tag:theconversation.com,2011:/nz/topics/artificial-sweeteners-37890/articlesArtificial sweeteners – The Conversation2023-07-21T12:26:43Ztag:theconversation.com,2011:article/2099572023-07-21T12:26:43Z2023-07-21T12:26:43ZWHO expert cancer group states that the sweetener aspartame is a possible carcinogen, but evidence is limited – 6 questions answered<figure><img src="https://images.theconversation.com/files/538137/original/file-20230718-27-wh515o.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3866%2C2590&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research on possible links between aspartame consumption and cancer is ongoing and far from conclusive.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/coffee-royalty-free-image/95061040?phrase=artificial%2Bsweetener">celsopupo/iStock via Getty Images Plus</a></span></figcaption></figure><p><em>The World Health Organization declared on July 14, 2023, that the widely used synthetic sweetener <a href="https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released">aspartame could be a “possible” carcinogen</a>, or cancer-causing agent, on the basis of “limited evidence for cancer in humans.”</em> </p>
<p><em>But the agency also concluded that the currently available data does not warrant a change of the acceptable daily intake of aspartame at this time.</em></p>
<p><em>The Conversation asked chronic disease epidemiologist <a href="http://gsm.utmck.edu/internalmed/faculty/terry.cfm">Paul D. Terry</a>, public health scholar <a href="https://publichealth.utk.edu/people/jchen/">Jiangang Chen</a> and nutrition expert <a href="https://nutrition.utk.edu/people/ling-zhao/">Ling Zhao</a>, all from the University of Tennessee, to put these seemingly contradictory findings into perspective based on the available scientific evidence.</em></p>
<h2>1. Why is aspartame being classified as ‘possibly’ cancer-causing?</h2>
<p>Aspartame is an artificial sweetener that is added to many foods, candies, gums and beverages, such as diet soda. Because it is approximately <a href="https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food">200 times sweeter than table sugar</a>, smaller amounts of aspartame are added to foods, and they contribute considerably fewer calories. NutraSweet and Equal are well-known brand names for aspartame sold in packages for individual use. </p>
<p>The <a href="https://www.iarc.who.int/cards_page/about-iarc/">International Agency for Research on Cancer</a>, an entity within the WHO, evaluated findings from both human and animal studies of aspartame and cancer. The group noted some positive associations between <a href="https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released">aspartame consumption and hepatocellular carcinoma</a>, a form of liver cancer. </p>
<p>This WHO group classifies degrees of evidence that an agent has cancer-causing potential as being “sufficient,” “limited,” “inadequate” or “suggesting lack of carcinogenicity.” “Limited” evidence, as it pertains to the WHO’s new announcement on aspartame, means that although there is some evidence for an association, that evidence cannot be considered “sufficient” to infer a causal relationship.</p>
<p>Ultimately, the group concluded that several limiting factors could possibly explain the positive associations in those studies. These include the small number of human studies available, the complexity of studying people’s dietary behaviors and possible bias from factors such as higher-risk people – for example, those with diabetes – selecting diet products more often and ingesting higher quantities of aspartame than the average consumer. Therefore, the classification of “limited evidence” implies the need for additional studies.</p>
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<figcaption><span class="caption">Aspartame is found in many products: diet soda, ice cream, cereals, toothpaste and even some medications.</span></figcaption>
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<h2>2. What are the current guidelines for aspartame consumption?</h2>
<p>The Food and Agriculture Organization’s <a href="https://www.fao.org/food-safety/scientific-advice/jecfa/en/#">Joint Expert Committee on Food Additives</a>, an international committee of science experts that is operated by both the WHO and the United Nations, currently <a href="https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released#">recommends a daily maximum</a> of 40 milligrams per kilogram of body weight for aspartame.</p>
<p>This amount of aspartame per day translates to approximately eight to 12 cans of soda, or approximately 60 packets of aspartame, for a person weighing 132 pounds (60 kilograms). For a child weighing 33 pounds (15 kg), it translates to between two to three cans of aspartame-sweetened soda per day, or approximately 15 packets of aspartame. Some individuals may consume more aspartame than this, but such high intake is not typical. </p>
<h2>3. Does the WHO’s new stance change that recommendation?</h2>
<p>Independently of the expert panel on cancer, the food safety group also evaluated the available evidence and concluded that there was no “convincing evidence” from either animal or human studies that aspartame consumption causes adverse effects within the currently established daily limits. </p>
<p>Based on assessments of the findings of both groups, the director of the Department of Nutrition and Food Safety of the WHO stated that, “while safety is not a major concern” at the doses in which aspartame are commonly used, “potential effects have been described that need to be investigated by more and better studies.” The American Cancer Society has also stated that it <a href="https://www.cancer.org/cancer/risk-prevention/chemicals/aspartame.html">supports further research into possible health concerns</a> related to aspartame.</p>
<p>It is important to note that people with the rare inherited disorder called <a href="https://my.clevelandclinic.org/health/diseases/17816-phenylketonuria">phenylketonuria</a>, or PKU, should <a href="https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food">avoid or restrict aspartame intake</a>. </p>
<h2>4. How can two consensus groups reach different conclusions?</h2>
<p>It is not uncommon for scientific consensus groups to differ in how they classify risk based on the results of published studies, even if more than one of those consensus groups is affiliated with the same agency or parent organization. </p>
<p>Whereas the WHO’s expert cancer group’s stance may appear to be more worrisome than that of the committee on food safety, in fact, the latter’s “no convincing evidence” is consistent with the cancer group’s “limited evidence” classification. Because, unlike the cancer group, the food safety committee considers risk of aspartame at specific consumption levels, the WHO as a whole continues to support the food safety committee’s existing recommendations for allowable daily aspartame intake of up to 40 milligrams per kilogram of body weight. </p>
<p>Of note, the committee’s recommended maximum daily intake is still more conservative than the current U.S. Food and Drug Administration’s <a href="https://www.cancer.org/cancer/risk-prevention/chemicals/aspartame.html">recommended maximum daily allowance</a> of 50 milligrams of aspartame per kilogram of body weight.</p>
<h2>5. How does aspartame compare to other sweeteners?</h2>
<p>Alternatives to aspartame include other <a href="https://theconversation.com/whats-the-difference-between-sugar-other-natural-sweeteners-and-artificial-sweeteners-a-food-chemist-explains-sweet-science-172571">artificial sweeteners</a> such as saccharin and sucralose, sugar alcohols like sorbitol and xylitol, naturally derived sugar-free sweeteners like Stevia and simple sugars, such as those in sugar cane, sugar beets and honey. </p>
<p>But, like aspartame, many of these sweeteners have been implicated in developing cancer. This list includes <a href="https://doi.org/10.1371/journal.pmed.1003950">acesulfame potassium, or Ace-K</a> – a synthetic calorie-free sugar substitute – as well as <a href="https://www.upstate.edu/news/articles/2023/2023-03-25-perl.php">sugar alcohols</a> and even <a href="https://doi.org/10.3390%2Fcancers14246042">simple sugar</a>. </p>
<p>The availability of a wide variety of approved sweeteners seems like a good thing, but studying the many possible risks associated with sweeteners is challenging, since <a href="https://www.science.org/content/blog-post/sugar-substitutes-surprise">people have complex diets and lifestyles</a>. </p>
<h2>6. So what should consumers do?</h2>
<p>For now, as is the case with aspartame, these sweeteners remain approved for human use because there isn’t sufficient evidence to support an association with cancer. And, <a href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/artificial-sweeteners/art-20046936">as noted by the Mayo Clinic</a>, artificial sweeteners may play a beneficial role for some people who are <a href="https://doi.org/10.1016/j.eprac.2021.06.013">seeking to manage their weight</a> or control their sugar intake. Studies show that sugar <a href="https://doi.org/10.1136/bjsports-2017-097971">may be addictive for some individuals</a>.</p>
<p>When making a decision about consumption of sweeteners, consumers should consider factors like taste preference, body weight and composition, diabetes status and risk, possible allergic responses and the evidence that may result from ongoing and future studies. In certain cases, such as with individuals who have or are at future risk of diabetes, people should talk with their physician or other health care provider to determine the best choice. </p>
<p>One thing is clear: Scientific studies on aspartame consumption will continue, and it will be important for both consumers and the research community to continue weighing potential risks.</p><img src="https://counter.theconversation.com/content/209957/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An expert panel found a potential association with liver cancer, but too little research exists to assume a causal connection. For now, the WHO left current consumption guidelines unchanged.Paul D. Terry, Professor of Epidemiology, University of TennesseeJiangang Chen, Associate Professor of Public Health, University of TennesseeLing Zhao, Professor of Nutrition, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2088442023-07-14T01:24:43Z2023-07-14T01:24:43ZDoes artificial sweetener aspartame really cause cancer? What the WHO listing means for your diet soft drink habit<figure><img src="https://images.theconversation.com/files/536737/original/file-20230711-23-sl30n6.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C3240%2C2155&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The International Agency for Research on Cancer (IARC), which is the specialised cancer agency of the World Health Organization, has declared aspartame may be a <a href="https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released">possible carcinogenic hazard to humans</a>. </p>
<p>Another branch of the WHO, the Joint WHO and Food and Agriculture Organization’s Expert Committee on Food Additives has assessed the risk and developed recommendations on how much aspartame is safe to consume. They have recommended the acceptable daily intake be 0 to 40mg per kilo of body weight, as we currently have <a href="https://www.foodstandards.gov.au/consumer/additives/aspartame/Pages/default.aspx">in Australia</a>.</p>
<p>A hazard is different to a risk. The hazard rating means it’s an agent that is capable of causing cancer; a risk measures the likelihood it could cause cancer.</p>
<p>So what does this hazard assessment mean for you?</p>
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<h2>Firstly, what is aspartame?</h2>
<p><a href="https://www.foodstandards.gov.au/consumer/additives/aspartame/Pages/default.aspx">Aspartame is an artificial sweetener</a> that is 200 times sweeter than sugar, but without any kilojoules. </p>
<p>It’s used in a <a href="https://www.foodstandards.gov.au/consumer/additives/aspartame/Pages/default.aspx">variety of products</a> including carbonated drinks such as Coke Zero, Diet Coke, Pepsi Max and some home brand offerings. You can identify aspartame in drinks and foods by looking for additive number 951. </p>
<p>Food products such as yogurt and confectionery may also contain aspartame, but it’s not stable at warm temperatures and thus not used in baked goods. </p>
<p>Commercial names of aspartame include Equal, Nutrasweet, Canderel and Sugar Twin. In Australia the acceptable daily intake is 40mg per kilo of body weight per day, which is about 60 sachets.</p>
<p><a href="https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food#:%7E:text=How%20many%20packets%20can%20a,based%20on%20its%20sweetness%20intensity%3F&text=Notes%20About%20the%20Chart%3A,50%20mg%2Fkg%20bw%2Fd">In America</a> the acceptable daily intake has been set at 75 sachets. </p>
<h2>What evidence have they used to come to this conclusion?</h2>
<p><a href="https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released">IARC looked closely</a> at the <a href="https://cdn.who.int/media/docs/default-source/nutrition-and-food-safety/july-13-final-summary-of-findings-aspartame.pdf?sfvrsn=a531e2c1_5&download=true">evidence base</a> from around the world – using data from observational studies, experimental studies and animal studies. </p>
<p>They found there was some limited evidence in human studies linking aspartame and cancer (specifically liver cancer) and limited evidence from animal studies as well. </p>
<p>They also considered the biological mechanism studies which showed how cancer may develop from the consumption of aspartame. Usually these are lab-based studies which show exactly how exposure to the agent may lead to a cancer. In this case they found there was limited evidence for how aspartame might cause cancer.</p>
<p>There were only three human studies that looked at cancer and aspartame intake. These large observational studies used the intake of soft drinks as an indicator of aspartame intake. </p>
<p>All three found a positive association between artificially sweetened beverages and liver cancer in either all of the population they were studying or sub-groups within them. But these studies could not rule out other factors that may have been responsible for the findings. </p>
<p>A study <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284800/">conducted in Europe</a> followed 475,000 people for 11 years and found that each additional serve of diet soft drink consumed per week was linked to a 6% increased risk of liver cancer. However the scientists did conclude that due to the rarity of liver cancer they still had small numbers of people in the study.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/35728406/">In a study from the US</a>, increased risk of liver cancer was seen in people with diabetes who drank more than two or more cans of a diet soda a week.</p>
<p>The <a href="https://aacrjournals.org/cebp/article/31/10/1907/709398/Sugar-and-Artificially-Sweetened-Beverages-and">third study</a>, also from the US, found an increase in liver cancer risk in men who never smoked and drank two or more artificially sweetened drinks a day. </p>
<p>From this they have decided to declare aspartame as a Group 2b “possible carcinogen”. But they have also said more and better research is needed to further understand the relationship between aspartame and cancer. </p>
<p>IARC has four categories (groupings) available for potential substances (or as they are referred to by IARC, “agents”) that may cause cancer.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cup of frothy soda" src="https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An Australian would have to consume unrealistic amounts of aspartame to reach the daily limit.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>What does each grouping mean?</h2>
<p><strong>Group 1 Carcinogenic to humans:</strong> an agent in this group is carcinogenic, which means there is convincing evidence from human studies and we know precisely <em>how</em> it causes cancer. There are 126 agents in this group, including tobacco smoking, alcohol, processed meat, radiation and ionising radiation.</p>
<p><strong>Group 2a Probably carcinogenic to humans:</strong> there are positive associations between the agent and cancer in humans, but there may still be other explanations for the association which were not fully examined in the studies. There are 95 agents in this group, including red meat, DDT insecticide and night shift work.</p>
<p><strong>Group 2b Possibly carcinogenic in humans:</strong> this means limited evidence of causing cancer in humans, but sufficient evidence from animal studies, or the mechanism of how the agent may be carcinogenic is well understood. This basically means the current evidence indicates an agent may possibly be carcinogenic, but more scientific evidence from better conducted studies is needed. There are now <a href="https://monographs.iarc.who.int/agents-classified-by-the-iarc/">323</a> agents in this group, including aloe vera (whole leaf extract), ginkgo biloba and lead.</p>
<p><strong>Group 3 Not classifiable as a carcinogen:</strong> there’s not enough evidence from humans or animals, and there is limited mechanistic evidence of how it may be a carcinogen. There are 500 agents in this group.</p>
<h2>So do I have to give up my diet soft drink habit?</h2>
<p>For a 70kg person you would need to consume about 14 cans (over 5 litres) of soft drink sweetened with aspartame a day to reach the acceptable daily intake.</p>
<p>But we need to remember there may also be aspartame added in other foods consumed. So this is an unrealistic amount to consume, but not impossible. </p>
<p>We also need to consider all the evidence on aspartame together. The foods we typically see aspartame in are processed or ultra-processed, which have recently also been <a href="https://theconversation.com/ultra-processed-foods-are-trashing-our-health-and-the-planet-180115">shown to be detrimental to health</a>.</p>
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Read more:
<a href="https://theconversation.com/ultra-processed-foods-are-trashing-our-health-and-the-planet-180115">Ultra-processed foods are trashing our health – and the planet</a>
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<p>And artificial sweeteners (including aspartame) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892765/#!po=59.3750">can make people crave more sugar</a>, making them want to eat more food, potentially causing them to gain more weight.</p>
<p>All together, this indicates we should be more careful about the amount of artificial sweeteners we consume, since they <a href="https://theconversation.com/the-who-says-we-shouldnt-bother-with-artificial-sweeteners-for-weight-loss-or-health-is-sugar-better-205827">do not provide any health benefits</a>, and have possible adverse effects. </p>
<p>But overall, from this evidence, drinking the occasional or even daily can of a diet drink is safe and probably not a cancer risk.</p>
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<p><em>Correction: this article originally stated each serve of soft drink in a study was linked to a 6% increased risk of liver cancer, however it was each additional serve per week. This has been amended.</em></p><img src="https://counter.theconversation.com/content/208844/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.</span></em></p>IARC has listed the artificial sweetener aspartame as possibly cancer causing. Here’s how to digest the findings.Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2088952023-07-04T15:11:40Z2023-07-04T15:11:40ZAspartame: popular sweetener could be classified as a possible carcinogen by WHO – but there’s no cause for panic<figure><img src="https://images.theconversation.com/files/535489/original/file-20230704-16-qfev1h.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5646%2C3764&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/double-cool-ice-soft-drink-cola-647315608">MMD Creative/Shutterstock</a></span></figcaption></figure><p>According to <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/whos-cancer-research-agency-say-aspartame-sweetener-possible-carcinogen-sources-2023-06-29/">reports</a>, the International Agency for Research on Cancer (IARC), part of the World Health Organization (WHO), is set to declare the artificial sweetener aspartame as “possibly carcinogenic to humans”. </p>
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<p><a href="https://pubmed.ncbi.nlm.nih.gov/26377607/">Aspartame</a> is about <a href="https://www.sciencedirect.com/science/article/abs/pii/0308814685901190">200 times sweeter</a> than sugar and is one of the most commonly used artificial sweeteners. It’s used particularly in “low calorie” or “diet” foods and beverages, but is contained in a wide variety of products including drinks, ice creams, chewing gums, confectionery, sauces and snacks.</p>
<p>We don’t have further information yet on what evidence the IARC will base this new classification on, but the WHO will publish the full data <a href="https://monographs.iarc.who.int/wp-content/uploads/2023/06/Meeting134-QA-June2023.pdf">on July 14</a>. </p>
<p>While reports like these can understandably be worrying, there’s no reason to panic at this stage.</p>
<p>Aspartame was first approved for use by the US Food and Drug Administration (FDA) <a href="https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2013.3496">in 1974</a>, and ever since then there have been claims made about its potential effects on health. </p>
<p>Over time, aspartame has not only been linked to cancer, but also to <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0116212">other conditions</a> such as multiple sclerosis, blindness, seizures, memory loss, depression, anxiety, birth defects and death. </p>
<p>However, frequent evaluations by regulatory agencies such as the <a href="https://apps.who.int/food-additives-contaminants-jecfa-database/Home/Chemical/62">WHO</a>, the FDA and the <a href="https://www.efsa.europa.eu/en/efsajournal/pub/3496">European Food Safety Authority</a> (EFSA) have found no evidence to support these assertions.</p>
