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
However, subsequent research studies found no relationship between the use of NNSs and appetite.28-30 Mattes and colleagues hypothesized that such a difference in findings could result from the fact that earlier studies focused on isolating NNSs from other energy-yielding products, which emphasized an association with heightened hunger.29 Subsequent studies showed that when NNSs were incorporated into energy-yielding products, there was no association between NNSs and increased hunger or appetite.
DO NNSs INCREASE THE RISK FOR TYPE 2 DIABETES MELLITUS?
The data are mixed. One study of women participating in the Nurses’ Health Study II showed that those who consumed caffeinated, artificially-sweetened beverages had a 35% higher risk of developing type 2 diabetes mellitus (T2DM); however, this risk was no longer significant after adjusting for BMI and energy intake.31
The Health Professionals Follow-Up Trial studied more than 40,000 men for more than 20 years and found that NNS consumption increased the risk of developing T2DM by 40%.32 However, this finding lost statistical significance after adjusting for BMI.32
These results make it difficult to determine whether there is any association between NNSs and T2DM; rather NNS-containing beverages are likely consumed more often by those who have higher BMIs and by those trying to lose weight.
A 2017 randomized crossover study involving 10 healthy men looked at the effects of a variety of caloric and non-caloric sweeteners on 24-hour glucose profiles and found no differences.33 Another study, a randomized, double-blind, crossover trial involving 60 non-obese adults without diabetes who did not consume NNSs, randomized the participants one-to-one to drink either 2 cans per day of either a beverage containing aspartame and acesulfame K or an unsweetened, no-calorie beverage for 12 weeks.34
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