2023-05-30| Special

Should People Looking to Lose Weight Skip Sugar Substitutes?

by Ting Chu
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The World Health Organization (WHO) recommends refraining from the use of non-sugar sweeteners (NSS). This recommendation aims to address two concerns: managing weight and mitigating the risk of noncommunicable diseases (NCDs).

Obesity is a Global Pandemic

The escalating prevalence of overweight and obesity represents a grave health concern impacting billions of individuals worldwide. It is estimated that nearly 40% of adults are affected, highlighting the magnitude of this global health issue.

Disturbingly, the number of overweight children under 5 years of age increased by nearly 6 million over the course of two decades, reaching a staggering figure of more than 38 million in 2020.

Overweight leads to high body mass index (BMI), and the consequences could be significant. With an estimated 4 million deaths in 2017 attributable to this condition. Additionally, obesity serves as a notable risk factor for various NCDs such as cardiovascular diseases (CVDs), type 2 diabetes, and specific cancer types. 

The impact of NCDs is prominent, accounting for approximately 71 % (41 million) of the total 55 million deaths recorded in 2019. Furthermore, it is important to highlight that obesity and certain NCDs also increase the susceptibility to severe illness resulting from COVID-19 infection.

NSS Fails at Achieving Long-Term Weight Control Goals

NSS are commonly promoted as substitutes for free sugars, offering reduced or zero calories. They are often marketed as helpful for weight management and are frequently advised for regulating blood glucose levels in individuals with diabetes. 

Each sweetener undergoes rigorous toxicological evaluation to determine appropriate levels of consumption, known as acceptable daily intake (ADI). Despite ongoing discussions, a consensus regarding the long-term effectiveness of NSS in weight control has yet to be reached. Moreover, there are apprehensions about the potential long-term health consequences linked to habitual consumption within the ADI.

Related Article: Scientists Unlocked the Secret of Genetic Impact of Time-restricted Eating in Mice

Unveiling the Insights from Scientific Inquiry of  NSS

Based on recent systematic review and meta-analyses of randomized controlled trials (RCTs) and prospective observational studies, it has been found that individuals who consume higher amounts of NSS during short-term RCTs tend to exhibit lower body weight and BMI compared to those who do not consume NSS or consume lower quantities. 

However, long-term prospective observational studies suggest that increased BMI and the risk of developing obesity are linked to higher NSS intake. It is worth mentioning that the impact on body weight and BMI in RCTs is evident when comparing the intake of NSS with the consumption of free sugars. And these effects are likely influenced by a decrease in energy intake. No significant effects or correlations were observed on indicators of body fatness in either RCTs or prospective cohort studies. When it comes to the use of NSS, studies conducted in children and pregnant women yielded more limited evidence compared to studies carried out in adults. In one RCT involving children, the replacement of sugar-sweetened beverages with beverages containing NSS resulted in a reduction in several indicators of body fatness. 

The findings of a meta-analysis encompassing three prospective observational studies unveiled a heightened risk of preterm birth connected to increased utilization of NSS during pregnancy. Notably, individual prospective observational studies yielded diverse results regarding the associations between NSS use during pregnancy and various outcomes in offspring. These associations included an increased risk of asthma and allergies, as well as impaired cognitive function.

The Feasibility of Tackling Human Obese Problems

To implement the recommendation effectively, it is likely that some degree of behavior change at the individual level will be necessary, regardless of the chosen interventions and policy measures. The success of such behavior change will depend on the willingness of individuals, who have developed a habituation to a certain level of sweetness in their dietary choices, to reduce the overall sweetness in their diets.

For individuals who are not accustomed to high levels of sweetness in their diet, including infants and young children, avoiding the consumption of NSS and excessive free sugars, particularly in the form of beverages, should be relatively feasible. However, it is important to note that consumers will need to exercise vigilance, as the labeling practices of foods and beverages containing NSS may require careful attention to effectively avoid their consumption.

What’s the Solution? Eat Your Whole Foods

Before advocating for a broad public health policy that urges individuals to reduce or eliminate the consumption of sugar substitutes, it is important to recognize that the evidence supporting the initial statement may not possess adequate strength or quality. In order to address this concern, a comprehensive review involving stakeholders and key consultants should be undertaken to ensure the reliability and validity of the recommendation.

The measures should not only focus on NSS use and reducing free sugars intake but should also aim to foster the adoption of a comprehensive healthy diet. Emphasizing the significance of incorporating whole fruits into the diet as a wholesome source of natural sweetness, enriched with essential nutrients, can greatly enhance the acceptability of the recommendation.

See more on WHO guideline on the Use Of Non-Sugar Sweeteners.

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