Just say no to sugar substitutes for better health

Published on Thursday, June 1, 2023

By: Andrea Wright Dilworth, awdilworth@umc.edu

If you’re among the millions who regularly opt for non-sugar sweeteners in beverages and desserts because you think they help keep unwanted pounds at bay, think again.  

The World Health Organization warns that while NSS – chemically synthesized substances -- may help you lose weight in the short term, they should not be used indefinitely.  

Not only are sugar substitutes not effective at maintaining weight loss, but long-term use could result in an increased risk of type 2 diabetes, cardiovascular diseases and even death.  

Because the sweeteners are widely available under so many names and commonly used in every age group regardless of health goals – some buy NSS products not to lose weight, but because they prefer its sweetness to that of real sugar – the WHO recommendation has far-reaching implications.  

Introduced to the food industry in the 1800s, artificial sweeteners first saw a huge boom in popularity at the beginning of this century. Estimates suggest that in just one year -- between 1999 and 2000 -- the consumption of artificial sweeteners by children and adolescents increased by roughly 200 percent and 54 percent in adults. About 25 percent of children and 41 percent of adults consumed artificial sweeteners at least once per day between 2009 and 2012. 

Rebecca Turner, a registered dietitian in the Department of Preventive Medicine’s Lifestyle Medicine Clinic, is not surprised by the WHO’s new recommendation or its suggestion there is no difference in health benefits between a regular soda and a diet soda.  

“Both are processed foods, providing zero nutritional value,” said Turner. “The WHO’s findings finally acknowledge what health care professionals working in preventive medicine have long understood: that when it comes to chronic diseases such as heart disease and diabetes, sugar is not always the only factor.” 

Dr. Josie Bidwell, associate professor and lifestyle medicine clinician in the Department of Preventive Medicine, adds that while we tend to be more worried about sugar, there is no one “bad” food we should be avoiding. 

“Simply swapping in an NNS for sugar is highly unlikely to produce meaningful health improvement in the long-term,” said Bidwell.  

While it’s still OK to use NSS occasionally, such as an infrequent carbonated beverage, they should not be part of your daily diet.  

It’s also important to note that sugar substitutes are usually 200 to 700 times sweeter than real sugar, said Bidwell.  

“So as a strategy to ‘get off’ sugar, they often aren’t successful. People will still crave hyper-sweetened items as their palate gets used to this level of sweetness. This may make moving from NSS sweetened items to naturally sweetened items like fruit even harder.” 

If you’re concerned about preventing chronic disease and maintaining a healthy weight – two key reasons people use artificial sugars – a healthier option is to reduce the sweetness in your diet altogether. 

“Instead of worrying about which sugar substitutes to avoid, people should focus on replacing foods sweetened with NSS with the whole food, unsweetened form,” Turner explained.  

For example, instead of NSS-sweetened light yogurts, try plain nonfat yogurts and add fruit yourself. Instead of oatmeal flavored with sugar substitutes, try plain oats and add in whole foods like fruit and nuts for flavor and texture. Instead of snack foods with NSS, consider whole fruits and trail mixes.  

The guideline is not all inclusive. Those with pre-existing diabetes are an exception to the recommendation, according to WHO.  

Popular NSS names on the market include, but are not limited to, acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives.  

Because low-calorie sugars and sugar alcohols are derived from sugar and contain a small amount of calories, they are excluded from the warning. Their names on nutrition labels usually end in -ol, including sorbitol, xylitol or erythritol.  

Still, sugar alcohols come with their own side effects, including abdominal pain, bloating and diarrhea when consumed in high doses, said Bidwell.   

While Turner reiterates the new guideline doesn’t say we should avoid NSS at all costs, she said it is reason enough to rethink our relationship with sugar, and to avoid getting our children hooked in the first place.  

“A better approach is working to reduce the need for sweetness in the diet altogether, starting early in life,” Turner said. “Lessening our dependence on sweet tasting foods and beverages is the only solution to have a lasting impact on health. Removing NSS or spending countless recourses on discovering better alternatives without addressing the addiction to sweet tasting foods and beverages will not help better manage obesity, diabetes and dental diseases.” 

Added Bidwell: “My bottom line is that not everything needs to taste super sweet, and you shouldn’t be using enough added sugar or NSS that it really impacts your health in the long run.”

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