The World Health Organization (WHO) has released a new guideline advising against the use of non-sugar sweeteners (NSS) for weight control, except for individuals with pre-existing diabetes. The recommendation is based on a systematic review that found no long-term benefit in reducing body fat in adults or children through NSS use, and potential undesirable effects, such as increased risk of type 2 diabetes, cardiovascular diseases, and mortality in adults.
WHO Director for Nutrition and Food Safety, Francesco Branca, emphasizes that NSS are not essential dietary factors and have no nutritional value. Instead, people should reduce the sweetness of their diet altogether, starting early in life, to improve their health. The recommendation applies to all synthetic and naturally occurring or modified non-nutritive sweeteners that are not classified as sugars found in manufactured foods and beverages or sold on their own to be added to foods and beverages by consumers.
Notably, low-calorie sugars and sugar alcohols (polyols) are not included in the recommendation and are considered to contain calories and are hence not considered NSS. The WHO has assessed the recommendation as conditional, indicating that policy decisions based on this recommendation may require substantive discussion in specific country contexts.
The low-calorie food and beverage industry represented by the Calorie Control Council (CCC) disagrees with the new guidelines. CCC President Robert Rankin points out that a substantial body of evidence supports the safety and effectiveness of low- and no-calorie sweeteners in reducing sugar and calorie consumption, alongside exercise and a healthy diet.
The International Sweeteners Association also believes that the WHO’s conclusions are largely based on low-certainty evidence from observational studies, which are at high risk of reverse causality. They argue that low/no calorie sweeteners continue to offer health benefits in reducing obesity, diabetes, and dental diseases.
While studies show potential links between artificial sweetener intake and increased cardiovascular disease risk, they demonstrate association and not causation. On the other hand, a recent study published in Nature found that high consumption of sucralose lowers activation of T-cells, an important component of the immune system, in mice, potentially leading to new therapies for patients with autoimmune diseases in the future.
Nonetheless, the WHO’s recommendation against NSS use for weight control highlights the need for people to reduce the sweetness of their diet and consume foods with naturally occurring sugars, such as fruit, or unsweetened food and beverages instead.