New World Health Organization (WHO) guidance advises against the use of sugar substitutes for weight loss purposes. The WHO conducted a systematic review of available evidence and concluded that non-sugar sweeteners do not offer long-term benefits in reducing body fat in adults or children.
While a mild reduction in body weight may occur in the short term, it is not sustainable over time. The recommendation applies to everyone except those with preexisting diabetes, as the review did not include individuals with diabetes, preventing a comprehensive assessment.
The review also highlighted potential negative effects associated with long-term use of sugar substitutes, including a slightly increased risk of type 2 diabetes and cardiovascular diseases. However, the WHO guidance clarified that their recommendation does not address the safety of consumption. Rather, it suggests that non-sugar sweeteners cannot provide the desired health effects related to obesity reduction, weight control or the prevention of noncommunicable diseases.
Nutritional Value of Sugar Substitutes
Non-sugar sweeteners are commonly used in prepackaged foods and beverages and are sometimes added directly by consumers. The interest in sugar alternatives intensified following the WHO’s 2015 guidelines, which recommended reducing daily free sugar intake to less than 10 percent of total energy intake. Experts emphasize that while artificial sweeteners are not effective for weight loss, reducing the consumption of sugar-sweetened drinks and using raw or lightly processed fruit for sweetness can be a healthier approach.
However, the Calorie Control Council, an international association representing the low-calorie food and beverage industry, disagrees with the WHO’s focus solely on preventing weight gain and non-communicable diseases, claiming that low- and no-calorie sweeteners are crucial tools for managing body weight and reducing disease risks.
The WHO guidance primarily targets government health organizations, providing them with scientific analysis to support potential policy changes. However, the implementation of these changes will depend on consumption patterns and preferences specific to each country.
WHO Guidance on Non-Sugar Sweeteners Explained
The review incorporated 283 studies, including randomized controlled trials and observational studies. Randomized trials indicated that non-sugar sweeteners had a low impact on reducing body weight and calorie intake compared to sugar, with no significant changes in diabetes markers. Observational studies also found a minimal impact on body weight and fat tissue but detected a slight increase in the risk of type 2 diabetes, high blood pressure, stroke, heart disease, heart disease-related death, bladder cancer and premature death from any cause.
The International Sweeteners Association, an industry association, expressed disappointment with the WHO’s guidance, arguing that they primarily relied on low-certainty evidence from observational studies, which carry a higher risk of reverse causality. Nevertheless, the WHO emphasized the importance of long-term observational studies to determine the impact of non-sugar sweeteners on weight loss, noting the lack of such evidence supporting the efficacy of sweeteners in reducing body weight.
The recommendation encompasses both low or no-calorie artificial sweeteners and natural extracts, whether chemically modified or not. This includes acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives. While stevia and its derivatives are considered newer sweeteners with less published research, the WHO notes that they likely function similarly to other sweeteners.
Recent research from the Cleveland Clinic discovered a potential association between erythritol (commonly used as a bulking agent or sweetener in stevia, monk fruit and keto reduced-sugar products) and blood clotting, stroke, heart attack and early death. Individuals with existing risk factors for heart disease, including diabetes, exhibited a higher likelihood of experiencing heart attacks or strokes with elevated levels of erythritol in their blood.