Non-nutritive Sweeteners: What Do They Offer to a Heart Healthy Diet?
Disclosure: Dr. Carson has nothing to disclose.
Pub Date: Monday, July 9, 2012
Author: Jo Ann S. Carson, PhD, RD, LD
Affiliation: Department of Clinical Nutrition, University of Texas Southwestern Medical Center, Dallas, Texas
Citation: Gardner C, Wylie-Rosett J, Gidding SS, Steffen LM, Johnson RK, Reader D, Lichtenstein AH; on behalf the American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Disease in the Young, and the American Diabetes Association. Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2012: published online before print July 9, 2012, 10.1161/CIR.0b013e31825c42ee.
In 2009, the American Heart Association (AHA) published a scientific statement1 concluding that the excessive consumption of excessive added sugar among Americans could be detrimental to cardiovascular health. Excessive added sugar increases caloric consumption which contributes to obesity. In addition, high intakes of added sugar may detrimentally influence other factors that lead to cardiovascular disease, such as elevations in serum triglycerides. AHA recommended reduction of added sugar intake by more than 50%, setting daily limits of 5 teaspoons for the average woman and 9 teaspoons for the average man1. Given these recommended reductions in added sugar, the question quickly arises as to wisdom of substituting non-nutritive sweeteners for at least some of the added sugar intake. Thus, it is quite appropriate and timely for the AHA to now address the issue of use of non-nutritive sweeteners2.
After careful review of the literature with an emphasis on recent publications since 2005, the 2012 AHA Scientific Statement determined that the published evidence is limited and is not conclusive regarding the benefits of substituting non-nutritive sweeteners for added sugars. Such substitutions could plausibly replace some added sugars, providing a reduction in caloric intake and promotion of a healthier weight. However, current research is equivocal as to whether use of non-nutritive sweeteners actually reduces caloric intake or whether subjects compensate for reduction of sugar intake with intake of other sources of calories2.
In looking to the AHA for a position on non-nutritive sweeteners, one should recognize the scope of their scientific statement. The statement addressed the six sweeteners currently approved by the US Food and Drug Administration (FDA): aspartame, acesulfame-K, neotame, saccharin, sucralose and stevia. The AHA relied upon the FDA acceptance of the safety of these products, and addressed within their paper what evidence supports guidance on use of non-nutritive sweeteners.
To what extent are non-nutritive sweeteners used in the US? About half of Americans report using NNS to some extent3-5. The primary source is from soft drinks. As one might expect, usage is more common among adults than children. Historical data from both dietary intake and food availability studies in the US confirms that although use of non-nutritive sweeteners in beverages and foods has increased, there has been no concomitant decrease in added sugar6,7. Given such widespread use, it is not surprising that consumers have frequent questions about NNS.
The AHA statement summarizes existing research that allows clinicians to respond to a number of consumer questions about whether NNS helps or hinders weight loss or maintenance of a healthy weight, as well as their benefits in glycemic control. Consumers messages that can be derived from the scientific statement include:
Given the dearth of published studies on the benefits of use of nonnutritive sweeteners, further research is definitely indicated. Future studies should attempt to control the many confounding variables in the study of nonnutritive sweeteners in free living humans. A clearer understanding of the potential benefit and/or harm of nonnutritive sweeteners can be elucidated if food frequency and other dietary assessment methods include greater specificity regarding types and amounts of sweetener used in beverages and foods. Of particular importance for future research are studies designed to tackle the “chicken or egg” phenomenon of greater use among obese compared to normal weight individuals.
Our current level of scientific knowledge does not answer whether use of nonnutritive sweeteners contributes to cardiovascular health or health in general. This current conclusion is consistent with the message that there is no one magical or evil food or additive. For weight control and cardiovascular health, the overall dietary pattern appears much important than whether one chooses to use or eliminate non-nutritive sweeteners.
- Johnson RK, Appel LJ, Brands M, Howard BV, Lefevre M, Lustig RH, et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2009; 120: 1011-1020.
- Gardner C, Wylie-Rosett J, Gidding SS, Steffen LM, Johnson RK, Reader D, Lichtenstein AH. Non-nutritive sweeteners: current use and health perspectives. Circulation. 2012:
- Colditz GA, Willett WC, Stampfer MJ, London SJ, Segal MR, Speizer FE. Patterns of weight change and their relation to diet in a cohort of healthy women. Am J Clin Nutr. 1990;51:1100-1105.
- de Koning L, Malik VS, Rimm EB, Willett WC, Hu FB. Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men. Am J Clin Nutr. 2011;93:1321-1327.
- Fowler SP, Williams K, Resendez RG, Hunt KJ, Hazuda HP, Stern MP. Fueling the obesity epidemic? Artificially sweetened beverage use and long-term weight gain. Obesity (Silver Spring, MD) 2008; 16:1894-1900.
- Mattes RD, Popkin BM. Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. Am J Clin Nutr. 2009;89:1-14.
- Marriott BP, Olsho L, Hadden L, Connor P. Intake of added sugars and selected 359 nutrients in the United States, National Health and Nutrition Examination Survey 360 (NHANES) 2003-2006. Crit Rev Food Sci Nutr. 2010;50:228-258.
- International Food and Information Council. Questions and Answers about Daily Average Intake. http://www.foodinsight.org/Resources/Detail.aspx?topic=Questions_and_Answers_About_Acceptable_Daily_Intake_