Can artificial sweeteners help people reach and maintain a healthy body weight? Maybe, according to two major medical societies.
A scientific statement issued by the American Heart Association and the American Diabetes Association concluded that using non-nutritive sweeteners could cut down on added sugars and therefore lead to beneficial effects.
But an extensive literature search found sketchy, limited, and often contradictory evidence, researchers concluded in Circulation: Journal of the American Heart Association and Diabetes Care.
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"Smart use of non-nutritive sweeteners could help you reduce added sugars in your diet, therefore lowering the number of calories you eat," said lead author Christopher Gardner of Stanford University in Palo Alto, Calif.
That reduction "could help you attain and maintain a healthy body weight, and thereby lower your risk of heart disease and diabetes," Gardner said in a statement.
But any beneficial effects, the researchers noted, could be undone if people "compensate" for the calorie cuts by eating more high-calorie foods – drinking a diet soda, for example, and then having an extra piece of cake later.
A high intake of dietary sugars has been shown to contribute to cardiovascular disease and obesity, which can lead to the development of diabetes. In 2009, the American Heart Association recommended a population-wide cutback in added sugars in foods, urging that women eat no more than 100 calories a day and men no more than 150 calories daily of added sugars.
For this analysis, the researchers looked at studies of the non-nutritive sweeteners aspartame, acesulfame-K, neotame, saccharin, sucralose, and stevia.
Few studies have looked directly at whether non-nutritive sweeteners can replace added sugars in the diet, the researchers found, although there are data about their effects on such things as obesity and cardiovascular disease.
But those data are inconclusive. In several studies, use of the substances was associated with unwanted outcomes, such as obesity, presumably because of reverse causation – those using the sweeteners were doing so because they already were overweight.
On the other hand, some people might clearly benefit from drinks and foods that replace sugar with non-nutritive sweeteners, according to co-author Diane Reader of the International Diabetes Center in Minneapolis, Minn.
"For example, soft drinks sweetened with non-nutritive sweeteners do not increase blood glucose levels, and thus can provide a sweet option for those with diabetes," Reader said in a statement.
But she cautioned that "just because a food product includes a non-nutritive sweetener" does not mean that it is healthy.
Reader added that non-nutritive sweeteners can be an important part of controlling carbohydrate intake in order to manage weight and control diabetes.
The researchers noted that the effect of non-nutritive sweeteners has to be considered in the context of the overall diet.
"Strategies for reducing calories and added sugars also involves choosing foods which have no added sugars or non-nutritive sweeteners – such as vegetables, fruits, high-fiber whole grains, and non- or low-fat dairy," Gardner said.