<p>So far, the regulators have all agreed that it’s safe for a person to consume <a href="https://www.efsa.europa.eu/en/efsajournal/pub/3496">40mg of aspartame</a> per kilogram of their body weight per day. That’s about 2.8g for a 70kg adult – and is much more than most people consume. </p>
<h2>What does ‘possibly carcinogenic’ actually mean?</h2>
<p>The safety of food additives is <a href="https://www.efsa.europa.eu/en/topics/topic/food-additive-re-evaluations">regularly reevaluated</a>. This is important as new evidence can emerge, especially with the development of different methods to assess the health effects of additives.</p>
<p>This year, aspartame has been reevaluated by two WHO agencies: the International Agency for Research on Cancer (<a href="https://www.iarc.who.int/">IARC</a>) and the Joint FAO/WHO Expert Committee on Food Additives (<a href="https://www.who.int/groups/joint-fao-who-expert-committee-on-food-additives-(jecfa)">JECFA</a>). </p>
<p>The two agencies have <a href="https://monographs.iarc.who.int/wp-content/uploads/2023/06/Meeting134-QA-June2023.pdf">very different remits</a>. The IARC looks at hazard and JECFA at risk. This distinction is important. For example, sunshine is a hazard as it can cause skin cancer, but the risk depends on the time spent in the sun and whether one uses sunscreen.</p>
<p>The IARC’s job is to investigate possible causes of cancer and identify hazards. In its <a href="https://monographs.iarc.who.int/">reports</a> (called monographs), it reviews all available evidence and classifies hazards into one of <a href="https://www.iarc.who.int/wp-content/uploads/2023/06/IARC_MONO_classification_2023_updated.png">four categories</a>: </p>
<ul>
<li>Group 1: carcinogenic to humans (sufficient evidence for cancer in humans)</li>
<li>Group 2a: probably carcinogenic to humans (limited evidence in humans, sufficient evidence in animals)</li>
<li>Group 2b: possibly carcinogenic to humans (limited evidence in humans, insufficient evidence in animals) </li>
<li>Group 3: not classifiable (inadequate evidence in humans or animals).</li>
</ul>
<p>Aspartame will reportedly be classified into group 2b. It shares this category with aloe vera leaves, electromagnetic radiation, the heart drug <a href="https://bnf.nice.org.uk/drugs/digoxin/">digoxin</a> and engine exhaust fumes, among <a href="https://www.bbc.com/future/article/20230630-aspartame-what-else-is-possibly-cancerous">many other things</a>. For all of these hazards, there is some limited data that suggests they might cause cancer – but nothing convincing. </p>
<p>These categories can be confusing, because they refer only to the strength of the evidence that something can cause cancer, not the degree of risk. Group 1 for example includes smoking, alcohol, <a href="https://theconversation.com/not-all-processed-meats-carry-the-same-cancer-risk-64622">processed meat</a>, plutonium and sunlight. There’s convincing evidence each one can cause cancer. </p>
<p>But the actual risks are very different and depend on amount and exposure. For instance, plutonium and smoking are best avoided, but there’s no reason to avoid processed meat or alcohol completely.</p>
<figure class="align-center ">
<img alt="A hand holds a cigarette." src="https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Smoking is known to cause cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/harmful-habit-hand-holding-cigarette-smoke-1885761310">Oakland Images/Shutterstock</a></span>
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<p>While the IARC assesses the hazard, it’s JECFA’s job to assess the risk and make a recommendation about the <a href="https://apps.who.int/iris/bitstream/handle/10665/37578/9241542705-eng.pdf">acceptable daily intake</a>. </p>
<p>Their assessment will also be published on July 14, but there hasn’t been an indication in the media reports what it will say. It’s possible the acceptable daily intake will remain at 40mg per kilogram of body weight, or it may be reduced. Without having access to the data, is impossible to predict. </p>
<h2>The evidence so far</h2>
<p>The last review of aspartame’s safety was <a href="https://www.efsa.europa.eu/en/press/news/131210">conducted by EFSA</a> in 2013. This review didn’t find any new evidence that aspartame causes cancer and confirmed previous reviews by other regulators.</p>
<p>One compound that was of particular interest was <a href="https://www.efsa.europa.eu/en/efsajournal/pub/3496">methanol</a>, which is formed in the gut when aspartame is broken down and converted into formaldehyde by the human body. Formaldehyde is a known carcinogen (group 1). However, the amount that can form after the consumption of aspartame is much lower than what the body produces naturally.</p>
<p>In the interim there has been some data from a French study, which asked participants to provide information about their diet and followed them up for several years afterwards. This research suggested high consumption of aspartame <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003950">increases cancer risk</a>.</p>
<p>However, the results are difficult to interpret as obesity is <a href="https://www.wcrf.org/diet-activity-and-cancer/risk-factors/obesity-weight-gain-and-cancer">an independent risk factor</a> for cancer and people who are obese often use sweeteners. It’s also difficult to estimate aspartame intake accurately <a href="https://theconversation.com/a-whole-new-way-of-doing-nutrition-research-148352">from diet data alone</a>.</p>
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Read more:
<a href="https://theconversation.com/artificial-sweeteners-linked-to-diabetes-and-obesity-95314">Artificial sweeteners linked to diabetes and obesity</a>
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<p>It’s likely that the upcoming assessments will include this data and therefore provide a better estimate of aspartame’s risk. Until then, there is no reason for concern. Aspartame has been scrutinised for a long time and the classification of “possibly carcinogenic” suggests it’s unlikely there will be any major change in assessment or implications for consumers.</p><img src="https://counter.theconversation.com/content/208895/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gunter Kuhnle has received research funding from Mars, Inc.</span></em></p>Reports have indicated the artificial sweetener aspartame will be classified as ‘possibly carcinogenic to humans’ by the WHO. Here’s what that means – and doesn’t mean.Gunter Kuhnle, Professor of Nutrition and Food Science, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2061752023-06-08T12:30:25Z2023-06-08T12:30:25ZWHO’s recommendation against the use of artificial sweeteners for weight loss leaves many questions unanswered<figure><img src="https://images.theconversation.com/files/530408/original/file-20230606-14983-a38265.jpg?ixlib=rb-1.1.0&rect=26%2C8%2C5798%2C3763&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sugar alternatives go by many names including artificial sweeteners, low-calorie sweeteners and nonsugar sweeteners.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/food-service-tray-with-sugar-packets-salt-and-royalty-free-image/1000353706?phrase=artificial+sweeteners&adppopup=true">Marie LaFauci/Moment via Getty Images</a></span></figcaption></figure><p>Do low-calorie sweeteners help with weight management? And are they safe for long-term use?</p>
<p>This is among the most controversial topics in nutritional science. In early May 2023, the World Health Organization issued a statement that cautions <a href="https://www.who.int/publications/i/item/9789240073616">against the use of nonsugar sweeteners</a> for weight loss except for people who have preexisting diabetes. </p>
<p>The WHO based its new recommendation on a <a href="https://www.who.int/publications/i/item/9789240046429">2022 systematic review and meta-analysis of scientific studies</a> on nonsugar sweetener consumption in humans. This type of study reviews a large body of research to draw a broad conclusion.</p>
<p>Based on its interpretation of that large-scale review, the WHO recommended <a href="https://www.who.int/news/item/15-05-2023-who-advises-not-to-use-non-sugar-sweeteners-for-weight-control-in-newly-released-guideline">against using artificial sweeteners for weight control</a> and concluded that there may be health risks associated with habitual consumption of nonsugar sweeteners over the long term. However, the WHO also acknowledged that the existing evidence is not conclusive and that more research needs to be done.</p>
<p>As neuroscientists, we study how dietary factors such as sweeteners affect the brain’s ability to perform critical functions, including metabolism, <a href="https://www.schierlab.com/">appetite</a>, and <a href="https://kanoskilab.com/">learning and memory</a>. </p>
<p>We found the WHO’s advisory surprising based on the study’s equivocal results. Determining the answers to these questions is immensely challenging, and public health messaging around recommendations can send mixed messages.</p>
<h2>‘Healthy’ versus ‘unhealthy’ sugars</h2>
<p>Natural sugars like glucose and fructose, together with fiber and other nutrients, are found in many food sources that are considered healthy, such as fruit. However, these simple carbohydrates have been increasingly added into manufactured food products, especially beverages. Sugar-sweetened beverages are usually high in calories and offer little else in the way of nutrition.</p>
<p>In the early 20th century, food and beverage manufacturers began incorporating naturally and chemically derived substances that satisfy sweet cravings but contain significantly fewer calories than natural sugars – and, in some cases, zero calories. Sugar substitutes became particularly widespread in the 1950s with the increasing popularity of diet sodas. Since then, consumers have <a href="https://doi.org/10.1016/j.physbeh.2016.03.030">increasingly turned to these sugar substitutes</a> in their everyday lives. </p>
<p>Sugar substitutes go by many names, including high-intensity sweeteners, artificial sweeteners, nonnutritive sweeteners, low-calorie sweeteners and, as termed in the WHO report, nonsugar sweeteners.“ These include synthetic compounds like sucralose, acesulfame potassium and aspartame, and naturally derived ones, such as those from the plant <em>Stevia rebaudiana</em>, among many others. </p>
<p>Each nonsugar sweetener has a unique chemical structure, but they all activate sweet taste receptors at very low concentrations. This means that you need to add only a tiny amount of them to sweeten your coffee or tea, as opposed to heaping spoonfuls of natural sugar.</p>
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<figcaption><span class="caption">Nonsugar sweeteners are found in many soft drinks, sports drinks and energy bars.</span></figcaption>
</figure>
<h2>Sugar substitutes and the quest for weight loss</h2>
<p>Obesity and its associated metabolic conditions, <a href="https://theconversation.com/drugs-that-melt-away-pounds-still-present-more-questions-than-answers-but-ozempic-wegovy-and-mounjaro-could-be-key-tools-in-reducing-the-obesity-epidemic-205549">like diabetes</a> and cardiovascular disease, are now among the leading <a href="https://www.cdc.gov/obesity/data/adult.html">causes of preventable death</a> in the U.S. The <a href="https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2022">obesity epidemic</a> has been linked in part to an increase in added sugar consumption over the past century. </p>
<p>In order to help address it, in 2015 the <a href="https://www.who.int/publications/i/item/9789241549028">WHO issued specific recommendations</a> to reduce sugar intake and adopt healthier diets. </p>
<p>But <a href="https://theconversation.com/a-taste-for-sweet-an-anthropologist-explains-the-evolutionary-origins-of-why-youre-programmed-to-love-sugar-173197">humans are hard-wired</a> to find the <a href="https://doi.org/10.1016/s0278-2626(03)00014-9">sweet taste of sugars pleasurable</a>, and the tastiness of real sugar makes it difficult for most of us to remove it from our diets. </p>
<p>Sugar substitutes were designed to help. The math seems straightforward: Replacing your favorite 12-ounce sugar-sweetened beverage that contains 150 calories with an artificially sweetened beverage of the same volume that contains zero calories should allow you to reduce the number of calories you take in each day and reduce your body weight over time. </p>
<p>But the science is not so straightforward. Research from <a href="https://doi.org/10.1080/17470218.2011.552729">both animal models and humans</a> indicates that <a href="https://doi.org/10.1172/jci.insight.167266">habitual nonsugar sweetener consumption</a> can lead to <a href="https://doi.org/10.2337/dc19-0734">long-term negative metabolic outcomes</a> and <a href="https://doi.org/10.3390/nu11122928">body weight gain</a>.</p>
<p>However, there are conflicting studies from <a href="https://doi.org/10.1016/j.appet.2016.05.011">animal models</a> <a href="https://doi.org/10.1038/s41430-019-0461-6">and humans</a> that have not found significant body weight gain associated with nonsugar sweeteners consumption.</p>
<h2>Parsing the health impacts</h2>
<p>Regardless of any potential benefits nonsugar sweeteners may have for weight control, their use must also be considered in the context of overall health. </p>
<p>Agencies like the WHO and the U.S. Food and Drug Administration periodically review available evidence and assess the safety of various food additives, including nonsugar sweeteners, for use in foods and beverages within what is called an <a href="https://www.fda.gov/food/food-additives-petitions/high-intensity-sweeteners">acceptable daily intake</a> limit. In this context, the acceptable daily intake is based on the estimated amount of a specific nonsugar sweetener that can be safely consumed daily over one’s entire life without adverse effects on health.</p>
<p>Each agency sets its own daily allowance based on the best available data. But because these experiments cannot account for all possible conditions in which these substances are used in real life, it is critical that scientists continue to investigate the health effects of food additives. </p>
<p>The authors of the WHO report relied on three main types of published research studies to determine whether nonsugar sweetener consumption was linked to adverse health effects. The gold standard for assessing causation is what are called <a href="https://doi.org/10.1111%2F1471-0528.15199">randomized controlled trials</a>. </p>
<p>In these studies, people are randomly assigned to either an experimental group – which receives the experimental substance, such as a nonsugar sweetener – or a control group – which receives a placebo or different substance. Participants in both groups are then tracked for a period of time, typically weeks or months. The majority of studies involving randomized controlled trials on nonsugar sweeteners to date involve this type of comparison, with nonsugar sweeteners replacing consumption of natural sugar-sweetened beverages. </p>
<p>The analysis of almost <a href="https://www.who.int/publications/i/item/9789240046429">50 randomized controlled trials</a> on which the WHO based its recommendation found modest benefits of using nonsugar sweeteners for weight loss and determined that the habitual use of those nonsugar sweeteners did not lead to diabetes symptoms or indicators of cardiovascular disease. But it did find that the use of nonsugar sweeteners was associated with a higher ratio of total cholesterol to HDL, short for high-density lipoprotein, which is considered the "good cholesterol.”</p>
<p>That means that habitual consumers of artificial sweetener had more of the low-density lipoprotein, or LDL version, in their system. That form of “bad cholesterol” is a <a href="https://www.cdc.gov/cholesterol/ldl_hdl.htm">risk factor for heart disease</a>. </p>
<p>However, other potential adverse consequences of consuming nonsugar sweeteners may take more time to appear than can be identified in the limited time frame of a randomized controlled trial. </p>
<p>The authors also evaluated what are called prospective cohort studies. Those studies track participants’ self-reported use of sweeteners alongside health outcomes, oftentimes over many years. They also took into account case-control studies, which identify people with or without a certain health issue, such as cancer, and then use available health records and interviews to determine the extent of nonsugar sweetener use in their past. </p>
<p>Examination of the cohort and case-control studies found that regular consumption of nonsugar sweetener was associated with increased fat accumulation, higher body mass index and increased incidence of <a href="https://www.cdc.gov/diabetes/basics/type2.html">Type 2 diabetes</a>. Those findings differ from the outcomes of the randomized control studies. </p>
<p>Analysis of the cohort and case-control studies also concluded that a history of regular nonsugar sweetener use was linked to increased frequency of stroke, hypertension, other adverse cardiovascular events and, in pregnant people, an increased risk for premature birth. The frequency of cancer in nonsugar sweetener consumers was very low in general, though <a href="https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food#">saccharin, an FDA-approved sweetener</a> found in many food products, was associated with a bladder cancer. </p>
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<figcaption><span class="caption">The history of artificial sweeteners.</span></figcaption>
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<h2>Caveats and takeaways</h2>
<p>On the face of it, these results are alarming, but they need to be taken with a grain of salt. As the WHO report points out, these studies have significant limitations that need to be considered. </p>
<p>Take, for example, in the cohort and case-control studies, that higher <a href="https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm">body mass index, or BMI</a>, was associated with greater nonsugar sweetener intake and poorer health outcomes. One possibility is that people with obesity used nonsugar sweeteners to help cut calories more than others without obesity. This makes it difficult to determine whether the disease is caused by sustained artificial sweetener use or by the other underlying conditions associated with obesity. </p>
<p>Additionally, the way nonsugar sweeteners are consumed is not controlled in these types of studies. So negative health outcomes could be associated with other affiliated harmful behaviors, such as more sugar or fat in the diet. </p>
<p>The picture is very mixed on both the benefits of nonsugar sweeteners for weight loss and their ties to adverse health issues. The WHO’s recommendation seems to have weighed the cohort and case-control studies over the randomized controlled ones, a decision that we found puzzling in light of the limitations of these studies for assessing whether nonsugar sweeteners have a causal role in disease.</p>
<p>As with all health-related choices, the science is complex. In our view, grabbing a diet drink to offset the calories in a slice of chocolate cake every once in a while will likely not be harmful for your health or lead to a significant weight change.</p><img src="https://counter.theconversation.com/content/206175/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lindsey Schier receives funding from the National Institutes of Health (NIDCD).</span></em></p><p class="fine-print"><em><span>Scott Kanoski receives funding from the National Institutes of Health. </span></em></p>The WHO report concluded that habitual use of nonsugar sweeteners is linked to a modest increase in diabetes, hypertension and stroke. But the research it’s based on has limitations.Lindsey Schier, Assistant Professor of Biological Sciences, USC Dornsife College of Letters, Arts and SciencesScott Kanoski, Associate Professor of Biological Science, USC Dornsife College of Letters, Arts and SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2058272023-05-18T04:11:45Z2023-05-18T04:11:45ZThe WHO says we shouldn’t bother with artificial sweeteners for weight loss or health. Is sugar better?<figure><img src="https://images.theconversation.com/files/526747/original/file-20230517-23-dlv1zx.jpg?ixlib=rb-1.1.0&rect=40%2C16%2C5422%2C3620&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/white-pink-blue-brown-sugar-bags-1023556240">Shutterstock</a></span></figcaption></figure><p>This week, the World Health Organization (WHO) <a href="https://www.who.int/news/item/15-05-2023-who-advises-not-to-use-non-sugar-sweeteners-for-weight-control-in-newly-released-guideline">advised</a> that “non-sugar sweeteners should not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases” such as diabetes and heart disease.</p>
<p>Artificial sweeteners are either natural compounds or synthesised compounds that taste sweet like sugar – and are are <a href="https://www.foodstandards.gov.au/consumer/additives/SiteAssets/Pages/Steviol-glycosides-%28960%29-%28intense-sweetener%29%20%28stevia%29/SteviolGlycosideRiskAssessment_April2023.pdf">up to 400 times</a> sweeter by weight – but provide no or negligible energy. As a comparison, sugar has 17kj (or four calories) per gram, so one teaspoon of sugar would have 85 kilojoules.</p>
<p>Several types of artificial sweeteners are <a href="https://www.foodstandards.gov.au/consumer/additives/pages/sweeteners.aspx">used in Australia</a>. Some are synthetic, others are extracted from foods such as monk fruit and the stevia plant. </p>
<p>So, what do the new WHO guidelines mean for people who have switched to artificial sweeteners for health reasons? Should they just go back to sugar?</p>
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Read more:
<a href="https://theconversation.com/food-and-drinks-are-getting-sweeter-even-if-its-not-all-sugar-its-bad-for-our-health-187605">Food and drinks are getting sweeter. Even if it's not all sugar, it's bad for our health</a>
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<h2>Promoted for weight loss</h2>
<p>As a practising clinical dietitian in the 1990s, I remember when artificial sweeteners began to appear in processed foods. They were promoted as a way of substituting sugar into food products that may lead to weight loss. </p>
