What we know—and don’t—about non-nutritive sweeteners
Here’s what’s known about the safety of these sweeteners and their effect on weight, appetite, and the risk for type 2 diabetes.
PRACTICE RECOMMENDATIONS
› Advise patients who are trying to lose weight that non-nutritive sweeteners (NNSs) are not beneficial for weight loss. A
› Reassure patients that NNSs do not appear to cause, or increase the risk of, developing type 2 diabetes mellitus. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Other lines of investigation, including animal studies, have shown that long-term use of NNSs is associated with numerous metabolic derangements including weight gain.21 The negative effects of NNSs appear to be the greatest in males and those who are obese and have high-calorie diets.21
A 2017 meta-analysis concluded that evidence from RCTs does not support a benefit of NNSs on weight management, and that routine consumption of NNSs may be associated with increased body mass index (BMI) and cardiometabolic risk.22 Another systematic review and meta-analysis found that there was a higher pooled risk for obesity among those who drank beverages containing NNSs vs those who drank sugar-containing beverages.23
Based on the most current literature, we conclude that NNSs are not beneficial for weight loss. While there is concern about weight gain through psychological effects (stimulation of sweetness receptors without satiety), further well-designed research is needed to explore whether this concern has merit.
WHAT IS THE EFFECT OF NNSs ON APPETITE?
There appears to be no effect. While original studies seemed to indicate there was an effect, later studies leaned to the contrary.
The notion that NNSs might enhance appetite and food intake was advanced in the 1980s by John Blundell and his research team.24 The hypothesis was that since NNSs uncouple sweet taste and calories, they do not exert the normal post-ingestive inhibitory influence that real sugar does. This, in turn, disrupts appetite control mechanisms.25-27
Continue to: However, subsequent research studies...
