ACP InternistNonsugar Sweeteners Should Not Be Used for Weight Loss, WHO Guideline States

Rethinking Nonsugar Sweeteners: A Health Asset or Liability?

The World Health Organization’s (WHO) latest guideline reveals that nonsugar sweeteners (NSS) may not contribute to weight control or reduction of noncommunicable diseases, casting doubt on common beliefs about these popular sugar substitutes.

Key Points:

• The WHO, citing low certainty evidence, found no support that short-term use of NSS affects body weight or other adiposity measures, and noted potential long-term undesirable effects.
• A systematic review showed no long-term benefit from NSS use in adults or children, and potential undesirable effects from long-term use include increased risk of type 2 diabetes, cardiovascular diseases, and mortality.
• NSS resulted in short-term reduced sugar and energy intake, lower body weight, and lower BMI, but had no significant effect on other body fatness or cardiometabolic health markers.
• Trials did not directly measure the effects of replacing free sugars with NSS.
• Evidence linked higher intake of NSS with higher BMI and an increased risk of obesity, type 2 diabetes, cardiovascular disease, and all-cause mortality over long-term follow-ups.

Additional Points:

• NSS use showed no difference in overall cancer incidence or mortality.
• NSS, predominantly saccharin, was associated with increased risk of bladder cancer.
• The guideline advised reducing free sugars to improve dietary quality, preferring natural sweetness sources, such as fruits, over NSS.

Conclusion:

• The WHO’s guideline discourages including NSS in the diet and urges policy and action, including behavior change interventions, fiscal policies, marketing regulation, product labeling, and manufactured product reformulation.

Did You Know?
Nonsugar sweeteners, though widely used as sugar substitutes, vary greatly in their sweetness, with some being up to 13,000 times sweeter than common table sugar.