Functions and Benefits
Energy Intake and Weight Management
Artificial sweeteners are classed as food additives which replicate the sweetness of sugar but without the addition of extra calories. For example, a recent systematic review and meta-analysis concluded that calorific sugar-sweetened beverages promoted weight gain in children and adults [6, 7]. For this reason, moderate use of artificial sweeteners may in part, assist in the reduction of total energy intake and facilitate weight loss or weight maintenance, if used in place of energy-dense options. Indeed, a systematic review concluded that whilst data suggested that artificial sweeteners may lead to clinically significant weight loss, these conclusions were based on a single trial . Equally, a recent meta-analysis investigating low-calorie sweeteners on body weight and composition found that substituting low-calorie sweetener options for their regular, more energy-dense versions resulted in a modest weight loss . Therefore, good quality long-term trials are required before definitive conclusions can be made.
Furthermore, it has been suggested that artificial sweeteners can interfere with normal homeostatic, physiological processes (e.g., altering taste and metabolic signaling). Indeed, it is possible that because blood glucose levels do not significantly alter with use of artificial sweeteners, hypoglycemia and a subsequent increase in food intake ensues, leading to a higher calorie consumption, weight gain and adiposity . However, a review of RCTs does not support this hypothesis .
Artificial sweeteners may play a role in dental health (i.e., prevention of dental caries) as they are non-cariogenic. In other words, they are not fermented by the oral microflora, unlike sugar and do not cause tooth decay. A recent systematic review and meta-analysis could not conclude whether or not xylitol-containing products can prevent tooth decay in infants, older children, or adults due to the low to very low quality evidence which was based on the small amount of available studies, uncertain results, and issues with the way studies were conducted . Equally, EFSA suggested that non-nutritive sweeteners may help maintain tooth mineralisation by decreasing the rate of tooth demineralisation .
Regulating blood glucose levels in those individuals with diabetes is important to prevent risk of diabetes-related health complications. Since artificial sweeteners are metabolised more slowly, replacing sugar with an artificial sweetener may help stabilise blood glucose levels over a longer period. This may also have particular relevance in those with reactive hypoglycaemia . EFSA also approved the health claim that non-nutritive sweeteners may help in the reduction of post-prandial glycaemic responses . Additionally, the use of non-nutritive sweeteners in those with T2DM may also help with weight loss or weight maintenance, thus facilitating good diabetes control. Current evidence-based recommendations for people with diabetes suggest artificial sweeteners are safe when consumed within the ADI .
Health and Safety
EFSA provides scientific analysis, opinion and recommendations to support policy development on food safety issues in the European Union (EU) . All artificial sweeteners used in the EU have undergone safety evaluation (e.g., toxicological testing) before being approved for use. The Joint Food and Agriculture Organisation (FAO)/World Health Organisation (WHO) Expert Committee on Food Additives (JECFA) and UK Government regulate and authorise the use of artificial sweeteners, providing food manufacturers with stringent guidelines on the maximum quantity of artificial sweetener that can be added to foods and drinks . As part of the safety and approval process, EFSA sets an ADI for each artificial sweetener. The ADI is an estimate of the amount of artificial sweetener (milligrams per kilogram of body weight) that can be safely consumed on a daily basis over a person’s lifetime without incurring health risks. From a safety perspective, the ADI includes a 100-fold safety factor. In other words, the ADI is calculated at one hundredth of the amount that may be safely consumed.
In the UK, it is a legal requirement if a food product contains Aspartame, it must be clearly stated on the label ‘Contains a source of phenylalanine’. Labelling is of particular importance for consumers with PKU; a rare genetic disorder in which the amino acid phenylalanine cannot be metabolized due to the deficiency of the enzyme phenylalanine hydroxylase. Phenylalanine can accumulate to harmful levels if not controlled with diet.
Foods Permitted For Use
Artificial sweeteners are permitted for use in a wide variety of foods and drinks in the UK including carbonated drinks, fruit juices, jellies, yogurts, desserts and ice cream, chewing gum and sweets and foods and drinks labelled as ‘sugar-free’ or ‘diet’.
Foods Not Permitted For Use
Artificial sweeteners are prohibited in some foods in the UK. For example, the use of sweeteners is prohibited in all foods for infants (under 12 months old) and young children (1-3 years old). This includes foods specifically prepared for infants and young children (i.e., ‘baby food’) .
From a consumer perspective, the safety of artificial sweeteners can be confused by mixed messages in the media. There continues to be on-going controversy regarding the use of artificial sweeteners and whether they pose a risk to health, more specifically, whether they play a role in the pathogenesis of cancer, lymphoma, leukaemia, chronic fatigue syndrome, Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, autism and lupus , however, there remains strong evidence that artificial sweeteners are considered safe to consume as per EFSA recommendations.
Correlations to Diet Quality
Currently, the limited research exploring diet quality and the use of natural or artificial sweeteners suggest that overall diet quality is lower in those individuals who consume naturally or artificially sweetened beverages compared to non or low consumers . These results suggest that for optimal health, natural sweeteners and artificial sweeteners should only be consumed in small amounts.
Concerns from BDA Perspective
While food products that contain artificial sweeteners must clearly state ‘With sweetener(s)’, it may not always be 100% clear to the consumer as to whether a particular food product contains an artificial sweetener or not. The BDA recommends clearer labelling on food products and beverages which states which artificial sweetener is used and the quantity contained within a food product or beverage, alongside the ADI.
Research Gaps and Future Research
Current obesity-related governmental policies do not currently address natural sweeteners, artificial sweeteners and the impact on weight. Additionally, no research exists examining the effects of sweeteners in breastmilk and potential implications in infants. Further research is also required investigating the hormonal and metabolic responses to sweeteners and whether the use of artificial sweeteners aid weight loss or weight gain.
Another topic for future discussion is whether artificial sweeteners should be encouraged by Dietitians in place of regular sugar options to assist in the control of calorie consumption. Given that intake of artificial sweeteners is mostly from beverages, emphasis should be placed upon encouraging behaviour change with focus on overall diet quality and eating patterns, rather than specific nutrients.