guideline will adversely affect the global campaign against diabetes: "Low/no calorie sweeteners are no magic bullet. However, they mean people can enjoy food and drinks that have less sugar, fewer calories while still meeting their taste preferences. ... While this guideline does not apply to people living with diabetes, it could mislead those who need to manage their carbohydrate and sugars intake." Peterson goes on to explain that health originations worldwide approve of these artificial sweetners for people with diabetes and that they are a way for brands to keep their products tasting the same or similar while adhering to changing nutritional recommendations.