<p>A can of sugar-sweetened soft drink contains on average about 500kj. Theoretically, the substitution of one sugar-sweetened can of soft drink with an artificially sweetened can of soft drink every day would reduce your weight by about 1kg per month. </p>
<p>But research over the past few decades shows this doesn’t hold up. </p>
<h2>What’s the new advice based on?</h2>
<p>The WHO has based its recommendation on a <a href="https://theconversation.com/how-do-we-know-what-works-systematic-research-reviews-5979">systematic review</a> it has <a href="https://www.who.int/publications/i/item/9789240073616">conducted</a>. Its objective was to provide evidence-based guidance on the use of artificial sweeteners in weight management and for disease prevention. </p>
<p><a href="https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/ncd-mortality">Weight management</a> is important, given obesity increases the risk of diseases such as diabetes and certain types of cancer, which are the <a href="https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/ncd-mortality">leading cause</a> of death globally.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1658164337758855168"}"></div></p>
<p>The <a href="https://www.who.int/publications/i/item/9789240073616">WHO’s systematic review</a> included data from different types of studies, which give us different information:</p>
<ul>
<li><p>50 were randomised controlled trials (when scientists intervene and make changes – in this case to the diet – while keeping everything else constant, to see the impact of that change)</p></li>
<li><p>97 were prospective cohort studies (when scientists observe a risk factor in a large group of people over a period of time to see how it impacts an outcome – without intervening or make any changes)</p></li>
<li><p>47 were case-control studies (another type of observational study that follows and compares two groups of otherwise matched people, aside from the risk factor of interest).</p></li>
</ul>
<p>Randomised controlled trials provide us with causal data, allowing us to say the intervention led to the change we saw. </p>
<p>Prospective cohort and case-control only give us associations or links. We can’t prove the risk factors led to a change in the outcomes – in this case, weight – because other risk factors that scientists haven’t considered could be responsible. But they give great clues about what might be happening, particularly if we can’t do a trial because it’s unethical or unsafe to give or withhold specific treatments. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="person puts sweetener in cup of tea" src="https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The WHO review looked at different types of studies investigating artificial sweeteners.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/N2n01mhpbmg">Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>The WHO’s systematic review looked at body fatness, non-communicable diseases and death. </p>
<p>For body fatness, the randomised controlled trials showed those consuming more artificial sweeteners had slightly lower weight – an average of 0.71kg – than those consuming less or no artificial sweeteners. </p>
<p>But the cohort studies found higher intakes of artificial sweeteners were associated with a higher BMI, or body mass index (0.14 kg/m2) and a 76% increased likelihood of having obesity.</p>
<p>The prospective cohort studies showed for higher intakes of artificial sweetened beverages there was a 23% increase in the risk of type 2 diabetes. If artificial sweeteners were consumed as a tabletop item (that the consumer added to foods and drinks) there was a 34% increase in the risk of diabetes.</p>
<p>In people with diabetes, artificial sweeteners did not improve or worsen any clinical indicators used to monitor their diabetes such as fasting blood sugar or insulin levels.</p>
<p>Higher intakes of artificial sweeteners were associated with an increased risk of type 2 diabetes, cardiovascular disease and death in the long-term prospective observational studies that followed participants for an average of 13 years. </p>
<p>But artificial sweeteners were not associated with differences in overall cancer rates or premature death from cancer. </p>
<p>Overall, while the randomised controlled trials suggested slightly more weight loss in people who used artificial sweeteners, the observational studies found this group tended to have an increased risk of obesity and poorer health outcomes.</p>
<h2>Does the review have any shortcomings?</h2>
<p>The WHO’s advice has led to <a href="https://www.sciencemediacentre.org/expert-reaction-to-new-who-guideline-which-advises-not-to-use-non-sugar-sweeteners-for-weight-control-or-to-reduce-the-risk-of-noncommunicable-diseases/">some criticism</a> because the randomised controlled trials did show some weight loss benefit to using artificial sweeteners, albeit small. </p>
<p>However the WHO clearly states its advice is based on the multiple research designs, not just randomised controlled trials. </p>
<p>Additionally, the WHO assessed the quality of the studies in the review to be of “low or very low certainty”.</p>
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<strong>
Read more:
<a href="https://theconversation.com/sweeteners-may-be-linked-to-increased-cancer-risk-new-research-179709">Sweeteners may be linked to increased cancer risk – new research</a>
</strong>
</em>
</p>
<hr>
<h2>Are they unsafe?</h2>
<p>This advice is not suggesting artificial sweeteners are unsafe or should be banned. The WHO’s scientific review was not about chemical or safety issues.</p>
<h2>So are we better off having sugar instead?</h2>
<p>The answer is no. </p>
<p>In 2015, the WHO released <a href="https://www.who.int/publications/i/item/9789241549028">guidelines on added sugar intake</a> to reduce the risk of excess weight and obesity. Added sugars are found in processed and ultra-processed foods and drinks such as soft drinks, fruits drinks, sports drinks, chocolate and confectionery, flavoured yoghurt and muesli bars. </p>
<p>It recommended people consume no more 10% of total energy intake, which is about 50 grams (ten teaspoons), of sugar per day for an average adult who needs 8,700kj a day. </p>
<p>The WHO’s recommendation is in line with the <a href="https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/recommended-number-serves-adults">Australian Dietary Guidelines</a>, which recommends no more than three serves of discretionary foods per day, if you need the extra energy. However it’s best to get extra energy from the core food groups (grains, vegetable, fruit, dairy and protein group) rather than discretionary foods. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/8-everyday-foods-you-might-not-realise-are-ultra-processed-and-how-to-spot-them-197993">8 everyday foods you might not realise are ultra processed – and how to spot them</a>
</strong>
</em>
</p>
<hr>
<h2>So what do I drink now?</h2>
<p>So if artificial and sugar in drinks are not advised for weight loss, what can you drink? </p>
<p>Some options include water, kombucha with no added sugar, tea or coffee. Soda and mineral water flavoured with a small amount of your favourite fruit juice are good substitutes. </p>
<p>Milk is also a good option, particularly if you’re not currently meeting you calcium requirements.</p><img src="https://counter.theconversation.com/content/205827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.</span></em></p>Here’s what the new WHO guidelines mean for people who have switched to artificial sweeteners for health reasons.Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1876052022-07-29T00:31:04Z2022-07-29T00:31:04ZFood and drinks are getting sweeter. Even if it’s not all sugar, it’s bad for our health<figure><img src="https://images.theconversation.com/files/476012/original/file-20220726-26-fd3ast.jpg?ixlib=rb-1.1.0&rect=26%2C35%2C5964%2C3952&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1527515545081-5db817172677?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=2070&q=80">Unsplash/Rod Long</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Humans have an evolutionary preference for sweetness. Sweet foods, like fruit and honey, <a href="https://theconversation.com/a-taste-for-sweet-an-anthropologist-explains-the-evolutionary-origins-of-why-youre-programmed-to-love-sugar-173197">were an important energy source</a> for our ancestors. </p>
<p>However, in the modern world, sweetened foods are readily available, very cheap and advertised extensively. Now, we are consuming too much sugar in foods and drinks – the kind that is added rather than sugar that is naturally occurring. Consuming too much added sugar is <a href="https://www.health.harvard.edu/heart-health/the-sweet-danger-of-sugar#:%7E:text=%22The%20effects%20of%20added%20sugar,Hu.">bad news</a> for health. It is linked to <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.12040">obesity</a>, <a href="https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report">type 2 diabetes and tooth decay</a>. </p>
<p>Because of these health concerns, manufacturers started using non-nutritive sweeteners to sweeten food as well. These sweeteners contain little to no kilojoules and include both artificial sweeteners, such as aspartame, and those that come from natural sources, such as stevia. </p>
<p>Our research, <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/global-trends-in-added-sugars-and-nonnutritive-sweetener-use-in-the-packaged-food-supply-drivers-and-implications-for-public-health/A6375EB569DCDA4899730EC40C69D1CC">published today</a>, shows the amount of added sugars and non-nutritive sweeteners in packaged foods and drinks has grown a lot over the last decade. This is especially true in middle-income countries, such as China and India, as well as in the Asia Pacific, including Australia. </p>
<h2>From lollies to biscuits to drinks</h2>
<p>Using market sales data from around the globe, we looked at the quantity of added sugar and non-nutritive sweeteners sold in packaged foods and drinks from 2007 to 2019. </p>
<p>We found per person volumes of non-nutritive sweeteners in drinks is now 36% higher globally. Added sugars in packaged food is 9% higher. </p>
<p>Non-nutritive sweeteners are most commonly added to confectionery. Ice creams and sweet biscuits are the fastest-growing food categories in terms of these sweeteners. The expanding use of added sugars and other sweeteners over the last decade means, overall, our packaged food supply is getting sweeter.</p>
<p>Our analysis shows the amount of added sugar used to sweeten drinks has increased globally. However, this is largely explained by a 50% increase in middle-income countries, such as China and India. Use has decreased in high-income countries, such as Australia and the United States. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/476172/original/file-20220726-12-fkmr9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="group of kids eat icypoles" src="https://images.theconversation.com/files/476172/original/file-20220726-12-fkmr9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476172/original/file-20220726-12-fkmr9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476172/original/file-20220726-12-fkmr9e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476172/original/file-20220726-12-fkmr9e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476172/original/file-20220726-12-fkmr9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476172/original/file-20220726-12-fkmr9e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476172/original/file-20220726-12-fkmr9e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Icecreams are among the foods increasing in sweetness the fastest.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/group-kids-eating-colorful-frozen-600w-1418895149.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://www.hsph.harvard.edu/nutritionsource/carbohydrates/added-sugar-in-the-diet/#:%7E:text=The%20AHA%20suggests%20a%20stricter,of%20sugar%20for%20most%20men.">It is recommended</a> men consume less than nine teaspoons of sugar a day, while women should have less than six. However, because sugar is added to so many foods and drinks, over half of <a href="https://www.abs.gov.au/ausstats/abs@.nsf/lookup/4364.0.55.011main+features12011-12#:%7E:text=In%202011%2D12%2C%20Australians%20consumed,from%20honey%20and%20fruit%20juice.">Australians exceed recommendations</a>, eating an average of 14 teaspoons a day. </p>
<p>The shift from using added sugar to sweeteners to sweeten drinks is most common in carbonated soft drinks and bottled water. The World Health Organization is <a href="https://www.who.int/news-room/articles-detail/online-public-consultation-draft-guideline-on-use-of-non-sugar-sweeteners">developing guidelines</a> on the use of <a href="https://www.who.int/publications/i/item/9789240046429">non-sugar sweeteners</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/476015/original/file-20220726-18-eepwwv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="girls with soda bottle drinks through straw" src="https://images.theconversation.com/files/476015/original/file-20220726-18-eepwwv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476015/original/file-20220726-18-eepwwv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476015/original/file-20220726-18-eepwwv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476015/original/file-20220726-18-eepwwv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476015/original/file-20220726-18-eepwwv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476015/original/file-20220726-18-eepwwv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476015/original/file-20220726-18-eepwwv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Drinks labelled ‘sugar-free’ might seem healthier, even if they’re not.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/drinks-people-lifestyle-concept-close-600w-677885284.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sugar-detox-cutting-carbs-a-doctor-explains-why-you-should-keep-fruit-on-the-menu-173992">Sugar detox? Cutting carbs? A doctor explains why you should keep fruit on the menu</a>
</strong>
</em>
</p>
<hr>
<h2>Rich and poor countries</h2>
<p>There is a difference in added sugar and sweetener use between richer and poorer countries. The market for packaged food and beverages in high-income countries has become saturated. To continue to grow, large food and beverage corporations are <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/obr.13126">expanding into middle-income countries</a>.</p>
<p>Our findings demonstrate a double standard in the sweetening of the food supply, with manufacturers providing less sweet, “healthier” products in richer countries.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/476013/original/file-20220726-25-nxdxfi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="spoonful of sugar with raspberry on top" src="https://images.theconversation.com/files/476013/original/file-20220726-25-nxdxfi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476013/original/file-20220726-25-nxdxfi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476013/original/file-20220726-25-nxdxfi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476013/original/file-20220726-25-nxdxfi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476013/original/file-20220726-25-nxdxfi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476013/original/file-20220726-25-nxdxfi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476013/original/file-20220726-25-nxdxfi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Added sugar is bad but rules to cut it out can have unintended consequences.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1628619876503-2db74e724757?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=3010&q=80">Unsplash/Myriam Zilles</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-much-longer-do-we-need-to-wait-for-australia-to-implement-a-sugary-drinks-tax-162434">How much longer do we need to wait for Australia to implement a sugary drinks tax?</a>
</strong>
</em>
</p>
<hr>
<h2>Unexpected consequences of control</h2>
<p>To reduce the health harms of high added sugar intakes, many governments have acted to curb their use and consumption. Sugar levies, education campaigns, advertising restrictions and labelling <a href="https://www.cambridge.org/core/journals/nutrition-research-reviews/article/abs/drivers-trends-and-dietary-impacts-of-nonnutritive-sweeteners-in-the-food-supply-a-narrative-review/32B903F1CAB239800F2C98279541B4C0">are among these measures</a>.</p>
<p>But such actions can encourage manufacturers to partially or completely substitute sugar with non-nutritive sweeteners to avoid penalties or cater to evolving population preferences. </p>
<p>In our study, we found regions with a higher number of policy actions to reduce sugar intakes had a significant increase in non-nutritive sweeteners sold in drinks. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1194398939383861248"}"></div></p>
<h2>Why is this a problem</h2>
<p>While the harms of consuming too much added sugar are well known, relying on non-nutritive sweeteners as a solution also carries risk. Despite their lack of dietary energy, recent <a href="https://www.who.int/publications/i/item/9789240046429">reviews</a>, suggest consuming non-nutritive sweeteners may be linked with <a href="https://www.who.int/publications/i/item/9789240046429">type 2 diabetes and heart disease</a> and can disrupt the <a href="https://academic.oup.com/advances/article/10/suppl_1/S31/5307224">gut microbiome</a>. </p>
<p>And because they are sweet, ingesting non-nutritive sweeteners <a href="https://www.who.int/publications/i/item/9789240046429">influences our palates</a> and encourages us to want more sweet food. This is of particular concern for children, who are still developing their lifelong taste preferences. Additionally, certain non-nutritive sweeteners are considered <a href="https://www.sciencedirect.com/science/article/abs/pii/S0147651318313368">environmental contaminants</a> and are not effectively removed from wastewater.</p>
<p>Non-nutritive sweeteners are only found in <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/ultraprocessed-foods-what-they-are-and-how-to-identify-them/E6D744D714B1FF09D5BCA3E74D53A185">ultra-processed foods</a>. These foods are industrially made, contain ingredients you would not find in a home kitchen, and are designed to be “hyper-palatable”. Eating more ultra-processed foods is linked with more <a href="https://www.mdpi.com/2072-6643/12/7/1955">heart disease, type 2 diabetes, cancer and death</a>.</p>
<p><a href="https://theconversation.com/ultra-processed-foods-are-trashing-our-health-and-the-planet-180115">Ultra-processed</a> foods are also <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30177-7/fulltext">environmentally harmful</a> because they use significant resources such as energy, water, packaging materials and plastic waste.</p>
<p>Foods that contain sweeteners can receive a “health halo” if they don’t contain sugar, misleading the public and potentially displacing nutritious, whole foods in the diet. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/476014/original/file-20220726-12-tep7aj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="sugar and sweetener sachets" src="https://images.theconversation.com/files/476014/original/file-20220726-12-tep7aj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476014/original/file-20220726-12-tep7aj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476014/original/file-20220726-12-tep7aj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476014/original/file-20220726-12-tep7aj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476014/original/file-20220726-12-tep7aj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476014/original/file-20220726-12-tep7aj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476014/original/file-20220726-12-tep7aj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Non-nutritive sweeteners can include those from artificial and natural sources.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/close-selective-focus-different-colored-600w-695565067.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/poorest-americans-drink-a-lot-more-sugary-drinks-than-the-richest-which-is-why-soda-taxes-could-help-reduce-gaping-health-inequalities-142345">Poorest Americans drink a lot more sugary drinks than the richest – which is why soda taxes could help reduce gaping health inequalities</a>
</strong>
</em>
</p>
<hr>
<h2>Focus on nutrition</h2>
<p>When making policy to improve public health nutrition, it is important to consider unintended consequences. Rather than focusing on specific nutrients, there is merit in advocating for policy that considers the broader aspects of food, including cultural importance, level of processing and environmental impacts. Such policy should promote nutritious, minimally processed foods. </p>
