Skip to main content
Knowledge4Policy
Knowledge for policy

Health Promotion and Disease Prevention Knowledge Gateway

A reference point for public health policy makers with reliable, independent and up-to date information on topics related to promotion of health and well-being.

  • Page | Last updated: 08 Apr 2021

Health effects related to sweeteners intake

Health Promotion Knowledge Gateway

Health effects related to sweeteners intake as described by food- and health-related organisations

Note that each institution may refer to sweeteners using different terminology.

 

Effect of sweeteners intake on cardiovascular health
  • 'The majority of observational studies showed no effects on lipid profile related to intense sweeteners. Two studies reported that replacing sugars with aspartame reduced plasma concentrations of triglycerides but the data are too limited to conclude that intense sweeteners have a beneficial effect on lipid profile'.
  • Insufficient data to conclude if displacing caloric sweeteners with non-caloric sweeteners in beverages and foods benefits 'cardio-metabolic risk factors'.

Effect of sweeteners intake on type 2 diabetes mellitus (T2DM) and blood glucose
  • 'a cause and effect relationship has been established between the consumption of foods/drinks containing xylitol, sorbitol, mannitol, maltitol, lactitol, isomalt, erythritol, D-tagatose, isomaltulose, sucralose or polydextrose instead of sugar and reduction in post-prandial blood glucose responses (without disproportionally increasing post-prandial insulinaemic responses) as compared to sugar-containing foods/drinks /drinks'. This scientific substantiation also applies to intense sweeteners.
  • 'A cause and effect relationship has not been established between the consumption of foods and beverages in which sugars have been replaced by intense sweeteners and maintenance of normal blood glucose concentrations'.
  • For blood glucose regulation short- and medium-term intense sweetener consumption 'does not result in the post-prandial elevation of blood glucose or insulin levels in healthy or diabetic subjects'.
  • In diabetics, regular consumption of intense sweeteners as sugar substitutes on blood glucose control has not demonstrated any benefits.
  • 'The most robust epidemiological studies on type 2 diabetes do not show a higher or lower incidence of diabetes' in daily intense sweetener consumers.
  • 'For some people with diabetes who are accustomed to sugar-sweetened products, nonnutritive sweeteners (containing few or no calories) may be an acceptable substitute for nutritive sweeteners (those containing calories such as sugar, honey, agave syrup) when consumed in moderation'.
  • 'Long-term observational studies conducted in adults provide inconsistent evidence of an association between low-calorie sweeteners and risk of type 2 diabetes'.

Effect of sweeteners intake on BMI/ weight management
  • 'a cause and effect relationship has not been established between the consumption of foods and beverages in which sugars have been replaced by intense sweeteners and contribution to the maintenance or achievement of a normal body weight'.
  • Replacing free sugars with non-nutritive sweeteners may reduce short term energy intake in the short-term, but their effectiveness remains to be evaluated as a strategy for weight management in the long term. There is a lack of research in children on the effects of non-nutritive sweeteners.
  • 'Randomised controlled trials conducted in adults indicate that increasing or decreasing the percentage of total dietary energy as sugars when consuming an ad libitum diet, either through the substitution of other macronutrient components or by replacing sugars with non-caloric sweeteners, leads to corresponding relative increases or decreases in energy intake'.
  • 'Evidence from trials conducted in children and adolescents indicates that consumption of sugars-sweetened beverages, as compared with non-calorically sweetened beverages, results in greater weight gain and increases in body mass index, however the evidence is limited to a small number of studies'.
  • 'Robust evidence from RCTs suggests non-caloric sweeteners are useful in weight maintenance/loss as they enable the calorie content of foods and drinks to be reduced while maintaining the same sweet taste desired by consumers. How these study outcomes reflect behaviour in reali life is however unclear'.
  • In most cases, the use of intense sweeteners as sugar substitutes 'results in a decrease in short-term energy intake due to their low calorie content and the lack of compensation. However, the available data cover insufficient time periods to guarantee the maintenance of this effect over the medium or long term'.
  • no conclusions can be drawn as to the long-term effect of replacing caloric sweeteners with intense sweeteners on the weight of regular adult consumers of sweet products. Similar for children and adolescents.
  • 'Moderate and generally consistent evidence from short-term RCTs conducted in adults and children supports that replacing sugar-containing sweeteners with low-calorie sweeteners reduces calorie intake, body weight, and adiposity'.
  • 'Long-term observational studies conducted in children and adults provide inconsistent evidence of an association between low-calorie sweeteners and body weight, as compared to sugar-containing sweeteners'.
  • 'Since the long-term effects of low-calorie sweeteners are still uncertain, those sweeteners should not be recommended for use as a primary replacement/substitute for added sugars in foods and beverages'.
  • Insufficient data to conclude if replacing caloric with non-caloric sweeteners reduces added sugars or carbohydrate intakes and benefits appetite, energy balance, or body weight.
  • Some data suggests that sweeteners 'may be used in a structured diet to replace sources of added sugars and that this substitution may result in modest energy intake reductions and weight loss'.
  • Non-caloric sweeteners, when used judiciously, 'could facilitate reductions in added sugars intake, thereby resulting in decreased total energy and weight loss/weight control, and promoting beneficial effects on related metabolic parameters. However, these potential benefits will not be fully realized if there is a compensatory increase in energy intake from other sources'.
  • Non-nutritive sweeteners, when substituting nutritive sweeteners, may help limit carbohydrate and energy intake as a strategy to manage blood glucose or weight.
  • Consumers who want a sweet taste without added energy can use non-nutritive sweeteners based on their personal taste preference and intended use.

