A succesful formula

Consumer interest in healthier foods and an overall improved diet has never been higher. At the same time, obesity rates and obesity-related diseases continue to rise in children and adults. Among other strategies targeting this problem, there is a public health call to the food industry to contribute to the global effort to reduce the prevalence of obesity-related health diseases by reformulating products to provide healthier options that are lower in sugar, salt and saturated fat that also meet consumer demand. In order to achieve the sugar reduction goal, low-calorie sweeteners are a useful tool for manufacturers to help achieve products with less sugar and fewer calories, while still being palatable to consumers.

Low-calorie sweeteners and food reformulation

Health organisations globally, including the World Health Organisation (WHO), recommend that sugars should not provide more than 10% of our total energy (calorie) intake, which corresponds to 50g a day for a 2,000-calorie diet.

In practice, being hundreds of times sweeter than sugar, low-calorie sweeteners are used in minute amounts to confer the desired level of sweetness to food and drinks, while contributing little to no energy at all to the final product. This offers one major advantage to food and drinks as well as to table-top sweetener manufacturers and ultimately consumers – providing a sweet taste while eliminating or substantially reducing the calories in a food or drink when replacing sugars.

In Europe, the use of low-calorie sweeteners in a food or beverage, in almost all cases, must also result in a product that has a total energy reduction of at least 30% according to EU Regulation 1333/2008 on food additives. For consumers, this can mean a significant calorie saving, which may be especially helpful in managing overall energy balance (the balance between calories ‘consumed and burned’ during the day). A variety of food and drink products, including soft drinks, table-top sweeteners, chewing gums, confectionery, yogurts and desserts, can be sweetened with low-calorie sweeteners, in line with local regulatory requirements.

Ensuring the safety of sweeteners

When food manufacturers consider food reformulation for their products, food safety is the number one priority. The use of low-calorie sweeteners in foods and drinks is safe, as consistently confirmed by regulatory food safety agencies around the world.

Low-calorie sweeteners are among the most thoroughly researched ingredients globally. All approved low-calorie sweeteners have undergone a stringent safety assessment by food safety agencies around the world, including the Joint Food and Agriculture Organisation (FAO)/WHO Expert Committee on Food Additives (JECFA), the US Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA), which have consistently and repeatedly confirmed their safety.

Weight and glucose control

There is often confusion as to whether and how low-calorie sweeteners can help in weight management and glucose control for people with diabetes. When scientists or health professionals want to understand the impact of any food ingredient on weight and glucose control, they rely on human studies that examine these effects, and especially on well-controlled, randomised clinical trials. These types of studies consistently show that low-calorie sweeteners, when used to replace sugars and as part of a healthy diet, can help us reduce our calorie and carbohydrate intake, and in turn, contribute to weight loss or maintenance, and to better glucose control for people with diabetes.

Recently, a paper published in the British Medical Journal (BMJ) found that some studies did show benefits for weight control. However, they also concluded that more research was likely needed. This has been interpreted by some as meaning that the totality of the data does not support the benefits of low-calorie sweeteners in weight management, despite the fact that the studies comparing low-calorie sweetener intake to sugar intake suggested improvements in body mass index and fasting concentrations of blood glucose favouring low-calorie sweeteners, and that, among children, their intake led to a smaller increase in body mass index z-score versus sugar intake.

The study has been criticised by experts in this field, highlighting that this paper has many important limitations and considered only a very small proportion of the published research.

In response to the study commissioned by WHO, experts commented in the BMJ that, “Given global concern about continuing increases in prevalence of overweight and obesity, it is important that evidence about tools to reduce excessive weight is assessed appropriately.” Experts also pointed out that, “The conclusions [of the study] also conflict with consensus statements by several international scientific groups recommending the use of lowcalorie sweeteners.”

In relation to food reformulation, experts commenting in the BMJ article warned that, “Increasingly, reformulation of mass-market sweet products is the principal strategy for sugar reduction, in developing and developed countries alike,” and stressed that sugar reduction is urgent and “reformulation without sweeteners will not suffice”.

Dental health benefits should not be neglected

While not emphasised frequently, the role of lowcalorie sweeteners in oral health is very important. Unlike sugar and other fermentable carbohydrates of our diet, low-calorie sweeteners are not broken down by oral bacteria, and that is why they do not contribute to tooth decay.

Frequent and/or high consumption of sugars contributes to tooth demineralisation (loss of calcium and phosphate from tooth enamel leading to tooth decay), while “consumption of foods/drinks containing low-calorie sweeteners instead of sugar and as part of a varied and balanced diet and a healthy lifestyle may help maintain tooth mineralisation by decreasing tooth demineralisation”, said an authorised health claim by the EFSA in 2011.

Low-calorie sweeteners and sugar intake

Several recent studies have shown that lowcalorie sweeteners can help reduce overall sugars intake, in line with public health recommendations. In recent studies in the US and the UK that analysed data from the national nutrition surveys (the US National Health and Nutrition Examination Survey and the UK National Diet and Nutrition Survey, respectively), it was found that consumers of low calorie sweetened beverages had a better diet quality, lower free sugars consumption and higher chances to meet the recommendations to reduce free sugars intake.

Conclusion

Overall, scientists and experts around the world agree that low-calorie sweeteners do help reduce body weight when they substitute for sugar in the diet, but nobody should expect them to be a magic bullet and the single answer to the obesity epidemic, which requires a wide toolkit of strategies. Experts know that causes for overweight and obesity are multifactorial.

Low-calorie sweeteners are also tooth-friendly ingredients and can help people with diabetes manage their sugar intake without causing a spike in blood glucose levels.

Taken together, the use of low-calorie sweeteners in food reformulation is useful in providing individuals with options that have less sugar and fewer calories, and thereby in supporting public health efforts to reduce excessive body weight and to promote calorie and sugar reduction.