Confused about sweeteners after new recommendation? MUSC dietitian has answers

May 22, 2023
Packets of sugar, Splenda, Sweet'N Low, Equal and Equal are linked up with sweeteners pouring out of them.
More than 140 million Americans use sugar substitutes sweeteners, according to the latest data from Statista. Photo by Sarah Pack

A new guideline about non-sugar sweeteners from the World Health Organization has left some people wondering if they should switch from Diet to regular Coke, toss the Sweet’N Low and light ice cream and quit trying to cut calories.

“That's not really the way that I think that it was meant to be taken,” said registered dietitian Tonya Turner. She’s a nutrition specialist with the Weight Management Center at MUSC Health.

Tonya Turner 
Tonya Turner

“They're really trying to say sugar substitutes alone are not going to promote or sustain weight change.That’s something that we all understand. Just for overall health measures, there's already been the recommendation to decrease added sugars. And so now, the WHO is taking it a step further in saying, ‘OK, not only limit sugars like maple syrup, agave, regular sugar, but you should also limit the amount of artificial sugar in your diet as well.’”

In its advisory, the WHO said a review of the available evidence found that non-sugar sweeteners don’t have any long-term benefits when it comes to reducing body fat in kids or adults. It also said the sweeteners may have some side effects, such as raising the risk of Type 2 diabetes, cardiovascular disease and early death. 

The food industry organization Calorie Control Council has pushed back, saying decades of scientific studies show that low- and no-calorie sweeteners are safe and do have health benefits. It also noted that the WHO called its guideline “conditional.” The WHO made that choice because it said the evidence might be affected by baseline characteristics of study participants and complicated patterns of non-sugar sweetener use.

The sweeteners the WHO cited included:

  • Acesulfame K, also known as acesulfame potassium: brand names Sunett, Sweet One.
  • Aspartame: brand names NutraSweet, Equal and Sugar Twin.
  • Advantame: a chemical derivative of aspartame.
  • Cyclamates: The Food and Drug Administration (FDA) banned this sweetener in the United States in 1970.
  • Neotame: brand name Newtame.
  • Saccharin: brand names Sweet and Low, Sweet’N Low, Sweet Twin and Necta Sweet.
  • Sucralose: brand name Splenda.
  • Stevia: Stevia leaf extract comes from a plant that grows in South America.
  • Stevia derivatives: brand names Truvia and Stevia in the Raw.

Turner said confusion over sugar substitutes is nothing new. “People are always like, ‘Are they healthy? Should I be using them?’”

She has a ready answer. “They have their place. If somebody's doing regular sweetened beverages and you're trying to cut your calories, switching to a sugar substitute is going to be a lower-calorie option. But at the same time, you don't want to have it be a free-for-all of using sugar substitutes because anything in excess is not a good idea.”

In other words, she said, one Diet Coke a day is OK. Six is not. “Just because it's calorie-free doesn’t mean it's a good thing. You still have to be mindful that it's a processed product.”

Turner also talked about Stevia, which some people use as a natural alternative to sugar. “Stevia is a plant-based sugar substitute. If you're actually using the Stevia plant, then that's absolutely fine. If you're doing it in the Truvia form that's been slightly chemically modified, it's no different than some of the other sugar substitutes.”

Turner encouraged people to turn to natural sources for flavoring. “I think even just using more fruit, flavoring things with actual fruit in a small amount, or lemons and lime juice, that type of thing, and getting away from so much of that sweetness.”

And that’s not her only advice. “There definitely needs to be an emphasis on eating more whole foods, foods rich in fiber, being physically active. So I think it's just one small component to a much larger picture. Sugars in general, whether they're coming in an artificial form versus a natural form, should be limited, and we should focus more on whole food sources.”

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