Effect of sweeteners intake on dental health
  • 'the consumption of foods/drinks containing xylitol, sorbitol, mannitol, maltitol, lactitol, isomalt, erythritol […] instead of sugar in sugar-containing foods/drinks, may maintain tooth mineralisation compared with sugar-containing foods, provided that such foods/drinks do not lead to dental erosion'.  This scientific substantiation also applies to intense sweeteners.
  • moderate evidence of a beneficial effect of polyols on dental caries. Use of chewing gum containing polyols, compared to not using a chewing gum,  is beneficial to oral health (mixed and permanent dentition).
  • insufficient/inconsistent evidence from RCTs on effects of polyols on caries of deciduous dentition, or of confectionary containing polyols on caries in mixed and permanent dentition.

Effect of sweeteners intake on appetite
  • not possible to determine the effect of regular intense sweetener consumption on sweetness habituation or increased cravings for sweetened products.
  • occasional consumption of intense sweeteners before or during a meal 'has no effect on food intake or energy intake during the next meal'.
  • Occasional intense sweetener consumption before a meal 'reduces the sensation of hunger and the desire to eat, just like caloric sweeteners, but this effect is temporary and disappears before the start of the meal'.
  • for habituation to sweetness, intense sweetener consumption 'has not shown any effects in adults'. However, in children, there are no data that demonstrate whether intense sweeteners have an effect on taste development, food preferences or the control of food intake.

Effect of sweeteners intake on gastrointestinal health
  • Limited evidence that consumption of some polyols increases faecal weight, mass and affects faecal bacterial content (e.g. Bifidobacterium spp.). The health impact of an effect on faecal bacteria is currently uncertain, thus, whether this observation is beneficial or biologically relevant cannot be determined. No effects on faecal pH, faecal short chain fatty acids, based on limited evidence.
  • insufficient/inconsistent evidence on effects of polyols on  intestinal transit time and constipation

Other effects of sweeteners intake on health
  • Lack of convincing scientific information to encourage systematic replacement of sugars with intense sweeteners in sweet products, in a public health policy framework.
  • Artificial sweetened beverages and sugar sweetened beverages should not be consumed as substitutes for water.
  • 'Because of the lack of research in children, a recommendation either for or against the routine use of NNSs in the diets of children cannot be made at this time'.
  • no official recommendations regarding the use of non-caloric sweeteners, due to limited studies in children
  • In nutrition standards for beverages for schools, sweeteners should only be allowed in high schools and only after the school day has ended (due to displacing milk and 100% fruit juice during meals).
  • For foods, no recommendations made regarding non-nutritive sweeteners, due to limited amount of consistent evidence.