The World Health Organization (WHO) has advised against using sugar substitutes to help with weight loss or to reduce the risk of diet-related diseases. In its new guidance, the WHO stated that there is no long-term benefit in reducing body fat in adults or children from the use of non-sugar sweeteners. While non-sugar sweeteners may help people lose weight over the short term, the changes are not sustained. The review also found that there may be “potential undesirable effects” from long-term use of non-sugar sweeteners, such as an increased risk of type 2 diabetes, cardiovascular diseases and mortality in adults. The WHO guidance applies to all people except those with preexisting diabetes. The review identified 283 studies, including both randomized controlled trials and observational studies. While observational studies can indicate an association with an outcome, they cannot show direct cause and effect. The WHO said the recommendation is “conditional” because the link between non-sugar sweeteners and disease outcomes is less certain.
The WHO recommendation applies to artificial and naturally occurring non-sugar sweeteners, such as acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia, and stevia derivatives. The WHO included not just artificial non-sugar sweeteners in their list, but also naturally occurring ones such as stevia. Low-calorie sugars and sugar alcohols, such as erythritol, are not considered non-sugar sweeteners. A recent study found that erythritol was linked to a higher risk of heart attack, stroke and early death. The authors of this study said the results are concerning because non-sugar sweeteners are often marketed to people with type 2 diabetes, obesity and existing cardiovascular disease — all of whom are at higher risk of future heart attack and stroke.
The WHO advises that individuals can retrain their taste buds by weaning themselves off sugar substitutes and replacing them with “natural sugars found in fruits and vegetables, and with unsweetened beverages.” If individuals want to cut back on their intake of non-sugar sweeteners, they should not go “cold turkey.” Instead, they should slowly wean themselves off. Individuals should also check the ingredient list on packaged foods and beverages to look for non-sugar sweeteners such as aspartame, sucralose, or stevia, as well as added sugars such as high fructose corn syrup and cane sugar. It is advisable to opt for whole, minimally processed foods whenever possible and to cook meals at home to have greater control over ingredients.