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Message: <blockquote data-quote="HSSS" data-source="post: 2608337" data-attributes="member: 480869">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.</blockquote>

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