Artificial sweeteners, also known as non-nutritive sweeteners (NNS), have been a subject of debate in the realm of health and wellness. Recently, the World Health Organisation (WHO) released an advisory that garnered significant attention and raised concerns about the use of artificial sweeteners.
Upon closer examination of the data and publication, however, there are several misconceptions and misinterpretations surrounding the WHO statement. We will delve into the topic of artificial sweeteners, address the WHO's recommendations, and provide a comprehensive analysis of the available evidence.
Artificial Sweeteners Don’t Help With Weight Loss?
The WHO advisory suggests that artificial sweeteners do not contribute to long-term weight loss. However, these findings were based on the data from cohort and cross-sectional observational studies, which suffer from many inherent limitations. These studies rely on self-reported NNS consumption without any dedicated intervention or lifestyle changes. The researchers then check back in on the participants many years later, and see if they lost or gained weight.
There are two big problems with this.
First, it is important to note that all long-term diets in general have horrible success rates, with a vast majority of individuals failing to lose weight, or regaining weight after. Why? Because change is hard, and most people are unable to sustain the strategies used. The same applies here to the use of NNS as a strategy for weight loss. The lack of weight loss observed in these studies may be attributed to the challenges associated with behaviour change, rather than the ineffectiveness of artificial sweeteners.
Second, multiple human randomised controlled trials (RCTs) have demonstrated weight loss and reductions in body mass index (BMI) with the use of artificial sweeteners, albeit over shorter durations. Human RCTs are generally much higher quality sources of evidence than observational studies with a much lower risk of bias and inaccuracy.
In these RCTs, where NNS is used as a substitution of sugar-sweetened beverages, the data clearly demonstrates that participants are able to achieve weight loss and improvements in BMI. This was evident even within the publication that the WHO based its guidelines on, so it is perplexing why the WHO advisory disregarded these high-quality RCTs in favour of lower-quality observational data.
Understanding the Relationship between Artificial Sweeteners and Diseases
The WHO advisory also suggests that people who consume artificial sweeteners are more likely to develop diseases such as diabetes, heart attacks, strokes, and are more likely to die in general. However, this association is likely to be largely attributable to reverse causality.
What this means is that individuals who consumed high amounts of artificial sweeteners (particularly in the mid-to-late 20th century) were often already attempting weight loss and were more likely to be obese or overweight. So the observed increase in disease risk can be attributed to their pre-existing risk of health conditions, rather than the artificial sweeteners themselves.
Overall, the data supporting the links between NNS and many diseases (particularly cancer) is inconsistent and weak.
Making Informed Choices Regarding Artificial Sweeteners
It is important to note that the WHO states that this is a "conditional recommendation" and that there is a need for better long-term data to make more definitive conclusions. Unfortunately, this nuance is lost in both the WHO's headlines and media coverage, leading to misinformation and misconceptions among the public.
The evidence supporting the negative outcomes associated with NNS is of "very low" or "low" quality as defined by the WHO themselves, highlighting the need for further research before drawing definitive conclusions.
When it comes to artificial sweeteners, it is important to approach the topic with an informed perspective. Blanket recommendations for everyone are inappropriate. Artificial sweeteners are by no means a magic weight-loss bullet and it is crucial to consider individual circumstances and health goals when deciding on their use.
If you are trying to lose weight, the highest-quality evidence available suggests that replacing sugar with artificial sweeteners is a perfectly viable option.
Weight loss itself is undeniably linked to improved health outcomes, particularly for those who are overweight or obese. If your goal is to lose weight or cut sugar from your diet, there is no reason to rule out the use of NNS.
For individuals that are not aiming for weight loss and that do not need to remove sugar from their diet for other health reasons, the role of artificial sweeteners may be less clear-cut. If you occasionally experience sweet cravings, choosing artificial sweeteners over sugar can be a favorable choice, especially taking into account your metabolic health or diseases like diabetes, fatty liver, or gout.
Nonetheless, it’s important to note that while current scientific evidence does not strongly support terrifying negative outcomes with artificial sweeteners (as implied by the WHO recommendation and surrounding media coverage), this does not rule side effects out completely. Ongoing research is needed to gain a deeper understanding of their potential effects, with recent research also demonstrating potential impacts on gut microbiome.
Ultimately, making the best choices regarding sweeteners, whether natural or artificial, involves a balanced approach that considers personal preferences, health goals, and disease risk profile. Consulting with healthcare professionals or registered dietitians can provide personalised guidance based on your specific needs and goals, ensuring you make the best choice on your health and wellness journey.