Trust the facts, not the headlines: low-calorie sweeteners

While individuals may opt for low-calorie sweeteners in place of sugar for many different reasons, the most common is to cut calories from their diet. By consuming fewer calories than the body needs, people can achieve the desired weight loss; thus, any strategy and dietary tool that can help reduce energy intake can be helpful. So, by virtue of lowering the energy density of the foods and drinks in which they are used, low-calorie sweeteners can help decrease overall daily energy intake and thereby be a useful tool in weight management.

The overall impact of integrating lowcalorie sweeteners in the diet on body weight depends on the total amount of sugar and calories replaced. However, low-calorie sweetened foods can also possibly help weight loss efforts by improving compliance to the dietary plan, as they can help dieters feel less deprived by maintaining the desired sweet taste in a low-calorie diet.

What the science shows

The role of low-calorie sweeteners in weight management has been studied in many controlled clinical human studies that have consistently shown that lowcalorie sweeteners can help with weight loss or weight loss maintenance under real-life conditions, when used as part of a weight control programme. For example, in the most recent, long-term study with over 300 participants, people who used low-calorie sweeteners while in a weight loss programme followed by a year-long weight maintenance programme had better results. In terms of effects on body weight, participants drinking low-calorie sweetened beverages had a mean weight loss of 6.21 ±7.65kg versus 2.45 ±5.59kg for the control group, at the end of the follow-up period.

Contrary to the consistent findings from human clinical trials, observational and animal or experimental studies show conflicting results, with some suggesting that low-calorie sweeteners may be linked to weight gain or compromise weight loss by increasing appetite and food intake. While all types of studies are important in examining effects of diets, certain foods, nutrients, and food ingredients such as low-calorie sweeteners on body weight, a causeand- effect relationship in humans can only be established by well-designed, randomised controlled trials, which consistently show a modest benefit in weight control with the use of low-calorie sweeteners.

See the benefit

While calorie reduction is a key objective in times of an obesity epidemic, the use of low-calorie sweeteners in place of sugar in foods and drinks is equally important for good dental health. Unlike sugars, lowcalorie sweeteners have no cariogenic effect as they cannot be fermented by oral bacteria, and therefore, they do not contribute to tooth decay. Thus, replacing sugar with low-calorie sweeteners in products, such as table-top sweeteners, chewing gums, candies, drinks and dairy products can have a great benefit to dental health.

Another key benefit of low-calorie sweeteners, when compared with sugars, is that they do not affect blood glucose and insulin levels after consumption. This is based on strong evidence from clinical studies that have been reviewed by the European Food Safety Authority (EFSA) in 2011, and recently by several systematic reviews and meta-analyses, which all confirm that low-calorie sweeteners do not affect glucose control. Reviewing the collective evidence, EFSA confirmed that consumption of foods containing intense sweeteners instead of sugar induces a lower blood glucose rise after their consumption compared with sugarcontaining foods. Furthermore, several health organisations around the world such as the American Diabetes Association and the Diabetes UK support that low-calorie sweeteners may be recommended to people with diabetes.

Low-calorie sweeteners can be a significant aid to people with diabetes who need to manage their carbohydrate and sugar intakes but still want to enjoy a good tasting diet. There should be no expectation that low-calorie sweeteners, by themselves, would decrease blood glucose levels as they are not substances that have pharmacologic-like effects. However, low-calorie sweeteners can provide people with diabetes with wider food choices and satisfy their cravings for sweet taste without contributing to raised blood sugar levels or increased insulin needs.

By the numbers

In practice, by replacing sugar with low-calorie sweeteners in foods and drinks, we can reduce the caloric and sugar content in the final product. Depending on the type of the reformulated product and the amount of sugars that are being replaced and removed, the food industry can achieve substantial decreases in the energy density of the final food or drink.

For example, in beverages, a diet or light soft drink contains less than one calorie, compared with a sugarsweetened soda drink that provides about 100 calories per glass (140 calories per can of 330ml). In other food groups, such as in dairy products, ice cream and some desserts, the energy and sugar reductions are also important, leading to savings of 50 calories or more per portion. In general, recent reviews have concluded that replacing sugar with low-calorie sweeteners can achieve the greatest magnitude of sugar and energy reduction in a number of foods including beverages, table-top sweeteners and dairy products, and thus it is one of the most successful techniques for sugar reduction as they provide the sweet taste desired by consumers without added calories.

Getting back to the consumer perspective, a wide range of low-calorie sweetened foods and drinks can be helpful to people who wish to manage and reduce their calorie and sugar intakes, when used in place of sugarsweetened foods and as part of an overall healthy and balanced diet.

Unravelling the myths

When it comes to nutrition science, it is critical to look beyond the headlines, to evaluate the totality of the available science and to trust the reports of credible voices such as of health, scientific and regulatory organisations. This is also largely the case for lowcalorie sweeteners and the myths around their use. While low-calorie sweeteners cannot be expected to act as a silver bullet and cause weight loss by themselves, they can help reduce overall daily calorie and sugar intake and thus contribute to weight loss efforts, better glucose control and good dental health, as long as they are consumed alongside an overall high-quality diet.