<p>We need to closely monitor the increasing sweetness of food and drinks and the growing use of added sugars and non-nutritive sweeteners. It is likely to shape our future taste preferences, food choices and human and planetary health.</p><img src="https://counter.theconversation.com/content/187605/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cherie Russell has received funding from an Australian Government Research Training Scholarship. The funder of the research was not involved in any aspect of the study. She is affiliated with the not-for-profit organisations Public Health Association of Australia and Healthy Food Systems Australia. </span></em></p><p class="fine-print"><em><span>Carley Grimes receives funding from the National Health and Medical Research Council and is affiliated with Dietitans Australia. </span></em></p><p class="fine-print"><em><span>Mark Lawrence receives funding from the Australian Research Council. He is a Board member of Food Standards Australia New Zealand. The views expressed in this article do not necessarily reflect the positions of any organisation with which he is associated. </span></em></p><p class="fine-print"><em><span>Phillip Baker receives funding from the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Rebecca Lindberg is affiliated with The Community Grocer. </span></em></p>There is more sugar and other sweeteners in our food and drinks globally than a decade ago, with manufacturers prioritising healthier options in richer countries.Cherie Russell, PhD Candidate, Deakin UniversityCarley Grimes, Senior Lecturer Population Nutrition, Deakin UniversityMark Lawrence, Professor of Public Health Nutrition, Institute for Physical Activity and Nutrition, Deakin UniversityPhillip Baker, Research Fellow, Institute for Physical Activity and Nutrition, Deakin University, Deakin UniversityRebecca Lindberg, Postdoctoral research fellow, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1797092022-03-24T18:13:26Z2022-03-24T18:13:26ZSweeteners may be linked to increased cancer risk – new research<figure><img src="https://images.theconversation.com/files/454089/original/file-20220324-17-1uexs5k.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4867%2C3240&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The sweetener aspartame is found is many common foods and drinks, such as diet sodas. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/thirsty-asian-young-woman-girl-holding-2105136650">Kmpzzz/ Shutterstock</a></span></figcaption></figure><p>Sweeteners have long been suggested to be bad for our health. Studies have linked consuming too many sweeteners with conditions such as <a href="https://link.springer.com/article/10.1007/s11894-017-0602-9">obesity</a>, <a href="https://www.sciencedirect.com/science/article/pii/S1043276013000878?casa_token=hmictGrhvYIAAAAA:iQc3yRiZOK5NKDKj9CbbG2p86xphcvXRkjjWTqWOgr4LTbjNaekoSDHft7kbo25Yudw8gSPBOg">type 2 diabetes and cardiovascular disease</a>. But links with cancer have been less certain.</p>
<p>An artificial sweetener, called cyclamate, that was sold in the US in the 1970s was shown to <a href="https://pubmed.ncbi.nlm.nih.gov/5432702/">increase bladder cancer</a> in rats. However, human physiology is very different from rats, and observational studies <a href="https://www.nejm.org/doi/full/10.1056/NEJM198003063021001">failed to find a link</a> between the sweetener and cancer risk in humans. Despite this, the media <a href="https://www.sciencedirect.com/science/article/pii/S0923753419510377">continued to report a link</a> between sweeteners and cancer.</p>
<p>But now, a <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003950">study published in PLOS Medicine</a> which looked at over 100,000 people, has shown that those who consume high levels of some sweeteners have a small increase in their risk of developing certain types of cancer.</p>
<p>To assess their intake of artificial sweeteners, the researchers asked the participants to keep a food diary. Around half of the participants were followed for more than eight years. </p>
<p>The study reported that aspartame and acesulfame K, in particular, were associated with increased cancer risk – especially breast and obesity-related cancers, such as colorectal, stomach and prostate cancers. This suggests that removing some types of sweeteners from your diet may reduce the risk of cancer. </p>
<h2>Cancer risk</h2>
<p>Many common foods <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899993/">contain sweeteners</a>. These food additives <a href="https://link.springer.com/article/10.1007/s13197-011-0571-1">mimic the effect of sugar</a> on our taste receptors, providing intense sweetness with no or very few calories. Some sweeteners occur naturally (such as stevia or <a href="https://pubmed.ncbi.nlm.nih.gov/25692980/">yacon syrup</a>). Others, such as aspartame, are artificial. </p>
<p>Although they have few or no calories, sweeteners still have an effect on our health. For example, aspartame <a href="https://www.sciencedirect.com/science/article/abs/pii/S1044579X98900773">turns into formaldehyde</a> (<a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/formaldehyde/formaldehyde-fact-sheet#:%7E:text=The%20International%20Agency%20for%20Research,Report%20on%20Carcinogens%20(3).">a known carcinogen</a>) when the body digests it. This could potentially see it accumulate in cells and cause them to become cancerous.</p>
<p>Our cells are hard-wired to self-destruct when they become cancerous. But aspartame has been shown to “<a href="https://www.sciencedirect.com/science/article/pii/S1319562X15001345">switch off</a>” the genes that tell cancer cells to do this. Other sweeteners, including sucralose and saccharin, have also been shown to damage DNA, which can <a href="https://www.tandfonline.com/doi/abs/10.3109/01480545.2014.966381">lead to cancer</a>. But this has only been shown in cells in a dish rather than in a living organism.</p>
<figure class="align-center ">
<img alt="A person puts aspartame sweetener into their mug of tea." src="https://images.theconversation.com/files/454090/original/file-20220324-25-7y52d5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454090/original/file-20220324-25-7y52d5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454090/original/file-20220324-25-7y52d5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454090/original/file-20220324-25-7y52d5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454090/original/file-20220324-25-7y52d5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454090/original/file-20220324-25-7y52d5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454090/original/file-20220324-25-7y52d5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Aspartame can affect our cells and gut microbiome.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/put-aspartame-cup-coffee-close-1433384099">RVillalon/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Sweeteners can also have a profound effect on <a href="https://www.tandfonline.com/doi/full/10.1080/19490976.2015.1017700">the bacteria that live in our gut</a>. Changing the bacteria in the gut can <a href="https://www.sciencedirect.com/science/article/pii/S153561081830120X">impair the immune system</a>, which could mean they no longer identify and remove cancerous cells. </p>
<p>But it’s still unclear from these animal and cell-based experiments precisely how sweeteners initiate or support cancerous changes to cells. Many of these experiments would also be difficult to apply to humans because the amount of sweetener was given at much higher doses than a human would ever consume.</p>
<p>The results from previous research studies are limited, largely because most studies on this subject have only observed the effect of consuming sweeteners without comparing against a group that hasn’t consumed any sweeteners. A recent systematic review of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ijcp.12703?casa_token=CZP_a8ydZbwAAAAA%3AFKfYJyy8EuFqO2MIKuOXojzfhRuiDaIyeSzVF_YLPkg53-pwQkMrKQ2XdM7fd_1zabfc_IEoGSKWZDQ">almost 600,000 participants</a> even concluded there was limited evidence to suggest heavy consumption of artificial sweeteners may increase the risk of certain cancers. A <a href="https://www.bmj.com/content/364/bmj.k4718">review in the BMJ</a> came to a similar conclusion.</p>
<p>Although the findings of this recent study certainly warrant further research, it’s important to acknowledge the study’s limitations. First, food diaries can be unreliable because people <a href="https://jech.bmj.com/content/54/8/611.abstract">aren’t always honest</a> about what they eat or they may forget what they have consumed. Although this study collected food diaries every six months, there’s still a risk people weren’t always accurately recording what they were eating and drinking. Though the researchers partially mitigated this risk by having participants take photos of the food they ate, people still might not have included all the foods they ate. </p>
<p>Based on current evidence, it’s generally agreed that using artificial sweeteners is <a href="https://www.scirp.org/html/13-8204292_84959.htm?pagespeed=noscript">associated with increased body weight</a> – though researchers aren’t quite certain whether sweeteners directly cause this to happen. Although this recent study took people’s body mass index into account, it’s possible that <a href="https://www.bmj.com/content/356/bmj.j477">changes in body fat</a> may have <a href="https://www.nature.com/articles/nrc3967">contributed to the development</a> of many of these <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.29552">types of cancers</a> – not necessarily the sweeteners themselves. </p>
<p>Finally, the risk of developing cancer in those who consumed the highest levels of artificial sweeteners compared with those who consumed the lowest amounts was modest – with only at 13% higher relative risk of developing cancer in the study period. So although people who consumed the highest amounts of sweetener had an increased risk of developing cancer, this was still only slightly higher than those with the lowest intake.</p>
<p>While the link between sweetener use and diseases, including cancer, is still controversial, it’s important to note that not all sweeteners are equal. While sweeteners such as aspartame and saccharin may be associated with ill health, not all sweeteners are. Stevia, produced from the <em>Stevia rebaudiana</em> plant, has been reported to be useful in controlling <a href="https://academic.oup.com/jn/article/148/7/1186S/5049670?login=true">diabetes and body weight</a>, and may also <a href="https://www.tandfonline.com/doi/full/10.3109/09637480903193049?casa_token=lO5FkbXzMEAAAAAA%3AhDdqp3moaBVdiKVBwE3xovSFl63vwVHpP2prqAEJveyAeFglbn_Z23BPXAkuUMdS27xSXbEnvW5c">lower blood pressure</a>. The naturally occurring sugar alcohol, xylitol, may also support the <a href="https://link.springer.com/article/10.1007/s00253-020-10708-7">immune system and digestion</a>. Both <a href="http://www.scielo.org.ar/scielo.php?pid=S1852-48342012000200003&script=sci_arttext&tlng=en">stevia</a> and <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010743.pub2/full">xylitol</a> have also been shown to protect from tooth decay, possibly because they kill bad oral bacteria.</p>
<p>So the important choice may be not the amount of sweetener you eat but the type you use.</p><img src="https://counter.theconversation.com/content/179709/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Brown has previously received funding from the EU Horizon 2020 scheme to study personalised approaches to food choices.</span></em></p>A study of over 100,000 people found aspartame and acesulfame K in particular may increase risk of developing cancer somewhat.James Brown, Associate Professor in Biology and Biomedical Science, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1725712022-01-05T13:45:41Z2022-01-05T13:45:41ZWhat’s the difference between sugar, other natural sweeteners and artificial sweeteners? A food chemist explains sweet science<figure><img src="https://images.theconversation.com/files/438548/original/file-20211220-15-4utuse.jpg?ixlib=rb-1.1.0&rect=349%2C445%2C4427%2C2663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sugar is just one of many flavor enhancers people and companies use to sweeten foods and beverages.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/food-service-tray-with-sugar-packets-salt-and-royalty-free-image/1000353706?adppopup=true">Marie LaFauci/Moment via Getty Images</a></span></figcaption></figure><p>A quick walk down the drink aisle of any corner store reveals the incredible ingenuity of food scientists in search of sweet flavors. In some drinks you’ll find sugar. A diet soda might have an artificial or natural low-calorie sweetener. And found in nearly everything else is high fructose corn syrup, the king of U.S. sweetness.</p>
<p>I am a <a href="https://chemistry.richmond.edu/faculty/knolin/">chemist who studies compounds found in nature</a>, and I am also a lover of food. With confusing food labels claiming foods and beverages to be diet, zero-sugar or with “no artificial sweeteners,” it can be confusing to know exactly what you are consuming.</p>
<p>So what are these sweet molecules? How can cane sugar and artificial sweeteners produce such similar flavors? First, it is helpful to understand how taste buds work.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/438556/original/file-20211220-50043-nhxa2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two girls licking lollipops." src="https://images.theconversation.com/files/438556/original/file-20211220-50043-nhxa2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438556/original/file-20211220-50043-nhxa2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438556/original/file-20211220-50043-nhxa2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438556/original/file-20211220-50043-nhxa2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438556/original/file-20211220-50043-nhxa2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438556/original/file-20211220-50043-nhxa2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438556/original/file-20211220-50043-nhxa2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You perceive sweet flavors when certain molecules bind to the taste buds on your tongue.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/two-girls-eating-lollipops-outdoors-royalty-free-image/724286183?adppopup=true">Bomin Jeong/EyeEm via Getty Images</a></span>
</figcaption>
</figure>
<h2>Taste buds and chemistry</h2>
<p>The “<a href="https://theconversation.com/that-neat-and-tidy-map-of-tastes-on-the-tongue-you-learned-in-school-is-all-wrong-44217">taste map</a>” – the idea that you taste different flavors on different parts of your tongue – is far from the truth. People are able to taste all flavors anywhere there are taste buds. So what’s a taste bud?</p>
<p>Taste buds are areas on your tongue that contain dozens of taste <a href="http://www.vivo.colostate.edu/hbooks/pathphys/digestion/pregastric/taste.html">receptor cells</a>. These cells can detect the five flavors – sweet, sour, salty, bitter and umami. When you eat, food molecules are dissolved in saliva and then washed across the taste buds, where they bind to the different taste receptor cells. Only molecules with certain shapes can bind to certain receptors, and this produces the perception of different flavors. </p>
<p>Molecules that taste sweet bind to specific proteins on the taste receptor cells called <a href="https://teachmephysiology.com/biochemistry/molecules-and-signalling/g-protein/">G-proteins</a>. When a molecule binds these G-proteins, it triggers a series of signals that are sent to the brain where it is interpreted as sweet. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/438560/original/file-20211220-23354-1etdb6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram of a glucose molucule." src="https://images.theconversation.com/files/438560/original/file-20211220-23354-1etdb6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438560/original/file-20211220-23354-1etdb6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=649&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438560/original/file-20211220-23354-1etdb6b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=649&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438560/original/file-20211220-23354-1etdb6b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=649&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438560/original/file-20211220-23354-1etdb6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=815&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438560/original/file-20211220-23354-1etdb6b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=815&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438560/original/file-20211220-23354-1etdb6b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=815&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Glucose is the simplest of sugars and is a circle of carbon atoms with oxygen and hydrogen atoms attached to the ring.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Alpha-D-Glucopyranose.svg#/media/File:Alpha-D-Glucopyranose.svg">NEUROtiker/WikimediaCommons</a></span>
</figcaption>
</figure>
<h2>Natural sugars</h2>
<p>Natural sugars are types of carbohydrates known as <a href="https://www.biologyonline.com/dictionary/saccharide">saccharides</a> that are made of carbon, oxygen and hydrogen. You can imagine sugars as rings of carbon atoms with pairs of oxygen and hydrogen attached to the outside of the rings. The oxygen and hydrogen groups are what make sugar sticky to the touch. They behave like Velcro, sticking to the oxygen and hydrogen pairs on other sugar molecules.</p>
<p>The simplest sugars are single-molecule sugars called monosaccharides. You’ve probably heard of some of these. Glucose is the most basic sugar and is mostly made by plants. <a href="https://foodinsight.org/what-is-fructose/">Fructose</a> is a sugar from fruit. <a href="https://chem.libretexts.org/Bookshelves/Biological_Chemistry/Supplemental_Modules_(Biological_Chemistry)/Carbohydrates/Monosaccharides/Galactose">Galactose</a> is a sugar in milk. </p>
<p>Table sugar – or <a href="https://www.sugar.org/sugar/what-is-sugar/">sucrose</a>, which comes from sugar cane – is an example of a dissacharide, a compound made of two <a href="https://www.biologyonline.com/dictionary/monosaccharide">monosaccharides</a>. Sucrose is formed when a <a href="https://sphweb.bumc.bu.edu/otlt/mph-modules/ph/ph709_basiccellbiology/PH709_BasicCellBIology3.html">glucose molecule</a> and a <a href="https://sphweb.bumc.bu.edu/otlt/mph-modules/ph/ph709_basiccellbiology/PH709_BasicCellBIology3.html">fructose molecule</a> join together. Other common dissacharides are lactose from milk and maltose, which comes grains.</p>
<p>When these sugars are eaten, the body processes each of them slightly differently. But eventually they are broken down into molecules that your body converts into energy. The amount of energy from sugar – and all food – is measured in calories.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/438557/original/file-20211220-15-88xiit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An aisle of soda." src="https://images.theconversation.com/files/438557/original/file-20211220-15-88xiit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438557/original/file-20211220-15-88xiit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438557/original/file-20211220-15-88xiit.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438557/original/file-20211220-15-88xiit.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438557/original/file-20211220-15-88xiit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438557/original/file-20211220-15-88xiit.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438557/original/file-20211220-15-88xiit.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">High fructose corn syrup is the main sweetener for many processed foods and drinks.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sanibel-island-jerrys-foods-grocery-store-soda-aisle-news-photo/1189380097?adppopup=true">Jeff Greenberg/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<h2>High fructose corn syrup</h2>
<p>High fructose corn syrup is a staple of U.S. foods, and this hybrid sugar sweetener needs a category all on its own. <a href="https://foodinsight.org/what-is-high-fructose-corn-syrup/">High fructose corn syrup</a> is made from corn starch – the main carbohydrate found in corn. Corn starch is made of <a href="http://www.vivo.colostate.edu/hbooks/pathphys/digestion/basics/polysac.html">thousands of glucose molecules</a> bonded together. At an industrial scale, the starch is broken into individual glucose molecules using <a href="https://www.fda.gov/food/food-additives-petitions/high-fructose-corn-syrup-questions-and-answers">enzymes</a>. This glucose is then treated with a second enzyme to convert some of it into fructose. Generally, high fructose corn syrup is roughly <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/high-fructose-corn-syrup">42%-55% fructose</a>.</p>
<p>This blend is sweet and cheap to produce but has a high calorie content. As with other natural sugars, <a href="https://theconversation.com/sugar-isnt-just-empty-fattening-calories-its-making-us-sick-49788">too much high fructose corn syrup is bad for your health</a>. And since most processed foods and drinks are packed full of the stuff, it is easy to consume too much. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/438561/original/file-20211220-23354-o8hpsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A small green plant in a pot." src="https://images.theconversation.com/files/438561/original/file-20211220-23354-o8hpsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438561/original/file-20211220-23354-o8hpsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=790&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438561/original/file-20211220-23354-o8hpsb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=790&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438561/original/file-20211220-23354-o8hpsb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=790&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438561/original/file-20211220-23354-o8hpsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=993&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438561/original/file-20211220-23354-o8hpsb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=993&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438561/original/file-20211220-23354-o8hpsb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=993&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A chemical in the stevia plant also produces sweet flavors.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Stevia_rebaudiana_(potted_plant).jpg#/media/File:Stevia_rebaudiana_(potted_plant).jpg">Gabriela F. Ruellan/WikimediaCommons</a></span>
</figcaption>
</figure>
<h2>Natural nonsugar sweeteners</h2>
<p>The second category of sweeteners could be defined as natural nonsugar sweeteners. These are food additives such as stevia and monk fruit, as well as natural sugar alcohols. These molecules aren’t sugars, but they can still bind to the sweet receptors and therefore taste sweet.</p>
<p><a href="https://dx.doi.org/10.1097%2FNT.0000000000000094">Stevia</a> is a molecule that comes from the leaves of the <em>Stevia redaudiana</em> plant. It contains “sweet” molecules that are much larger than most sugars and have three glucose molecules attached to them. These molecules are 30 to 150 times sweeter than glucose itself. The sweet molecules from monk fruit are similar to stevia and 250 times sweeter than glucose. </p>
