Sugar is sweet and so are you: just how safe are low-calorie sweeteners?

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Sweetener vs Sugar

Dr Robert Lustig, who is probably the sugar industry’s public enemy #1, says that about 80% of the processed foods and beverages that fill most of the shelves in the food aisles in US supermarkets contain added sugars in some form or another http://www.uctv.tv/shows/The-Skinny-on-Obesity-Ep-1-An-Epidemic-for-Every-Body-23305

This focus by industry on sugar sweetened foods and beverages is proof enough that we love sweet things. In fact, some scientists even say that sugar is physiologically addictive. And so if we love sweet foods and beverages, and yet we know that  sugar is not good for us, what are we to do?

Low-calorie sweeteners

Fortunately for those of us with a ‘sweet tooth’ this question has received lots of attention from the food and beverage industry. They have been quick to capitalise on growing market opportunities created by ‘Bad Sugar’. The food and beverage industry has created synthetic compounds, or they identified natural sweeteners, that are able to fool our taste receptors into perceiving that whatever it is we are eating or drinking is sweet.

The common collective noun for these sweetening agents is ‘Artificial Sweeteners’, which is a bit of a misnomer as not all of the compounds lumped under this heading are produced synthetically. Some, like Stevia, occur naturally, although most of those in use today are ‘man made’. For this reason terms like ‘low-calorie sweeteners’ (LCS) or  ‘intense sweeteners’ (IS) rather than the term artificial sweeteners are often used in the scientific literature.

Does ‘natural’ always mean good for us?

It’s a common misconception that natural = good. Take the element Arsenic for example; it occurs naturally in many minerals and yet is a deadly poison, even in very small amounts. On the flipside of the good/bad coin, not everything man made is bad for us, even if the label ‘good for me’ can’t be necessarily applied. LCS may fall into the this category. However, many will know that LCS have received quite a bit of bad press in recent times. Statements like ‘cause cancer’ or ‘cause obesity’ are sometimes made about LCS. But what is the collective voice of nutritional science really saying about the possible benefits or harms associated with consuming LCS?

What does the research say?

Nutritional studies are notoriously difficult to get to grips with because the dietary habits of a large group of people have to be studied over a fairly long time. And even then this is not enough. We need to be sure that the information people provide about what they eat and drink is accurate. And still this is not enough to satisfy scientific criteria. Scientists have to ‘control’ for all possible ‘confounders’, which in plain language means account for the possible effects of  any other food and beverage consumed, any medication used, the existing health conditions of study participants, their age, gender, ethnicity, etc.

Only then can scientists be reasonably sure that whatever food or ingredient that has been studied, may be responsible for any observed effect. When it comes to observational studies we are often only able to point to association and not to causation. In science ,being associated with does not always mean being the cause of.  However, this is not a hard and fast rule as some observational studies do point to causation with a great degree of confidence, as is the case with smoking tobacco and developing lung cancer.

Are low-cal sweeteners bad for us?   

The scientific answer to this question is currently weighted in favour of No. However, the No is carrying a ‘Maybe’. This does not appear to be particularly helpful, you might say. In an attempt to resolve the problem of ambiguity in observational nutritional studies,  scientists may rely on a method of analysing research data known as Systematic Review. Researchers, using this methodology, pool the data from a number of studies that satisfy certain predetermined criteria. This is done in an attempt to ‘level the playing fields’ so to speak.

In an effort to help you decide for yourself about to the important LCS benefit vs harm question, I took a look at a recent  Systematic Review entitled ‘Review of the nutritional benefits and risks related to intense sweeteners’, which was published in 2015 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590273/.

The review included more than 10,000 studies that the authors believed could shed light on any possible health benefits and risks to adults and children for the following LCS, which are authorised for use in Europe:

  • Aspartame
  • Acesulfame potassium,
  • Cyclamic acid and its salts (e.g. Sodium cyclamate)
  • Steviol glycosides (e.g. Stevia)
  • Saccharine
  • Sucralose

The following key findings were made by the authors of the review:

  • No beneficial effects, for either adults or children,  were shown to arise from the regular consumption of LCS. Importantly, LCS do not aid in preventing chronic diseases of lifestyle such as obesity or Type 2 diabetes.
  • The occasional use of LCS were not associated with any health risk in either adults or children.
  • The lack of comprehensive research data meant that “…certain risks in the event of regular prolonged consumption…particularly in beverages” could not be discounted.
  •   “It should be recommended that artificially-sweetened and sugar sweetened soft drinks shall not be consumed as a replacement for water.” 

  As is often the case, we need to take a balanced but informed approach in assessing any possible health benefits or risks associated with what we eat and drink. With this in mind, I am reminded of something that Dr Richard Bernstein, and expert on diabetes, once said to me when I asked him the question: “In your opinion are  LCS safe to use?”. His answer: “I know that many people die each year from the complications of diabetes fuelled by consuming too much sugar, but I have never heard of anyone dying from drinking Diet Coke”.

For me that says it all.

I am Dr Peter Hill for UpForIt

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