Long-term harm by use of artificial sweetners not ruled out- Study reaffirms WHO Advisory

India: Non-sugar sweeteners (NSS) could be an attractive replacement for sugar in people with obesity/overweight in the short-term, but long-term harm cannot be fully rejected, a recent study by Indian researchers have shown. The researchers recommended restricting consumption of non-sugar sweeteners in adults without diabetes, whenever possible, in their review published in Diabetes & Metabolic Syndrome: Clinical Research & Reviews.

Awadhesh Kumar Singh, Sun Valley Hospital & Diabetes Research Centre, Guwahati, Assam, India, and colleagues deciphered the WHO recommendations on non-sugar sweeteners and health outcomes in adults without diabetes in the Indian context. 

Non-sugar sweeteners are widely used as a replacement for sugar to reduce excess energy intake. The 2022 WHO meta-analysis which assessed the health outcomes of non-sugar sweeteners is the most robust and critically analyzed document available to date. Despite the absence of any strong conclusion that suggests NSS consumption increases the cardio-metabolic disorders risk, no firm evidence also rejects this statement.

The researchers suggest avoiding sugar consumption and restricting intake of non-sugar sweeteners wherever possible until long-term studies confirm or refute these findings.

Dr Anoop Misra at C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India, and author of study told Medical Dialogues "Aspartame is an artificial (chemical) sweetener widely used in various food and beverage products since the 1980s, including diet drinks, chewing gum, gelatin, ice cream, dairy products such as yogurt, breakfast cereal, toothpaste and medications such as coughdrops and chewable vitamins. Acceptable daily dose of Aspartame is 0-40 mg/kg while one can of sweetened drink has 200-300 mg. Although Three trials show its association with liver cancers experimental evidence is limited. Depite association of Aspartame with cancer risk is not definite it should better be avoided.Based on current evidence all artificial sweetners, except perhaps stevia, should be stopped in all patients, especially for those with heart disease."

The WHO had conducted a systematic review and meta-analysis to assess the health outcomes of non-sugar sweeteners in RCTs (randomized controlled trials) and PCSs (prospective cohort studies) and reported conflicting findings. Dr. Kumar Singh and colleagues aimed to decipher these conflicting findings in RCTs and PCSs by critically reviewing their results. They compared them with previous meta-analyses, and provided a simplified interpretation including the Indian perspective. 

They critically reviewed the e 210-page dossier of WHO including the full text of most of the key studies of NSS included in the meta-analysis and they then compared it with previous meta-analyses to identify differences and similarities to address a few key questions pertaining to health outcomes associated with NSS use in adults.