<p>The human body has a really hard time breaking down both stevia and monk fruit. So even though they’re both really sweet, you don’t get any calories from eating them.</p>
<p><a href="https://www.ynhh.org/services/nutrition/sugar-alcohol.aspx">Sugar alcohols</a>, like sorbital, for example, are not as sweet as sucrose. They can be found in a variety of foods, including pineapples, mushrooms, carrots and seaweed, and are often added to diet drinks, sugar-free chewing gum and many other foods and drinks. Sugar alcohols are made of chains of carbon atoms instead of circles like normal sugars. While they are composed of the same atoms as the sugars, sugar alcohols are not absorbed well by the body so they are considered low-calorie sweeteners.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/438555/original/file-20211220-50538-tkxi4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Packets of Splenda, Sweet'N Low and Equal." src="https://images.theconversation.com/files/438555/original/file-20211220-50538-tkxi4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438555/original/file-20211220-50538-tkxi4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=237&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438555/original/file-20211220-50538-tkxi4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=237&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438555/original/file-20211220-50538-tkxi4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=237&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438555/original/file-20211220-50538-tkxi4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=298&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438555/original/file-20211220-50538-tkxi4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=298&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438555/original/file-20211220-50538-tkxi4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=298&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Chemists have developed a number of lab-made chemicals that taste sweet and are sold as no-sugar sweeteners.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:No-Calorie-Sweetener-Packets.jpg#/media/File:No-Calorie-Sweetener-Packets.jpg">Evan Amos/WikimediaCommons</a></span>
</figcaption>
</figure>
<h2>Artificial sweeteners</h2>
<p>The third way to make something sweet is to add <a href="https://dx.doi.org/10.1007%2Fs13197-011-0571-1">artificial sweeteners</a>. These chemicals are produced in labs and factories and are not found in nature. Like all things that taste sweet, they do so because they can bind to certain receptors in taste buds. </p>
<p>[<em>Over 140,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140ksignup">Sign up today</a>.] </p>
<p>So far, the U.S. Food and Drug Administration has <a href="https://www.fda.gov/food/food-additives-petitions/additional-information-about-high-intensity-sweeteners-permitted-use-food-united-states">approved six artificial sweeteners</a>. The most well known are probably saccharin, aspartame and sucralose – better known as Splenda. Artificial sweeteners all have different chemical formulas. Some resemble natural sugars while others are radically different. They are usually many times sweeter than sugar – saccharin is an incredible 200 to 700 times sweeter than table sugar – and some of them are hard for the body to break down.</p>
<p>While a sweet dessert may be a simple pleasure for many, the chemistry of how your taste buds perceive sweetness is not so simple. Only molecules with the perfect combination of atoms taste sweet, but bodies deal with each of these molecules differently when it comes to calories. </p>
<p></p><hr> <p></p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/439239/original/file-20220103-48418-1p7tcpi.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/439239/original/file-20220103-48418-1p7tcpi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439239/original/file-20220103-48418-1p7tcpi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439239/original/file-20220103-48418-1p7tcpi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439239/original/file-20220103-48418-1p7tcpi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439239/original/file-20220103-48418-1p7tcpi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439239/original/file-20220103-48418-1p7tcpi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
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<p><em>This article is part of a series examining sugar’s effects on human health and culture. <a href="https://theconversation.com/us/topics/sugar-2022-114641">You can read the articles on theconversation.com.</a></em></p><img src="https://counter.theconversation.com/content/172571/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristine Nolin does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Just because something is sweet doesn’t necessarily mean it is sugary. There are a number of molecules that taste sweet. To understand how and why takes a little bit of chemistry.Kristine Nolin, Associate Professor of Chemistry, University of RichmondLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1711882021-11-16T13:11:59Z2021-11-16T13:11:59ZCompanies are pushing sweetened drinks to children through advertising and misleading labels – and families are buying<figure><img src="https://images.theconversation.com/files/432039/original/file-20211115-25-kfn3p9.jpg?ixlib=rb-1.1.0&rect=63%2C31%2C2054%2C1378&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are dozens of options for children's drinks in most supermarkets. Choosing the healthy options is difficult.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mother-and-daughter-shopping-in-supermarket-royalty-free-image/1210359370?adppopup=true"> ferrantraite/E+ via Getty Images</a></span></figcaption></figure><p>Walking down the drink aisle at any grocery store will take you past hundreds of drinks, from sodas to sports drinks. Children’s drink sections are filled with a vast array of products as well. Most parents want to buy what is healthy for their children, but with so many options in the drink aisle, it can be difficult to make the right choice – especially when drink companies make it hard to do so.</p>
<p>I am a researcher at the <a href="https://uconnruddcenter.org/">UConn Rudd Center for Food Policy and Health</a>, and <a href="https://uconnruddcenter.org/person/frances-fleming-milici/">I’ve studied how food is marketed to kids and parents</a> of young children for more than a decade. Companies <a href="http://sugarydrinkfacts.org/resources/FACTS2019.pdf">spend huge sums advertising</a> children’s drinks with added sweeteners. Despite the sweeteners, companies market these drinks as healthy choices for kids.</p>
<p>In a <a href="https://doi.org/10.1016/j.amepre.2021.06.013">recent study</a> I co-authored with colleagues at the Rudd Center, we examined advertising and purchasing trends of children’s drinks from 2006 to 2017. We found, not surprisingly, that ad spending drove people to buy the drinks being advertised. The problem is that companies spend tens of millions of dollars per year promoting sweetened children’s drinks. This study was one of the first to <a href="https://www.sciencedirect.com/science/article/pii/S0749379721004098">directly tie that ad spending to household purchases</a> of unhealthy beverages. In addition, we also found that households with lower incomes were more responsive to this advertising and purchased more sweetened children’s fruit drinks than households with higher incomes.</p>
<p>Decades of research has shown that drinking too many sugary drinks can <a href="https://doi.org/10.1542/peds.2019-0282">raise the risk of heart disease, high blood pressure, type 2 diabetes and tooth decay</a>. Advertising appears to increase companies’ profits, but not children’s health.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/C3krPh_fTUA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Many drink commercials are aimed at children.</span></figcaption>
</figure>
<h2>Advertising and demographics</h2>
<p>The food and beverage industry spends nearly <a href="https://uconnruddcenter.org/research/food-marketing/">US$14 billion per year</a> advertising their products, and around 80% of the spending promotes highly processed foods. This includes “fruit drinks” – fruit-flavored beverages with not much juice, like SunnyD – and flavored waters like Capri Sun Roarin’ Waters. Both are marketed as being for children, but they contain ingredients <a href="https://healthydrinkshealthykids.org/app/uploads/2019/09/HER-HealthyBeverageTechnicalReport.pdf">health experts say kids should not consume</a>, including <a href="http://sugarydrinkfacts.org/resources/FACTS2019.pdf">added sugar, diet sweeteners or both</a>. </p>
<p>In 2018, <a href="http://sugarydrinkfacts.org/resources/FACTS2019.pdf">companies spent $21 million advertising</a> these sweetened drinks across all media in the U.S. They spent $18.5 million of that promoting sweetened children’s drinks through TV ads. This was far more than the $13.6 million companies spent on TV ads for unsweetened children’s drinks like 100% juices and juice and water blends.</p>
<p>Marketing sugary drinks directly to young kids is another tactic that companies use.</p>
<p>In 2018, children 2 to 5 years old saw <a href="http://sugarydrinkfacts.org/resources/FACTS2019.pdf">twice as many TV ads for sugary children’s drinks</a> than they did for unsweetened juice products. Some fruit drink brands also disproportionately targeted advertising to <a href="http://sugarydrinkfacts.org/resources/FACTS2019.pdf">Spanish-speaking households as well as Black children</a>. Even packaging is aimed at kids, with sweetened drinks featuring more <a href="http://sugarydrinkfacts.org/resources/FACTS2019.pdf">cartoons, brand characters and wacky names</a> compared to drinks without added sweeteners.</p>
<p>This advertising can undermine parents’ efforts to serve healthy drinks.</p>
<p>To measure the effect of this advertising, my colleagues and I looked at 12 years of monthly purchase data. We found that <a href="https://doi.org/10.1016/j.amepre.2021.06.013">people living in households with lower incomes</a> purchased significantly more sweetened fruit drinks and fewer unsweetened juices than people in households with higher income. People in non-Hispanic Black and Hispanic households also purchased more sweetened fruit drinks than non-Hispanic white households. This matches research that shows that communities of color and lower-income communities drink relatively <a href="https://doi.org/10.1186/s40608-017-0178-9">more sugary drinks than other groups</a>, which contributes to disparities in diet-related disease.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/432075/original/file-20211115-21-ok6jsj.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A graph showing large increases in price for unsweetened juices and flavored waters but only small increases for fruit drinks." src="https://images.theconversation.com/files/432075/original/file-20211115-21-ok6jsj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432075/original/file-20211115-21-ok6jsj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=521&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432075/original/file-20211115-21-ok6jsj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=521&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432075/original/file-20211115-21-ok6jsj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=521&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432075/original/file-20211115-21-ok6jsj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=655&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432075/original/file-20211115-21-ok6jsj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=655&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432075/original/file-20211115-21-ok6jsj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=655&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Prices for all children’s drinks increased over the study period, but sweetened ‘fruit drinks’ like SunnyD saw by far the smallest price increase.</span>
<span class="attribution"><span class="source">Choi, Andreyeva, Fleming-Milici & Harris, 2021</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Lower prices</h2>
<p>Advertising is one thing that drives consumption, but pricing strategies also add to demographic differences in purchases.</p>
<p>I’ve conducted focus groups with parents of young children, and they say they’d like to purchase 100% juice. But when these parents compare prices in the supermarket, they end up buying cheaper sweetened drinks instead of the healthier beverages they intended to buy.</p>
<p>The recent study shows that such price disparities are getting worse. Over the 12 years we covered, prices increased for all children’s drink types, but sweetened children’s fruit drinks increased by an average of just <a href="https://www.sciencedirect.com/science/article/pii/S0749379721004098">1 cent per ounce</a>, compared to the 4 cents-per-ounce increase of unsweetened juice products.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/432043/original/file-20211115-23-1pdrs24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A closeup of three Vitamin Water labels showing health claims." src="https://images.theconversation.com/files/432043/original/file-20211115-23-1pdrs24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432043/original/file-20211115-23-1pdrs24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=346&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432043/original/file-20211115-23-1pdrs24.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=346&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432043/original/file-20211115-23-1pdrs24.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=346&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432043/original/file-20211115-23-1pdrs24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=435&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432043/original/file-20211115-23-1pdrs24.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=435&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432043/original/file-20211115-23-1pdrs24.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=435&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Drinks like Vitaminwater are designed to look healthy despite large amounts of added sweeteners.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/EarnsCocaCola/68ef61041d8a4f9398040439a9e0385a/photo?Query=vitamin%20water&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=56&currentItemNo=0">AP Photo/Stephan Savoia, File</a></span>
</figcaption>
</figure>
<h2>Misleading labels</h2>
<p>Another way companies try to push sweetened drinks is to use labels that make them appear healthier than they really are.</p>
<p>This happens in two main ways. First, sweetened drink labels often <a href="https://doi.org/10.1016/j.jand.2020.08.009">highlight nutrition-related claims</a> – like “Vitamin C” or “Less sugar,” for example. Second, these drinks often use <a href="https://doi.org/10.2105/AJPH.2020.305621">pictures of fruit or words with no regulatory definitions</a> – like “water” and “natural.” Taken together, these tactics mask ingredients such as added sugars and diet sweeteners and convey the idea that these drinks are healthy choices, which likely contribute to sales. </p>
<p>Brands also often offer both sweetened and unsweetened drinks with <a href="http://sugarydrinkfacts.org/resources/FACTS2019.pdf">nearly identical packaging and claims</a>, so it is easy to see why parents <a href="https://doi.org/10.1111/ijpo.12791">misperceive what is in these drinks</a>. I challenge any reader to head down a children’s drink aisle in the supermarket and successfully separate the healthier drinks from the less healthy ones. </p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p>
<h2>What to do?</h2>
<p>Between the marketing, pricing and labels, it’s no wonder kids are drinking more sugary drinks. Overall, our research found that purchases of sweetened flavored waters increased by 68% from 2006 to 2017. Today, households with young children purchase <a href="https://www.sciencedirect.com/science/article/pii/S0749379721004098">three times as many ounces of sweetened fruit drinks as unsweetened juice</a>.</p>
<p>Reducing the amount of sweetened drinks kids consume when they are young could go a long way in keeping them healthy for a lifetime. Better <a href="https://bbbprograms.org/programs/all-programs/cfbai">industry self-regulation of advertising</a> is one way to reduce this overconsumption, but the U.S. Food and Drug Administration could also get involved by <a href="https://doi.org/10.2105/AJPH.2020.305621">mandating clear and consistent disclosures</a> of added sugars and diet sweeteners, as well as juice percentages, on packaging. Reducing disproportionate targeted marketing of sugary drinks to communities of color would be a step in the right direction, too.</p>
<p>If you care about the health of children, the goal should be to make the healthy choice the easy choice. Unfortunately, our research seems to show a trend in the opposite direction.</p><img src="https://counter.theconversation.com/content/171188/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fran Fleming-Milici receives funding from The Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.</span></em></p>A new study looked at advertising and purchase data for children’s drinks and suggests that ads and pricing strategies contribute to sweetened children’s drink purchases.Fran Fleming-Milici, Director of Marketing Initiatives, Rudd Center for Food Policy and Health, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1185712019-07-01T10:52:11Z2019-07-01T10:52:11ZSugar substitutes: Is one better or worse for diabetes? For weight loss? An expert explains<figure><img src="https://images.theconversation.com/files/280570/original/file-20190620-149814-17p8d8c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sugar and artificial sweeteners comes in many shapes and colors.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/flat-lay-composition-different-types-sugar-1057731923?studio=1">New Africa/Shutterstock.com</a></span></figcaption></figure><p>Wandering through the grocery store, it is easy to be overwhelmed by the numerous brands and health claims on the dozens of sugar substitutes. It can be particularly confusing for those with diabetes or pre-diabetes who must keep their blood sugar in check and control their weight. </p>
<p>With the <a href="https://www.who.int/news-room/fact-sheets/detail/diabetes">growing diabetes and obesity epidemic</a>, there has been increasing awareness around the use of added sugars in foods. The most recent edition of the <a href="https://health.gov/dietaryguidelines/2015/">U.S. Dietary Guidelines for Americans</a> recommends that added sugars should be kept to less than 10% of the calories consumed, which turns out to be roughly 270 calories per day. </p>
<p>This is because “added sugars” add sweetness or flavor but add very little nutritional value. Because of this trend, the food industry has embarked on a quest to find or develop the perfect substitute to replace sugar – with the same taste and none of the calories that lead to weight gain. </p>
<p>As a pharmacist who is also board certified in advanced diabetes management, I talk to patients every day about blood sugars and ways to help them take control of their diabetes. They often ask me whether the perfect substitute to sugar has been found. The short answer is no. Here is the long answer.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/281801/original/file-20190628-94716-tinmxq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/281801/original/file-20190628-94716-tinmxq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281801/original/file-20190628-94716-tinmxq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281801/original/file-20190628-94716-tinmxq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281801/original/file-20190628-94716-tinmxq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281801/original/file-20190628-94716-tinmxq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281801/original/file-20190628-94716-tinmxq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many artificial sweeteners are available at the grocery store.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/subang-jaya-malaysia-23rd-december-2017-781850755?studio=1">Zety Akhzar/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Sugar alcohols</h2>
<p>Sugar substitutes can be categorized into two main groups: sugar alcohols and high intensity sweeteners. The sugar alcohols include sorbitol, xylitol, lactitol, mannitol, erythritol and maltitol. <a href="https://www.fda.gov/food/food-additives-petitions/high-intensity-sweeteners">High-intensity sweeteners</a> include saccharin, aspartame, acesulfame potassium (Ace-K), sucralose, neotame, advantame, stevia, and Siraitia grosvenorii Swingle fruit extract (SGFE).</p>
<p><a href="http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/sugar-alcohols.html">Sugar alcohols</a> are often found in toothpaste, chewing gum, and some “sugar-free” foods. They are carbohydrates with a chemical structure that resembles sugar, but also the components that make them an alcohol. They are about 25-100% sweeter than sugar and have <a href="https://doi.org/10.1016/j.foodres.2019.03.019">a similar taste</a>. But here is the catch: They are not calorie free. Most have <a href="http://doi.org/10.1016/j.jand.2012.03.009">between 1.5 and two calories per gram</a>. Now compare the calorie count to sugar, also known as sucrose, which has four calories per gram – twice as much. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/281805/original/file-20190628-94708-lua3oo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/281805/original/file-20190628-94708-lua3oo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/281805/original/file-20190628-94708-lua3oo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=847&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281805/original/file-20190628-94708-lua3oo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=847&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281805/original/file-20190628-94708-lua3oo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=847&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281805/original/file-20190628-94708-lua3oo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1064&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281805/original/file-20190628-94708-lua3oo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1064&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281805/original/file-20190628-94708-lua3oo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1064&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Which foods have a low glycemic index and are better choices for those trying to control their blood sugar.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/chart-infographics-vector-drawn-glycemic-index-390100423?src=lLctBPmzaHfK2TKO97-FXw-1-5&studio=1">Irina Izograf</a></span>
