WHO releases conditional advice regarding non-sugar sweeteners

Interesting read. Fundamentally it seems to be saying evidence for the advice is generally low to very low but generally advise against their use - in favour of simply reducing free sugars in the diet.

NSS (non sugar sweeteners - which doesnt include polyols/sugar alcohols btw) aren’t a magic solution. The focus of the report is on weight/body fat. They only help that short term if they actually replace higher energy alternative like sugar rather than are eaten as a “healthy” extra in addition to usual energy intake. The evidence is poor that they help weight long term and may even make it worse. There’s a fair bit of discussion about how other factors might influence these outcomes (which NSS, how it’s used, other dietary factors, pre-existing risk factors effecting who uses them etc etc)

Importantly on this forum, there is specific exception in this advice to people with diabetes as that was outside of the scope of the recommendations beyond reducing free sugar consumption is an approach open to diabetics. And any studies used excluded pre existing diabetes. It did however claim NSS may contribute to the development of Type 2.

“Long-term NSS use was associated with increased risk of type 2 diabetes, cardiovascular diseases (CVDs) and mortality in prospective cohort studies conducted in adults. However, significant effects were not observed on intermediate markers of disease such as fasting glucose, fasting insulin or blood lipids when assessed in short-term RCTs.”

Now that to me is contradictory. Elsewhere it does give very low to low rating of the evidence for that claim. There seems little explanation for this in the report. They do largely dismiss weight as a confounder (yet don’t all at the same time)

“However, in the majority of studies, particularly for type 2 diabetes, associations persisted in some way in fully adjusted models after sensitivity and other exploratory analyses. Since associations largely persist when body weight is controlled for, and there is limited evidence for an effect of NSS on incident obesity (48, 49), it is possible that increased body weight (resulting from chronic NSS use) may be an intermediary step in the development of disease rather than a confounding factor.”

and also largely dismiss whatever else is being eaten without being specific what a quality diet looks like (eatwell/SAD level of carbs other than sugar anyone?)

“Overall dietary quality has also been cited as a potential confounder. However, there was no consistent difference between levels of NSS use and diet quality at baseline in the studies included in the systematic review (i.e. diet quality was not consistently lower, higher or equivalent in individuals using more NSS compared with those using less), and many studies controlled for dietary quality without a significant impact on the observed associations.
It was concluded that, although reverse causation and residual confounding may be contributing factors, the available evidence suggests that the associations observed between NSS use and health outcomes in observational studies cannot be dismissed as being solely a result of reverse causation or residual confounding.”

There is no discussion how NSS might raise the risk of type 2 in light of the fact they don’t effect fasting glucose or insulin and that to me is rather important to consider given the very low rating of the evidence.

HSSS said:

There is no discussion how NSS might raise the risk of type 2 in light of the fact they don’t effect fasting glucose or insulin and that to me is rather important to consider given the very low rating of the evidence.

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Some years ago, I read a study which was saying, for some people, NSS can trick more than just to tastebuds into thinking it is sugar,
Apparently, there have been cases of people experiencing hypos from eating NSS as their body releases insulin in response to the fake sugar.

Sadly, I cannot find this study now but it stuck in my memory.

In Response said:

Some years ago, I read a study which was saying, for some people, NSS can trick more than just to tastebuds into thinking it is sugar,
Apparently, there have been cases of people experiencing hypos from eating NSS as their body releases insulin in response to the fake sugar.

Sadly, I cannot find this study now but it stuck in my memory.

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This does discuss the effects on sweet sensors elsewhere than in the mouth. But it also says there’s no change to glucose and insulin. Confusing.

I’ve certainly read about an encephalitic induced insulin response (ie the body expects sugar because of the taste and releases insulin as a result). Presumably not type 1 as they don’t have the insulin to release in most cases (eta past the honeymoon stage)

This paper may be relevant to this discussion

And another one

PS I think T1D in honeymoon period may see some effect for a while.

Yes, very interesting.And, yes, not sure how this adds up for non-diabetic yet sweet toothed souls trying to navigate the world of food and drink out there. And this is about fat storage, and the effect of too much fat storage and disease. Nice that we type twos were exempted from this.

And bearing in mind, how many people out there are very attached to food and drink products that have sugar in it. And just the enormous amount of sugar in food and drink products. And the type two diabetes epidemic is being called a tidal wave/tsunami. Hmmmmm.

So is what is good for us with too many sick fat cells, not good for the general public? Regarding weight loss. So says WHO, interestingly.

And that sugar could very well, ought to be called out more for it, perhaps, be addictive in the purest sense of the world. Not mentioned. Hmmmm.

