2 major health organizations give nod to noncaloric sweeteners

Physicians should consider encouraging overweight patients to swap their sugary beverages and foods for products that contain nonnutritive sweeteners such as aspartame and saccharin, a report said. Doing so could help people reach and maintain a healthy weight by reducing their calorie consumption, said a scientific statement by the American Heart Assn. and American Diabetes Assn.

However, data show that this approach is effective only if people continue to regulate the amount of sugars and calories they consume throughout the day, according to the statement published online July 9 in the journals Circulation and Diabetes Care.

“If you choose a beverage sweetened with nonnutritive sweeteners instead of a 150-calorie soft drink but then reward yourself with a 300-calorie slice of cake or cookies later in the day, nonnutritive sweeteners are not going to help you control your weight because you added more calories to your day than you subtracted,” said Christopher Gardner, PhD, chair of the group that wrote the statement.

When added to a balanced diet, nonnutritive additives can help control glucose levels in patients with diabetes who have trouble giving up sweet foods and beverages, the statement said. Unlike caloric sweeteners, the sweeteners don’t increase blood glucose levels.

Despite the potential short-term gains, there are insufficient data to determine the long-term health benefits of nonnutritive sweeteners, according to the scientific report. High intake of dietary sugars contributes to cardiovascular disease, obesity and type 2 diabetes. The AHA recommends that most women consume no more than 100 calories per day from added sugar, and no more than 150 such calories a day for men.

A committee of health professionals affiliated with the AHA or ADA reviewed about 58 studies and reports on nonnutritive sweeteners published between 1988 and 2012 (link).

The committee focused on six additives: acesulfame-K, aspartame, neotame, saccharin, sucralose and stevia. The first five are regulated as food additives by the Food and Drug Administration. The FDA has not made a determination as to the “generally recognized as safe” status of stevia, the committee said.

The six substances have a higher intensity of sweetness per gram than caloric sweeteners, and they are added to products in smaller quantities. Such additives often are used in diet desserts, soft drinks and yogurt.

The committee’s goal was to determine whether there were adequate data to offer guidance on the use of nonnutritive sweeteners. The safety of the additives was not assessed.

“Smart use of nonnutritive sweeteners could help you reduce added sugars in your diet, therefore lowering the number of calories you eat,” said Gardner, associate professor of medicine at the Stanford Prevention Research Center at Stanford University School of Medicine in California. But, he added, this is just “a small step. It’s not the answer to the obesity epidemic. You can’t make health food out of junk food by taking out the sugar.”

Gardner recommends that doctors continue to advise patients to eat more fruits, vegetables and whole grains and drink water.

The American Medical Association’s House of Delegates approved policy in June that urges the AMA to advocate for studies on the effects of long-term consumption of noncaloric sweeteners in beverages. The policy also said taxing sugar-sweetened beverages is one way states and communities can finance much-needed obesity prevention programs and obesity education campaigns. Revenue from such taxes primarily should be used for programs designed to treat obesity and related conditions and for research into population health outcomes that might be affected by the taxes, the policy said.