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<p>Although sugar alcohols contain fewer calories, they will still increase a patient’s blood sugar, especially when eaten in excess. When compared to sugar, the effect is less dramatic though. This is because of how these molecules are processed in the body. We measure this using the glycemic index. </p>
<p>The glycemic index is a reference to how quickly a food is broken down and absorbed. The higher the number, the more quickly the food breaks down and the faster the sugar goes into the blood. Sucrose has a <a href="https://www.glycemicindex.com/">glycemic index</a> of 65; whereas sugar alcohols, like xylitol, have a glycemic index of around seven. This means that sugar alcohols are harder to digest, and cause a slower and lower increase in post-meal blood sugars – which is typically better for people with diabetes. Because sugar alcohols are harder for the body to break down though, some of them remain in the gut, and if a person consumes too much they may experience <a href="http://doi.org/10.1016/j.jand.2012.03.009">digestive complaints like</a> gas, cramping and diarrhea.</p>
<p>Here is the other downside to foods containing sugar alcohols: They often have <a href="http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/sugar-alcohols.html">higher quantities of fat or salt</a> to make up for the lower sugar content.</p>
<h2>Artificial sweeteners</h2>
<p>High-intensity sweeteners, are zero- or low-calorie alternatives to sugar. They are made from a variety of sources, and are 100 to 20,000 times as sweet as sugar. Some leave a bitter or metallic taste behind. Two newer substitutes – stevia and SGFE – come from plants and are at times referred to as “natural” substitutes. </p>
<p>According to the <a href="https://care.diabetesjournals.org/content/42/Supplement_1">American Diabetes Association 2019 guidelines</a>, the use of high-intensity sweeteners may decrease calorie and carbohydrate intake. However, you cannot replace these “free” calories with calories from other food sources, you will lose or the benefits on blood sugar control and weight loss. </p>
<p>Researchers have seen this in some of the studies on high-intensity sweeteners. Some of the trials show <a href="http://doi.org/10.1503/cmaj.161390">no difference or even a possible increase in weight</a>. But in other studies where intake of food is better regulated and patients don’t replace these free calories with other high-caloric foods, <a href="http://doi.org/10.3945/ajcn.113.082826">the weight loss is maintained</a>. </p>
<h2>The takeaway</h2>
<p>All sugar substitutes are labeled as food additives and are under the regulation of the U.S. Food and Drug Administration. The latest trend has been labeling some of the sugar substitutes as “derived from plants” or “natural.” That does not necessarily mean that these are safer or more effective in blood sugar control or weight loss. If it is used in excess, side effects such as bloating or diarrhea may still result. </p>
<p>Several concerns by researchers have been raised about high-intensity sweeteners – saccharin and aspartame – and cancer. To date, the National Cancer Institute has concluded that there is no clear evidence that any of the high-intensity sweeteners is <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/artificial-sweeteners-fact-sheet">associated with an increased risk of cancer</a>. </p>
<p>As a pharmacist specializing in advanced diabetes, I talk to patients every day about how to control their blood sugar level and their diabetes. There are three main ways to do that: medication, increased activity and diet. The last two are probably more important in the long run. </p>
<p>If diet and activity level never change, it is really hard to help patients bring their blood sugars down. Medication after medication will likely have to be added. With this comes the potential for side effects. So if I can persuade patients to make changes to their diet, like switching to a beverage with a sugar substitute, it makes a huge difference in helping to control blood sugars and the dose of medications.</p>
<p>The overall focus for diabetes management should be on reducing the consumption of sugar-sweetened beverages and foods. If you can switch one of these sugar-sweetened products to a food that has a high-intensity sugar substitute, that is better. But best of all is consuming <a href="https://care.diabetesjournals.org/content/42/Supplement_1">food and drinks that are not highly processed</a> and do not have added sugars.</p><img src="https://counter.theconversation.com/content/118571/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jamie Pitlick does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is a huge variety of sugar substitutes available. What’s the difference? Is one better for controlling blood sugar levels for diabetes? Is one better for individuals trying to lose weight?Jamie Pitlick, Associate Professor of Pharmacy Practice , Drake UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1134552019-04-23T20:13:23Z2019-04-23T20:13:23ZSickly sweet or just right? How genes control your taste for sugar<figure><img src="https://images.theconversation.com/files/270320/original/file-20190423-15218-9to8i9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Genes not only influence how sweet you think something is, but also how much sugary food you eat.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/123816682?src=AXenF6GhIp4jrizZ5_Awdg-1-14&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>You might love sugary doughnuts, but your friends find them too sweet and only take small nibbles. That’s partly because your genes influence how you perceive sweetness and how much sugary food and drink you consume.</p>
<p>Now our <a href="https://academic.oup.com/ajcn/advance-article-abstract/doi/10.1093/ajcn/nqz043/5475742?redirectedFrom=fulltext">recently published study</a> shows a wider range of genes at play than anyone thought. In particular, we suggest how these genes might work with the brain to influence your sugar habit.</p>
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Read more:
<a href="https://theconversation.com/fact-or-fiction-is-sugar-addictive-73340">Fact or fiction – is sugar addictive?</a>
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<h2>What we know</h2>
<p>When food touches our taste buds, taste receptors produce a signal that travels along taste nerves to the brain. This generates a sensation of flavour and helps us decide if we like the food.</p>
<p>Genetic research in the past decade has largely focused on genes for sweet taste receptors and whether variation in these genes influences how sensitive we are to sweetness and how much sugar we eat and drink. </p>
<p><a href="https://doi.org/10.1017/thg.2015.42">Our previous study</a> showed genetics accounts for 30% of how sweet we think sugars or artificial sweeteners are. However, at the time, we didn’t know the exact genes involved.</p>
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Read more:
<a href="https://theconversation.com/curious-kids-how-do-tongues-taste-food-103744">Curious Kids: how do tongues taste food?</a>
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<h2>What our latest study found</h2>
<p>Our new study looked at data from 176,867 people of European ancestry from Australia, the US and UK.</p>
<p>We measured how sweet 1,757 Australians thought sugars (glucose and fructose) and artificial sweeteners (aspartame and <a href="https://pubchem.ncbi.nlm.nih.gov/compound/neohesperidin_dihydrochalcone">neohesperidin dihydrochalcone</a>) were. We also looked at how sweet 686 Americans thought sucrose was and whether they liked its taste. </p>
<p>We also calculated the daily intake of dietary sugars (monosaccharide and disaccharide sugars found in foods such as fruit, vegetables, milk and cheese) and sweets (lollies and chocolates) from 174,424 British people of European descent in the <a href="https://www.ukbiobank.ac.uk/">UK Biobank</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/270326/original/file-20190423-15221-1hw5opp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/270326/original/file-20190423-15221-1hw5opp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/270326/original/file-20190423-15221-1hw5opp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/270326/original/file-20190423-15221-1hw5opp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/270326/original/file-20190423-15221-1hw5opp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/270326/original/file-20190423-15221-1hw5opp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/270326/original/file-20190423-15221-1hw5opp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/270326/original/file-20190423-15221-1hw5opp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">How many lollies do you eat a day? The researchers combined these types of questions with genome analysis to find links between sugar intake and people’s genes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1092965624?src=cL9zC9-ie-rJm9Emlw2ZFw-1-29&size=medium_jpg">from shutterstock.com</a></span>
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<p>Then we looked at the associations between millions of genetic markers across the whole genome and the perception of sweet taste and sugar intake, using a technique known as <a href="https://doi.org/10.1371/journal.pcbi.1002822">genome-wide association analysis</a>.</p>
<p>After a 15-year study, we showed that several genes (other than those related to sweet taste receptors) have a stronger impact on how we perceive sweetness and how much sugar we eat and drink.</p>
<p>These included an association between the <a href="https://ghr.nlm.nih.gov/gene/FTO">FTO gene</a> and sugar intake. Until now, this gene has been associated with obesity and related health risks. However, the effect is possibly driven <a href="https://www.cell.com/cell-metabolism/fulltext/S1550-4131(15)00475-1?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1550413115004751%3Fshowall%3Dtrue">not by FTO but nearby genes</a> whose protein products act in the brain to regulate appetite and how much energy we use.</p>
<p>We believe a similar situation may be influencing our sugar habit; genes near the FTO gene may be acting in the brain to regulate how much sugar we eat.</p>
<p>Our study suggests the important role the brain plays in how sweet we think something is and how much sugar we consume. That’s in addition to what we already know about the role of taste receptors in our mouth.</p>
<h2>Why we love sweet foods</h2>
<p>Our natural enjoyment of sweet foods could be an evolutionary hangover. Scientists believe being able to taste sweetness might have helped our ancestors identify energy-rich food, which played a critical part in their survival.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-ancient-obsession-with-food-humans-as-evolutionary-master-chefs-42899">Our ancient obsession with food: humans as evolutionary Master Chefs</a>
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<p>However, being able to taste sweetness doesn’t always mean you prefer to eat lots of sweet-tasting food. </p>
<p>So it looks like there are genes associated with the consumption of sweet foods, but not how sweet we think they are, such as FTO. There might also be genes that influence our perception of sweetness but not how likely we are to eat sweet food.</p>
<h2>Regional differences</h2>
<p>We were surprised to find genes for sweet taste receptors had no effect on either the ability to taste sweetness or on the amount of sugar consumed in our study, which looked only at large populations of European descent.</p>
<p>But by comparing people of different ancestries in the UK Biobank, we showed there was some variation between different populations that variations in genes for sweet taste receptors might explain. For instance, we found people of African descent tended to eat more sugar than people of European and Asian descent.</p>
<h2>So, how can we use this?</h2>
<p>Just like genetics can help explain <a href="https://theconversation.com/why-you-like-coffee-and-i-choose-tea-its-in-the-genes-106854">why some people choose tea over coffee</a>, our latest study helps explain why some people prefer sweet food. That could lead to personalised diets to improve people’s eating habits based on their genetics.</p>
<p>However, genetics is not the only factor to influence your taste for sugary foods and how much of these you eat or drink. So you can’t always blame your genes if you’ve ever tried to quit sugary drinks or snacks and failed.</p><img src="https://counter.theconversation.com/content/113455/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel Liang-Dar Hwang is affiliated with The University of Queensland and QIMR Berghfoer Medical Research Institute. </span></em></p>People with a sweet tooth can (partly) blame their genes for their sugar habit. New research shows how the brain also gets involved.Daniel Liang-Dar Hwang, Postdoctoral Researcher, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/961812018-05-17T10:42:12Z2018-05-17T10:42:12ZDiet soda may be hurting your diet<figure><img src="https://images.theconversation.com/files/218510/original/file-20180510-34027-134a0es.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Coca-Cola is the world's most popular carbonated soft drink. The original is made with sugar, but the others contain artificial sweeteners that are now linked to a rise in obesity and diabetes.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/230138068?src=NUy_997g4GskZiRl7oIRGQ-1-80&size=huge_jpg">By Chones/shutterstock.com</a></span></figcaption></figure><p>Artificial sweeteners are everywhere, but the jury is still out on whether these chemicals are harmless. Also called non-nutritive sweeteners, these can be synthetic – such as saccharin and aspartame – or naturally derived, such as steviol, which comes from the Stevia plant. To date, the U.S. Food and Drug Administration has approved <a href="https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm397725.htm">six types of artificial and two types of natural non-nutritive sweeteners</a> for use in food. </p>
<p>That’s been great news for those working hard to curb their sugar consumption. <a href="https://doi.org/10.3945/ajcn.111.030833">Aspartame</a>, for example, is found in more than 6,000 foods worldwide, and about 5,000-5,500 tons are consumed every year in the United States alone. </p>
<p>The American Diabetes Association – the most well-respected professional group focusing on diabetes – <a href="http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/what-can-i-drink.html">officially recommends diet soda as an alternative</a> to sugar-sweetened beverages. To date, seven U.S. municipalities have imposed a sugary beverage tax to discourage consumption.</p>
<p>However, recent medical studies suggest that policymakers eager to implement a soda tax may also want to include diet drinks because these sweeteners may be contributing to chronic diabetes and cardiovascular diseases as well.</p>
<h2>Why are these sweeteners calorie-free?</h2>
<p>The key to these virtually calorie-free sweeteners is that they are not broken down during digestion into natural sugars like glucose, fructose and galactose, which are then either used for energy or converted into fat. </p>
<p>Non-nutritive sweeteners have different byproducts that are not converted into calories. Aspartame, for example, undergoes a different metabolic process that doesn’t yield simple sugars. Others such as saccharin and sucralose are not broken down at all, but instead are absorbed directly into the bloodstream and excreted in the urine. </p>
<p>Theoretically, these sweeteners should be a “better” choice than sugar for diabetics. Glucose stimulates release of insulin, a hormone that regulates blood sugar levels. Type 2 diabetes occurs when the body no longer responds as well to insulin as it should, leading to higher levels of glucose in the blood that damages the nerves, kidneys, blood vessels and heart. Since non-nutritive sweeteners aren’t actually sugar, they should sidestep this problem.</p>
<h2>Artificial sweeteners, your brain and your microbiome</h2>
<p>However, there is growing evidence over the last decade that these sweeteners can alter healthy metabolic processes in other ways, specifically in the gut. </p>
<p>Long-term use of these sweeteners has <a href="https://doi.org/10.2337/dc08-1799">been associated with a higher risk of Type 2 diabetes</a>. Sweeteners, such as saccharin, have been shown to <a href="http://doi.org/10.1038/nature13793">change the type and function of the gut microbiome</a>, the community of microorganisms that live in the intestine. Aspartame <a href="https://doi.org/10.1139/apnm-2016-0346">decreases the activity of a gut enzyme</a> that is normally protective against Type 2 diabetes. Furthermore, this response may be exacerbated by the “mismatch” between the body perceiving something as tasting sweet and the expected associated calories. The greater the discrepancy between the sweetness and actual caloric content, the <a href="http://doi.org/10.1016/j.cub.2017.07.018">greater the metabolic dysregulation</a>.</p>
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<p>Sweeteners have also been shown to change brain activity associated with eating sweet foods. A functional MRI exam, which studies brain activity by measuring blood flow, has shown that sucralose, compared to regular sugar, <a href="https://doi.org/10.1016/j.appet.2011.12.001">decreases activity in the amygdala</a>, a part of the brain involved with taste perception and the experience of eating. </p>
<p>Another study revealed that longer-term and higher diet soda consumption are linked to <a href="https://doi.org/10.1016/j.physbeh.2012.05.006">lower activity in the brain’s “caudate head,”</a> a region that mediates the reward pathway and is necessary for generating a feeling of satisfaction. Researchers have hypothesized that this decreased activity could lead a diet soda drinker to compensate for the lack of pleasure they now derive from the food by increasing their consumption of all foods, not just soda. </p>
<p>Together these cellular and brain studies may explain why people who consume sweeteners still have a <a href="https://doi.org/10.1371/journal.pone.0167241">higher risk of obesity</a> than individuals who don’t consume these products. </p>
<p><a href="https://doi.org/10.1503/cmaj.161390">As this debate on the pros and cons of these sugar substitutes rages on</a>, we must view these behavioral studies with a grain of salt (or sugar) because many diet soda drinkers – or any health-conscious individual who consumes zero-calorie sweeteners – already has the risk factors for obesity, diabetes, hypertension or heart disease. Those who are already overweight or obese may turn toward low-calorie drinks, making it look as though the diet sodas are causing their weight gain.</p>
<p>This same group may also be less likely to moderate their consumption. For example, those people may think that having a diet soda multiple times a week is much healthier than drinking one case of soda with sugar.</p>
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<p>These findings signal that consumers and health practitioners all need to check our assumptions about the health benefits of these products. Sweeteners are everywhere, from beverages to salad dressing, from cookies to yogurt, and we must recognize that there is no guarantee that these chemicals won’t increase the burden of metabolic diseases in the future. </p>
<p>As a physician of internal medicine specializing in general prevention and public health, I would like to be able to tell my patients what the true risks and benefits are if they drink diet soda instead of water. </p>
<p>Legislators considering soda taxes to encourage better dietary habits perhaps should think about including foods with non-nutritive sweeteners. Of course, there is an argument to be made for being realistic and pursuing the lesser of two evils. But even if the negative consequences of sugar substitutes doesn’t sway our tax policy – for now – at least the medical community should be honest with the public about what they stand to lose or gain, consuming these foods. </p>
<p><a href="https://theconversation.com/las-bebidas-light-pueden-perjudicar-tu-dieta-98534"><em>Leer en español</em></a>.</p><img src="https://counter.theconversation.com/content/96181/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eunice Zhang does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Mounting evidence suggests that artificial sweeteners are linked to chronic health problems like obesity and diabetes. Should there be a tax on these foods?Eunice Zhang, Clinical Instructor, University of California, Los AngelesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/953142018-04-23T11:54:45Z2018-04-23T11:54:45ZArtificial sweeteners linked to diabetes and obesity<figure><img src="https://images.theconversation.com/files/215908/original/file-20180423-133876-1y79zs6.jpg?ixlib=rb-1.1.0&rect=0%2C38%2C998%2C624&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/97352366?src=Xz2aWr1ZNrer_09w80dfcA-1-57&size=medium_jpg">MSPhotographic/Shutterstock.com</a></span></figcaption></figure><p>Many countries have introduced a <a href="https://www.beveragedaily.com/Article/2017/12/20/Sugar-taxes-The-global-picture-in-2017">sugar tax</a> in order to improve the health of their citizens.