Anyway. I think about this in regards to children - does one give them sugar sweetened products or stevia sweetened products? And I have been on the side of stevia, because, as far as I know, stevia is not addictive. But I am no expert. (I have never groaned with pleasure eating any of the foods I have sweetened with steiva. Not so with sugar. But I am just one human.) Meanwhile, Childhood obesity is a huge and getting huger issue, and very pertinent with regards to later disease, as we know, which is related to those sick fat cells and too much glucose for the cells, ie insulin resistance. For me it's cut down on the sweetener, and use stevia, when feeding children in my own life. But this is contrary to what WHO is saying. Hmmm. And sugar and its effect on dental decay. Since I have cut sugar down enormously so have my cavities. And that is with stevia replacing sugar in my baked goods and ice cream when sweetener is called for. Which is a general response - nothing to do with having a shonky blood glucose system or not. ie what is good for me there for my teeth is for non-diabetics too. But this study is just focussing on sugar and its effect on weight.

I am still thinking about this. I don't know how this is a good call in this day and age, where sugar is far too much far too everywhere in food and drink. And the fact that it is toxic in its dose, not mentioned enough. And by WHO, even, it seems.

I'm in one of the fattest countries in the world, with too many fat children, and a very high and increasing type two diabetes rate. I cannot see how telling folks to eat more fruit for natural sweeteners, rather than do something about those high levels of potentially toxic sugar in so much of the food and drink, can be a good move right now. And I am deliberately saying this in a understated way.

The sugar industry must be delighted with this study.

Personally I thought it was a rubbish report, since it could not separate the wheat from the chaff. there are so many confounders that could not be isolated, and so their conclusions are basically finger in the air decisions. The main confounders are that many people who turn to NSS are doing so because they are overweight or obese, which has its own comorbidities associated. They could not account for diet influences on health either.

Yep agree here too. my first sentence in my earlier identifies they admit how low the evidence is.

AloeSvea said:

in regards to children - does one give them sugar sweetened products or stevia sweetened products?

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Neither. Both encourage them to like sweet foods.

Hi @CatsFive. My understanding is one doesn't need to encourage anyone to like sweet foods - it's part of our species. We have evolved to like sweet, because back in the pre industrial day if we came upon a berry bush, or a beehive with honey - it would do wonderful things for us to get comfortable and consume that sweet loveliness! And how different are we today? Not. But it isn't berries in season, that involves work to get to, but sweeties in packets in the supermarket and convenience store, and, all the huge quantity of foods with sugar added. One personally does not need to encourage, or prevent (I had a girlfriend at school whose mother didn't let her eat sweets - um! That didn't work so well.) So it's about navigation? I would suggest. Helping kids make choices amongst their choices, and better choices. For me - that's stevia over sugar. Because I know stevia doesn't raise blood glucose, or minimally. But this is a big health issue for sure.

plantae said:

@AloeSvea other industries are probably looking closely as well. Australia has a health star rating system where manufacturers can optionally put a health star rating from 0.5 stars (not so healthy) to 5 stars (great) on product packaging to help consumers make healthy choices. Recently they changed the algorithm for rating fruit juices and now, for example, orange juice gets 2.5 stars (previously it was 4.5) because of the natural sugars. Soft drinks sweetened with NSSs get a higher rating — usually 3.5 stars. Many juice producers are now not putting the voluntary star ratings on the packaging at all. I think if I was a parent I’d prefer my child to have a small orange juice rather than a coke zero sugar, but the star ratings are, in my opinion, confusing (e.g. a dairy based liquid breakfast drink with the same carbs and roughly the same amount of lactose as juice has fructose, and sweetened with NSSs gets 5 stars… I can’t work it out)

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Yeah. I see fruit juice consumption as hugely dangerous for me personally. A very big deal in my poor old body's blood glucose breakdown. I was brought up with the 'fact' that we needed fruit juice for vitamin C, and that was my own attitude in feeding my own children, as I too had been fed. Sigh. Now my adult kids know how I see fruit juice, and it would never be on my table for my as yet merely postulated grandchildren.

AloeSvea said:

Yeah. I see fruit juice consumption as hugely dangerous for me personally. A very big deal in my poor old body's blood glucose breakdown. I was brought up with the 'fact' that we needed fruit juice for vitamin C, and that was my own attitude in feeding my own children, as I too had been fed. Sigh. Now my adult kids know how I see fruit juice, and it would never be on my table for my as yet merely postulated grandchildren.

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We moved to Australia when my kids were in primary School. Fruit juice was cheaper there than the uk and I thought it was good for them (then!). Within a year they showed early signs of tooth decay that they didn’t have before - or after as the juice was promptly swapped for water. Juice became a very rare occurrence when eating out instead. Vitamin c came from whole fruit and veg instead.

Yes @HSSS - agreed. I am very sad now that my mother did not take to breastfeeding, for instance, but preferred to pop some ribena in my baby bottle and put me in my crib. We have discussed it at length now, and I totally get that my parents just did not know, or did not think it through, as I did not think the logic through when the big fat is evil and whole grains are good thing came about in the late 70s where I was living. People trusted food manufacturers, I know I did, and we trusted - egads to say it now - our politicians who told us what was healthy and what wasn't and got us to change what we had been eating. Do so at your own peril, my rooted blood glucose system says, loudly.

Which is where I am at with this NSS thumbs down. Where stevia and aspartame are put to the same test. It defies logic.