Alternative Sweeteners and their Health Implications

 

Sugar is one of the most widely consumed ingredients in the world, but it also has many negative effects on health, such as weight gain, diabetes and tooth decay. Many people try to reduce their sugar intake by using alternative sweeteners, also known as non-sugar sweeteners or artificial sweeteners. These are substances that mimic the taste of sugar but have fewer or no calories. Some examples of non-sugar sweeteners are aspartame, sucralose, stevia and monk fruit. 

But are alternative sweeteners really a healthy choice? What are the benefits and risks of using them? How do they affect our appetite, metabolism and blood sugar levels? In this blog post, we will explore the latest evidence and guidance on the use of alternative sweeteners and their health implications.

Benefits of alternative sweeteners

According to the World Health Organization (WHO), one of the main benefits of alternative sweeteners is that they can help people reduce their energy intake and prevent weight gain when they replace sugary drinks. This is because non-sugar sweeteners are much sweeter than sugar, so very little is needed to sweeten foods and drinks. This can lower the amount of calories and carbohydrates consumed, which can be beneficial for weight management and blood glucose control.

Another benefit of alternative sweeteners is that they do not cause tooth decay and cavities, unlike sugar. This is because non-sugar sweeteners are not metabolized by oral bacteria that produce acid and erode the enamel. Therefore, using non-sugar sweeteners  instead of sugar can improve oral health and prevent dental problems.

Risks of alternative sweeteners

However, alternative sweeteners are not without risks. Some studies have suggested that long-term use of non-sugar sweeteners could increase the risk of various health problems, such as type 2 diabetes, cardiovascular diseases, kidney damage and cancer. The mechanisms behind these associations are not fully understood, but some possible explanations are: 

Alternative sweeteners may alter the gut microbiota, which plays a key role in digestion, immunity and metabolism. Some non-sugar sweeteners may have antibacterial effects that disrupt the balance of beneficial and harmful bacteria in the gut, leading to inflammation, insulin resistance and metabolic disorders.

Alternative sweeteners may interfere with the hormonal regulation of appetite and satiety. Some non-sugar sweeteners may stimulate the release of insulin, a hormone that lowers blood sugar levels and signals fullness. However, since non-sugar sweeteners do not provide any calories or nutrients, this may create a mismatch between the hormonal and metabolic signals, resulting in increased hunger and cravings for sugary foods. 

Alternative sweeteners may have psychological effects that influence food choices and behaviors. Some people may perceive non-sugar sweeteners as a license to overeat or indulge in unhealthy foods, thinking that they can compensate for the calories saved by using non-sugar sweeteners. This may lead to increased consumption of high-fat, high-salt and processed foods, which can have negative consequences for health. 

WHO guidelines on alternative sweeteners

Given the mixed evidence on alternative sweeteners and health, the WHO has issued a guideline on the use of non-sugar sweeteners to reduce the risk of unhealthy weight gain and diet-related noncommunicable diseases in adults and children. The guideline is based on a systematic review of 56 studies that assessed the effects of non-sugar sweeteners on body weight, body mass index (BMI), waist circumference, energy intake, blood glucose levels and other metabolic outcomes.

The main recommendation from the WHO guideline is:

         There is insufficient evidence to recommend routine use of non-sugar sweeteners by adults or children for body weight management.

This means that there is no clear benefit or harm from using non-sugar sweeteners for weight control in the long term. The WHO advises that people who choose to use non-sugar sweeteners should do so in moderation and as part of a balanced diet that includes fruits, vegetables, whole grains, nuts, seeds, lean proteins and healthy fats. The WHO also emphasizes that non-sugar sweeteners are not a substitute for physical activity, which is essential for maintaining a healthy weight and preventing chronic diseases.

The WHO guideline also provides some additional considerations for specific groups of people:

    For people with diabetes, non-sugar sweeteners may have a small beneficial effect on blood glucose levels when they replace sugar-sweetened beverages. However, this effect is not consistent across studies and may depend on the type and dose of non-sugar sweeteners used. Therefore, people with diabetes should consult their health care providers before using non-sugar sweeteners and monitor their blood glucose levels regularly.

·        For pregnant people, there is no evidence that non-sugar sweeteners have any adverse effects on pregnancy outcomes or fetal development. However, there is also no evidence that non-sugar sweeteners have any benefits for pregnant people or their babies. Therefore, pregnant people should follow the general dietary advice for healthy pregnancy and limit their intake of added sugars.

·        For children under 2 years old, there is no evidence to support the use of non-sugar sweeteners. The WHO advises that children under 2 years old should not consume any foods or drinks with added sugars or non-sugar sweeteners, as they may displace the intake of nutritious foods and affect their growth and development.

Conclusion

Alternative sweeteners are widely used as a sugar replacement, but their health effects are not fully understood. Some studies have shown that non-sugar sweeteners can help lower calorie intake and prevent tooth decay, but others have suggested that non-sugar sweeteners may increase the risk of various health problems and have no effect on weight management. The WHO guideline recommends that people who use non-sugar sweeteners should do so in moderation and as part of a healthy lifestyle that includes a balanced diet and physical activity. People with diabetes, pregnant people and children under 2 years old should consult their health care providers before using non-sugar sweeteners or avoid them altogether.