As a result, food and drink companies are changing their products to include low and zero-calorie sweeteners instead of sugar. However, there is <a href="https://theconversation.com/artificial-sweeteners-may-make-you-fat-93452">growing evidence</a> that sweeteners may have health consequences of their own. </p>
<p>New <a href="https://plan.core-apps.com/eb2018/abstract/382e0c7eb95d6e76976fbc663612d58a">research</a> from the US, presented at the annual Experimental Biology conference in San Diego, found a link with consuming artificial sweeteners and changes in blood markers linked with an increased risk of obesity and type 2 diabetes in rats. Does this mean we need to ditch sweeteners as well as sugar?</p>
<p>Sweeteners are generally “non-nutritive” substances meaning we can’t use them for energy. Some of these compounds are entirely synthetic chemicals, produced to mimic the taste of sugar. These include saccharin, sucralose and aspartame. Others sweeteners are refined from chemicals found in plants, such as stevia and xylitol. Collectively, sweeteners are being <a href="https://www.sciencedaily.com/releases/2017/01/170110101625.htm">consumed in increasing amounts</a> with most diet or low-calorie food and drink containing some form of non-nutritive sweetener.</p>
<h2>Combating or fuelling the obesity crisis?</h2>
<p>Artificially sweetened foods and drinks have become popular largely due to the <a href="http://www.who.int/mediacentre/factsheets/fs311/en/">growing worldwide obesity crisis</a>. As sugar contains four calories per gram, sweet foods and drinks are normally highly calorific. In principle, by removing these calories we reduce energy intake and this helps to prevent weight gain. </p>
<p>Increasingly, however, evidence suggests that consuming artificially sweetened products might be associated with an <a href="https://www.karger.com/Article/FullText/484566">increased risk of being overweight or obese</a>, although this is controversial. If true, it suggests that using sweeteners is <a href="https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2008.284">fuelling, not fighting obesity</a>. Research has suggested that consuming lots of artificial sweeteners scrambles the bacteria in our gut, causing them to make our bodies <a href="https://www.nature.com/articles/nature13793">less tolerant to glucose</a>, the main building-block of sugar. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/artificial-sweeteners-may-make-you-fat-93452">Artificial sweeteners may make you fat</a>
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</em>
</p>
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<p>The new research, from the Medical College of Wisconsin and Marquette University, looked at some biological effects of sweeteners in rats and in cell cultures. They wanted to know if artificial sweeteners affect how food is used and stored. These are called metabolic changes and the research combined many different aspects of metabolism to build an overall picture. </p>
<p>The team also looked at the impact of sweeteners on blood vessel health by studying how these substances affect the cells that form the inner lining of blood vessels. </p>
<p>The scientists gave rats food that was high in either sugar (glucose or fructose) or calorie-free artificial sweeteners (aspartame or acesulfame potassium). After three weeks they saw significant negative changes in both groups of rats. These changes included the concentrations of blood lipids (fats). </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/215920/original/file-20180423-133853-1930vzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/215920/original/file-20180423-133853-1930vzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/215920/original/file-20180423-133853-1930vzy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/215920/original/file-20180423-133853-1930vzy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/215920/original/file-20180423-133853-1930vzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=464&fit=crop&dpr=1 754w, https://images.theconversation.com/files/215920/original/file-20180423-133853-1930vzy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=464&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/215920/original/file-20180423-133853-1930vzy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=464&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Artificial sweeteners change how the body processes fat.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/114601549?src=Stb7G29glJyT2KCiyw3f1g-1-11&size=huge_jpg">ADA_photo/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>They also found that acesulfame potassium, in particular, accumulated in the blood and harmed the cells that line blood vessels. The study authors state that these changes are “linked to obesity and diabetes”. These results suggest that consuming sweeteners change how the body processes fat and gets its energy at a cellular level.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-evidence-that-low-calorie-sweeteners-are-bad-for-your-health-81037">More evidence that low-calorie sweeteners are bad for your health</a>
</strong>
</em>
</p>
<hr>
<h2>Limit your intake</h2>
<p>What does this mean for the average consumer of artificial sweeteners? As the study was performed in animals and not humans it would be wrong to draw firm conclusions about what might happen in people. The findings of the study do, however, add to the growing body of research that suggests that sweeteners are not benign alternatives to sugar. </p>
<p>The European Food Safety Authority suggests <a href="https://www.efsa.europa.eu/en/topics/topic/sweeteners">a daily limit to most artificial sweeteners</a> of around five milligrams per kilogram of body weight, per day. With so many foods including artificial sweeteners now, it is relatively easy to reach this limit. </p>
<p>It is important to note that not all sweeteners are equal. This recent study focused on artificial sweeteners, like most of the research that has identified negative effects. Some sweeteners are associated with health benefits. </p>
<p>Stevia, for example, has been shown to <a href="https://www.ncbi.nlm.nih.gov/pubmed/20370653">improve blood pressure and glucose tolerance</a> while xylitol has been shown to help <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5320817/">prevent tooth decay</a>. This means that choosing the type of sweetener that you use may be more important than choosing a sweetener over sugar.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coke-life-lands-a-blow-against-sugar-but-its-worthy-credentials-could-still-be-trouble-31208">Coke Life lands a blow against sugar, but its worthy credentials could still be trouble</a>
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</em>
</p>
<hr>
<p>It is likely that the best advice is the blandest: everything in moderation. There is no such thing as good or bad food, only good or bad amounts. Maybe avoid consuming too much of either sugar or sweetener, especially in drinks.</p><img src="https://counter.theconversation.com/content/95314/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Brown previously received funding from an independent food manufacturer to consult on their use of non-nutritive sweeteners</span></em></p><p class="fine-print"><em><span>Alex Conner does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new study in rats adds to the evidence that artificial sweeteners may be bad for your health.James Brown, Senior Lecturer in Biology and Biomedical Science, Aston UniversityAlex Conner, Senior Lecturer in Biomedical Sciences, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/934522018-03-19T13:30:34Z2018-03-19T13:30:34ZArtificial sweeteners may make you fat<figure><img src="https://images.theconversation.com/files/210975/original/file-20180319-31621-15kfyty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/175095215?src=5gFmXuwfC7DpchyY6CBcxg-1-2&size=medium_jpg">Monika Wisniewska/Shutterstock</a></span></figcaption></figure><p>With nearly <a href="http://www.who.int/gho/ncd/risk_factors/overweight/en/">40% of the world’s population</a> now classified as obese, and <a href="http://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/">increasing evidence</a> pointing to sugar as the culprit, people are turning to foods that contain low-calorie sweeteners to give them the sweet taste they enjoy, without the risk of gaining weight. However, <a href="https://www.eurekalert.org/pub_releases/2018-03/tes-cls031418.php">new research</a> from George Washington University in the US suggests that artificial sweeteners may actually increase a person’s risk of becoming obese. </p>
<p>The obesity epidemic is caused by an increase in fat and sugar in people’s diets. Fat accumulation in obesity increases the chances of getting type 2 diabetes, heart conditions and cancer. As such, new guidelines from Public Health England encourage the public to buy <a href="https://www.gov.uk/government/news/plans-to-cut-excess-calorie-consumption-unveiled">lower calorie</a> and <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/604336/Sugar_reduction_achieving_the_20_.pdf">lower sugar</a> products. </p>
<p>So changing our diet to include low-calorie sweeteners, such as sucralose and aspartame, should be a good way to get all the sweet taste without any of the guilt. Instead, the new study suggests that eating these sweeteners could do the opposite and increase the chance of us accumulating fat in our bodies, in a “dose-dependent” fashion. In other words, the more artificial sweetener you consume, the more fat your body creates and stores. </p>
<h2>What they do to your body</h2>
<p>For many years, we have known that sweet substances (sugars or artificial sweeteners) bind to sensors in our mouth called “sweet-taste receptors”. These receptors send a message to our brain to tell us that we are eating something sweet. </p>
<p>In the last decade, these sensors have been found in other parts of our body, such as the <a href="https://www.sciencedirect.com/science/article/pii/S0022534711045137?via%3Dihub">bladder</a>, the <a href="https://www.physiology.org/doi/10.1152/ajplung.00490.2016">lungs</a> and even in <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0086454">bones</a>. This has raised questions about what effect sweeteners, and these sweet taste receptors, could be having inside our bodies. </p>
<p>The new research, results of which were presented at ENDO 2018, the 100th annual meeting of the Endocrine Society in Chicago, looks at the effect that artificial sweeteners have on the cells that make up our fat stores. These cells have a glucose transporter (a protein that helps glucose get into a cell) <a href="http://www.jbc.org/content/268/30/22243.long">called GLUT4</a> on their surface and, when we eat more sugar, the cells take up more glucose, accumulate more fat and become larger. </p>
<p>The researchers in this latest study found that the artificial sweetener, sucralose, commonly found in diet foods and drinks, increases GLUT4 in these cells and promotes the accumulation of fat. These changes are associated with an increased risk of becoming obese. </p>
<p>Indeed, the research studied a small number of obese people who consume artificial sweeteners and found that they had more of these fat cells and increased expression of genes associated with fat production. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/210977/original/file-20180319-31633-jzbi9i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/210977/original/file-20180319-31633-jzbi9i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210977/original/file-20180319-31633-jzbi9i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210977/original/file-20180319-31633-jzbi9i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210977/original/file-20180319-31633-jzbi9i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210977/original/file-20180319-31633-jzbi9i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210977/original/file-20180319-31633-jzbi9i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Artificial sweeteners may promote the accumulation of fat.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/312824243?src=-jzc4NSaYnbZ4XwbAbKw_w-1-11&size=medium_jpg">kurhan/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>No clear answer yet</h2>
<p>When consumed in low quantities, artificial sweeteners have been shown to <a href="https://www.ncbi.nlm.nih.gov/pubmed/12324283?dopt=Abstract&holding=npg">aid weight loss</a>, <a href="http://care.diabetesjournals.org/content/35/8/1798.long">improve metabolic conditions</a> and even <a href="https://www.physiology.org/doi/10.1152/ajplung.00490.2016">protect against injury during infection</a>. However, this new study suggests that, rather than keeping us healthy, artificial sweeteners, especially when consumed in larger doses, could be contributing to the obesity epidemic. </p>
<p>Given the limited number of studies on the subject – and that few studies compare low-calorie sweeteners with sugar – we do not yet have clear answers. However, with a supply of new, natural sweeteners on the market, such as stevia and monk fruit, we have plenty of them to choose from. These are based on fruit extracts and are aimed at providing a more natural approach to improving the tastiness of food and drink compared with their artificial counterparts. However, it’s too early to say whether these natural products are a safer option than artificial sweeteners or whether they, too, have the potential to increase the risk of obesity.</p><img src="https://counter.theconversation.com/content/93452/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Havovi Chichger has previously received funding from Diabetes UK and Wellcome Trust to study the effect of artificial sweeteners in the vasculature. </span></em></p>Sucralose increases the expression of genes linked with fat production.Havovi Chichger, Senior Lecturer, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/825762017-09-12T02:25:57Z2017-09-12T02:25:57ZHealth Check: should I replace sugar with artificial sweeteners?<figure><img src="https://images.theconversation.com/files/184108/original/file-20170831-24230-fay5cz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Artificial sweeteners pose their own problems. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>We know Australians are consuming too much sugar. The latest results from the <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4364.0.55.011main+features12011-12">Australian Bureau of Statistics</a> show 52% of the population are consuming more than is <a href="http://www.who.int/nutrition/publications/guidelines/sugars_intake/en/">recommended</a>, and this is affecting weight and dental health.</p>
<p>But criticism of sugar is so widespread that sugar in foods such as milk and fruit have also come under fire. We should be mindful it’s really added sugar we need to focus on. Whole foods such as fruit and milk come with many other beneficial components. Fruit also contains vitamins, fibre and various phytochemicals compared to other sources of sugar, such as soft drinks. And the amount of sugar we consume from whole foods is generally lower, since the amount of sugar per serve is lower. In the case of fruit, we are unlikely to eat multiple pieces of fruit in one go when consumed as whole fruit compared to when consumed as fruit juice. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-much-sugar-is-it-ok-to-eat-57345">Health Check: how much sugar is it OK to eat?</a>
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</em>
</p>
<hr>
<p>There’s now <a href="http://www.mdpi.com/2072-6643/9/7/701">evidence</a> to show much of the food we eat contains high levels of added sugar. Currently in Australia, there’s no requirement to label foods with the amount of sugar added. This can be tricky for consumers, given “sugar” on the label may appear under many different names. So if added sugar is something to avoid, should we look to alternatives like artificial sweeteners?</p>
<h2>Artificial sweeteners - friend or foe?</h2>
<p>Artificial sweeteners are food additives, also known as “intense sweeteners”. They have a sweetness level that is many times that of sugar and so can be used in small amounts in food and beverages. In Australia, the use of these food additives is regulated by <a href="http://www.foodstandards.gov.au/consumer/additives/intensesweetener/Pages/default.aspx">Australia New Zealand Food Standards Code</a>. </p>
<p>There are a range of intense sweeteners approved for use including acesulfame potassium (Ace K), aspartame, saccharin, sucralose and steviol glycosides. Food additives, including intense sweeteners, undergo a safety review before they’re permitted to be used in foods. This involves assessing whether there are any harmful effects from the additive, and modelling of potential consumption levels. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/184109/original/file-20170831-22218-jqtn15.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/184109/original/file-20170831-22218-jqtn15.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/184109/original/file-20170831-22218-jqtn15.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/184109/original/file-20170831-22218-jqtn15.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/184109/original/file-20170831-22218-jqtn15.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/184109/original/file-20170831-22218-jqtn15.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/184109/original/file-20170831-22218-jqtn15.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/184109/original/file-20170831-22218-jqtn15.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Artificial sweeteners don’t stop us craving sweet foods.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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</figure>
<p>While artificial sweeteners have been proposed as a <a href="https://www.ncbi.nlm.nih.gov/pubmed/22709780">strategy</a> for reducing energy intake and preventing weight gain, there is emerging evidence to suggest artificial sweeteners may not be as beneficial as some think. </p>
<p>Evidence for a role in weight gain prevention has been mixed (although conclusions seems to be influenced by the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015869/">source of funding</a>). </p>
<p>A recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/28716847">review</a> of 37 trials and cohort studies has shown that over the long term, use of artificial sweeteners may be associated with higher risk of metabolic syndrome (a collection of conditions that increase your risk of diabetes, stroke and heart disease) and type 2 diabetes. </p>
<p>There is also emerging evidence artificial sweeteners may adversely impact the <a href="https://www.ncbi.nlm.nih.gov/pubmed/27090230">gut microbiota</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/25231862">glucose tolerance</a>. But the existing studies in this area have mainly been conducted in animal models, so further work is required in human trials before recommendations can be made.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-five-sweeteners-and-what-they-mean-for-you-14928">Health check: five sweeteners and what they mean for you</a>
</strong>
</em>
</p>
<hr>
<p>A final concern with the use of artificial sweeteners relates to the fact that their use does not necessary help people change their taste preferences for sweetness. Therefore, they may not lead to changes in behaviours or desire for sweet foods and may lead to overconsumption <a href="https://www.ncbi.nlm.nih.gov/pubmed/25184369">elsewhere</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/184110/original/file-20170831-24230-h5dk5q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/184110/original/file-20170831-24230-h5dk5q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/184110/original/file-20170831-24230-h5dk5q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/184110/original/file-20170831-24230-h5dk5q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/184110/original/file-20170831-24230-h5dk5q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/184110/original/file-20170831-24230-h5dk5q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/184110/original/file-20170831-24230-h5dk5q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/184110/original/file-20170831-24230-h5dk5q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Unfortunately, the answer is the same as usual - eat more fruits, vegetables and whole foods.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>So it’s clear we need to reduce the consumption of added sugars in our diet. Artificial sweeteners are considered safe for consumption and may be an alternative. While there is emerging evidence around some health issues, we definitely need more robust evidence, particularly in human studies, before ruling them out.</p>
<p>But the best advice is to look at reducing your consumption of foods high in added sugars, which are commonly processed and packaged foods, and focus on <a href="https://www.ncbi.nlm.nih.gov/pubmed/26746178">dietary patterns</a> rich in core foods such as vegetables, legumes, fruit, wholegrains, lean meat, fish, nuts and dairy foods. </p>
<p>If you keep your intake of added sugar low, you should only need to use artificial sweeteners occasionally.</p><img src="https://counter.theconversation.com/content/82576/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah McNaughton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We know we need to cut back on sugar, and focussing on eating more whole foods can help change our desire for sweetness.Sarah McNaughton, Associate Professor, Institute for Physical Activity and Nutrition, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/758912017-04-18T06:08:46Z2017-04-18T06:08:46ZArtificial sweeteners are said to be ‘lite’ but they leave a heavy burden on your health<figure><img src="https://images.theconversation.com/files/165313/original/image-20170413-25886-1ucpien.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Diet drinks are even worse for our health than regular sugary sodas.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/tomhilton/29187714266">tomhilton/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Diet soda drinkers, beware. Recent epidemiological <a href="https://www.ncbi.nlm.nih.gov/pubmed/27044603">studies</a> have confirmed that the sweeteners used in diet sodas and other lite drinks increase the risk of type 2 diabetes.</p>
<p>Often asymptomatic, type 2 diabetes is <a href="http://ceed-diabete.org/en/diabetes/diabetes-and-complications/type-2-diabetes/">the most common form of diabetes</a>, and is most often found among people who are overweight and sedentary. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/28214853">Just published research results out of France</a> show that people who “always or almost always” add sweeteners to their drinks – in sachet or tablet form – had an 83% higher risk of developing diabetes than those who use them “never or rarely”. </p>
<p><a href="https://www.cancer.org/cancer/cancer-causes/aspartame.html">Aspartame</a>, the most commonly used sweetener, and, more recently, <a href="https://authoritynutrition.com/sucralose-good-or-bad/">sucralose</a> (aka Splenda), have been used to replace <a href="https://theconversation.com/fact-or-fiction-is-sugar-addictive-73340">sugar</a> in so-called “diet” sodas for over 30 years. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/165494/original/image-20170417-25898-91ysdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/165494/original/image-20170417-25898-91ysdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/165494/original/image-20170417-25898-91ysdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/165494/original/image-20170417-25898-91ysdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/165494/original/image-20170417-25898-91ysdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=487&fit=crop&dpr=1 754w, https://images.theconversation.com/files/165494/original/image-20170417-25898-91ysdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=487&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/165494/original/image-20170417-25898-91ysdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=487&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Not so pretty in pink.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/bjLFrW">Fort Greene Focus/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Even though the quantity of artificial sweeteners in our <a href="https://theconversation.com/fr/topics/alimentation-21911">diet</a> has increased massively in recent years as industrial manufacturers add them with growing abandon to not just drinks but also cereals, biscuits, cakes, low-calorie yogurts and even certain medicines, reliable and precise data on their health impacts are rare. </p>
<p>Such products are marketed as low-calorie alternatives that are therefore healthy. This perception encourages consumers to overuse sweeteners to avoid putting on weight. But, even in moderation, these additives can have negative effects on health. </p>
<p>Today, sweeteners are increasingly controversial, and suspected of contributing to weight gain and being carcinogenic. </p>
<p>This has <a href="https://www.ncbi.nlm.nih.gov/pubmed/26199070">independent researchers</a> across the world seeking to measure their real effects on health, particularly their impact on metabolic diseases. </p>
<h2>Increase risk of diabetes and cancer</h2>
<p>Our team at France’s <a href="http://cesp.inserm.fr/">Centre for Research in Epidemiology and Population Health</a> at Inserm, has been contributing to this growing body of health knowledge since 2012 through a research program on the risk factors for <a href="http://www.ameli-sante.fr/diabete-de-type-2.html">type 2 diabetes</a>.</p>
<p>The program’s findings suggest that sugar substitutes should be treated with the utmost caution. In February, <a href="https://www.ncbi.nlm.nih.gov/pubmed/28214853">we published a study</a> showing that the risk of diabetes increases with the consumption of artificial sweeteners. We had already shown that <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Consumption+of+artificially+and+sugar-sweetened+beverages+and+incident+type+2+diabetes+in+the+E3N-EPIC+Cohort.+The+American+journal+of+clinical+nutrition">this risk was higher with so-called “diet” drinks</a> than with regular sodas.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/28214853">Our research</a> is based on data from a cohort of nearly 100,000 French women in the Epidemiological Study of Women in National Education or <a href="http://www.e3n.fr">E3N</a>, one of the world’s few cohorts of this size.</p>
<p>This prospective cohort study has been monitoring the health of women who belong to the mutual health insurance company for French national education staff for the past 27 years. <a href="https://www.youtube.com/watch?v=qnofZ6efkOo">Initiated by epidemiologist Françoise Clavel-Chapelon</a>, the study aims to improve understanding of women’s health and their risks of developing chronic conditions, such as cancer or type 2 diabetes.</p>
<p>Participants have completed <a href="http://www.e3n.fr/images/Questionnaires_pdf/Questionnaire_8_alimentaire.pdf">detailed questionnaires</a> on their diets since 1993, giving full details of each food intake, including snacks and appetisers prior to the three main meals and evening snacks. This gives researchers precise <a href="http://www.e3n.fr/images/Questionnaires_pdf/Questionnaire_3_cahier_photos_BD.pdf">information, including pictures</a>, of both the foods and drinks consumed and the average nutritional intake for each woman. The study ended in 2007.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/165496/original/image-20170417-25865-1ayqmjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/165496/original/image-20170417-25865-1ayqmjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=335&fit=crop&dpr=1 600w, https://images.theconversation.com/files/165496/original/image-20170417-25865-1ayqmjn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=335&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/165496/original/image-20170417-25865-1ayqmjn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=335&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/165496/original/image-20170417-25865-1ayqmjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=421&fit=crop&dpr=1 754w, https://images.theconversation.com/files/165496/original/image-20170417-25865-1ayqmjn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=421&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/165496/original/image-20170417-25865-1ayqmjn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=421&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Standard glasses used to estimate the quantities of sugary, sweetened and artificially sweetened beverages consumed.</span>
<span class="attribution"><a class="source" href="http://www.e3n.fr/images/Questionnaires_pdf/Questionnaire_3_cahier_photos_BD.pdf">G.Fagherazzi</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Want a soda? Avoid diet</h2>
<p>Studying this data in 2013, our team was able to demonstrate for the first time a higher risk of diabetes associated with diet drinks rather than with regular sodas.</p>
<p>Of the 66,118 women followed during this project, 1,369 were diagnosed with type 2 diabetes. Our team modelled the risk of developing the disease depending on consumption of three types of drinks: regular sodas, artificially sweetened sodas and 100% pure fruit juice. We took into account other factors such as physical activity, body mass index and family history.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/27044603">Other studies</a> had already shown an increased risk of diabetes associated with high consumption of soda in general. </p>
<p>This time, we managed to distinguish between them. For example, at 1.5 litres per week (the equivalent of a large bottle), the risk of diabetes was 60% higher with diet drinks than with regular sugary drinks. These results are all the more striking considering that people then drank less sugar-free sodas than we do today. The average back then was about 328 ml of sugary drinks each week (about a can), and 568 ml of “diet” drinks.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/165495/original/image-20170417-25875-1r46avu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/165495/original/image-20170417-25875-1r46avu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=310&fit=crop&dpr=1 600w, https://images.theconversation.com/files/165495/original/image-20170417-25875-1r46avu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=310&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/165495/original/image-20170417-25875-1r46avu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=310&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/165495/original/image-20170417-25875-1r46avu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=390&fit=crop&dpr=1 754w, https://images.theconversation.com/files/165495/original/image-20170417-25875-1r46avu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=390&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/165495/original/image-20170417-25875-1r46avu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=390&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The solid line indicates type 2 diabetes risk according to the quantity consumed of: sugary drinks (left), sweetened drinks (centre), and fruit juice (right).</span>
<span class="attribution"><a class="source" href="http://ajcn.nutrition.org/content/97/3/517/F1.expansion.html">Guy Fagherazzi</a></span>
</figcaption>
</figure>
<p>Significantly, there was no increase in the risk of diabetes with 100% pure fruit juices, which are naturally sweetened products.</p>
<h2>Artificial sugar makes you feel hungry</h2>
<p>Recently, our team used the E3N study to look at women’s consumption of sweeteners in sachet or tablet form. <a href="https://www.ncbi.nlm.nih.gov/pubmed/28214853">In our latest study</a> we show that those who use them “always or almost always” had an 83% higher risk of developing diabetes than those who use them “never or rarely.” </p>
<p>Participants who used them regularly for more than ten years had a 110% higher risk than those who never or rarely used them, suggesting a cumulative effect over time.</p>
<p>The increase in risk persists when <a href="http://www.inserm.fr/dossiers-d-information/indice-de-masse-corporelle">body mass index</a> is taken into account, although it is slightly lower. It therefore appears that sweeteners have a direct effect on the risk of diabetes, even if being overweight is also a risk factor.</p>
<p>From a physiological point of view, the mechanism behind these results is still far from clear. One hypothesis is that people who consume a lot of sweeteners have a greater appetite for sugar, coupled with a tendency to overeat in general. </p>
<p>Sweeteners <a href="https://www.ncbi.nlm.nih.gov/pubmed/27085864">are thought to increase the feeling of hunger</a> or to activate the T1R2/T1R3 receptors, which detect a wide variety of chemically and structurally diverse sweet-tasting molecules, along the digestive tract. If that’s the case, obviously sweeteners will not produce the desired effect, namely staying slim.</p>
<p>Another hypothesis is that those who consume large amounts of sweeteners also produce less of the GLP-1 (Glucagon-Like Peptide-1) hormone, <a href="https://www.ncbi.nlm.nih.gov/pubmed/25828597">which promotes pancreatic insulin secretion</a>, and suffer more frequent deregulation of their glucose metabolism.</p>
<h2>Sweeteners can alter our gut microbiota</h2>
<p>Lastly, research on animals at the Weizmann Institute of Science in Israel <a href="http://www.jpost.com/Israel-News/Health/Artificial-sweeteners-could-actually-lead-to-diabetes-say-scientists-at-Weizmann-Institute-375668">has shown</a> that high consumption of certain sweeteners causes <a href="https://www.ncbi.nlm.nih.gov/pubmed/25231862">changes in the intestinal microbiota</a>. </p>
<p>We now know these microorganisms, which regulate digestive, metabolic, immune and neurological functions in the human body, to be important for health. Altering them is thought to lead to glucose intolerance and insulin resistance, a trigger for type 2 diabetes.</p>
<p>Whether people are trying to lose weight or avoid sugars, it’s time to convey a more accurate message about the benefits – or rather, the risks – of so-called “lite” foods.</p><img src="https://counter.theconversation.com/content/75891/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Guy Fagherazzi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Artificial sweeteners used in diet sodas and other low-calorie foods can actually contribute to weight gain and type 2 diabetes. The more you use, the higher the risk.Dr Guy Fagherazzi, Chercheur en épidémiologie du diabète, UMR 1018, Inserm, Université Paris-SaclayLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/502882015-11-18T11:13:53Z2015-11-18T11:13:53ZDo sweetened drinks really cause heart failure?<figure><img src="https://images.theconversation.com/files/100967/original/image-20151105-16263-1b5fcc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>Drinking two or more sweetened drinks a day increases the risk of developing heart failure by 23%, according to a <a href="http://www.ncbi.nlm.nih.gov/pubmed/26526418">recent study</a>. This sounds very precise and very alarming. The problem with nutrition studies is that they’re usually reported with more certainty than they warrant. And the relative dangers of consuming a particular food or drink are usually not that alarming when presented as absolute figures.</p>
<p>The reported 23% increase in risk was calculated as a “hazard ratio”, which represents the study participants’ risk of having heart failure at any point in time over the average 12-year period they were studied for. </p>
<p>Hazard ratios can be misleading. To make sense of this information we need to know what specific group of people we are discussing, their baseline risk of heart failure and the increase in risk. </p>
<p>Using hypothetical figures: in 50-year-old men, if the baseline risk of having heart failure is 4 in 1000, a 23% increase in risk means one more person in 1000 will die at the age of 50 if they drink two or more sweet drinks a day. </p>
<p>Discussing the risk in absolute terms is much less alarming than the relative risk, but it doesn’t make for good headlines. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/102042/original/image-20151116-4964-1bnea0s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/102042/original/image-20151116-4964-1bnea0s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=585&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102042/original/image-20151116-4964-1bnea0s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=585&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102042/original/image-20151116-4964-1bnea0s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=585&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102042/original/image-20151116-4964-1bnea0s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=735&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102042/original/image-20151116-4964-1bnea0s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=735&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102042/original/image-20151116-4964-1bnea0s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=735&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Absolute figures don’t make good headlines.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=HwuCDnil5gtdy99e8cZHFg&searchterm=medical%20news&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=84849004">www.shutterstock.com</a></span>
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</figure>
<h2>Fallible memory</h2>
<p>Studying nutrition is difficult. The gold standard of trial design is the randomised placebo-controlled trial (RCT). RCTs are great for studying medicines, but they’re not so great for studying nutrition – at least, not for long periods of time. They are expensive to run and they lack “ecological validity”. In other words, they don’t represent real life very well because they often add a level of control not present in everyday life – people tend to make different choices when they know they are being studied. </p>
<p>Some nutrition studies do use the RCT design, but most are observational studies where people are not randomly assigned to one treatment group or another. These types of studies can usually afford to recruit way more people than RCTs.</p>
<p>But large observational studies come with their own problems. They depend on surprisingly simplistic and naïve data collection methods such as recollection and self-reporting, which produce notoriously unreliable data. </p>
<p>Not only is memory fallible, but people tend to <a href="http://nutritionreviews.oxfordjournals.org/content/48/10/373">under report</a> what they consume. In this study, data was collected using a “food frequency questionnaire”. Participants were asked: “How many soft drinks or sweetened juice drinks do you drink per day or per week?” It does not take a disciple of science, to realise that this might not be reliable.</p>
<p>Any study that uses self-reported data, such as this latest study from Sweden, should be treated with caution.</p>
<h2>Accounting for everything</h2>
<p>What an observational study can’t do is prove that consuming sweetened drinks causes heart failure. It can only prove that the two things are associated. </p>
<p>Lots of things are associated with heart failure, such as diabetes, high blood pressure, smoking, and body mass index. These “confounders”, and others, were taken into account by the researchers when calculating the hazard ratios. </p>
<p>But what if they missed something out in their analysis? Perhaps people who consume lots of sweetened drinks have worse diets overall. It seems likely that people who consciously choose not to drink sweetened drinks are more health conscious overall. </p>
<p>The predictive power of any observational study is limited by potentially unaccounted for confounders.</p>
<h2>Sugar is not a poison</h2>
<p>This study doesn’t differentiate between drinks that are sweetened with sugar and those that are sweetened with artificial sweeteners, such as aspartame and sucralose, so we can’t tell what role – if any – these artificial sweeteners played in increasing the risk of heart disease. </p>
<p>Previous studies have shown that sugar sweetened drinks are associated with a number of health problems, including <a href="http://www.ncbi.nlm.nih.gov/pubmed/24583500">coronary heart disease</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/24932880">type 2 diabetes</a>. However, even if the people in this study did mainly consume sugar sweetened drinks, we should be careful about linking one aspect of nutrition to a particular health outcome. </p>
<p>Sugar is not intrinsically bad – it is not a poison – but it contributes to surplus energy intake which, in turn, is associated with a range of metabolic problems. </p>
<p>Consumption of sweetened beverages may be associated with increased risk of heart failure, but this needs to be viewed alongside diet as a whole – as well as a person’s broader lifestyle. Focusing on one nutrient at a time can be misleading and even counterproductive. It contributes to the seemingly endless controversies about what we should eat and how much we should eat. These controversies might sell newspapers and bogus health products, but they don’t do anything to help the consumer make informed choices.</p><img src="https://counter.theconversation.com/content/50288/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Haines does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new study linking sweetened drinks to heart disease is more confusing than enlighteningMatthew Haines, Senior Lecturer in Health and Wellbeing, University of HuddersfieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/312082014-09-19T13:51:47Z2014-09-19T13:51:47ZCoke Life lands a blow against sugar, but its worthy credentials could still be trouble<figure><img src="https://images.theconversation.com/files/59045/original/vvm8qrz4-1410791465.jpg?ixlib=rb-1.1.0&rect=306%2C324%2C1621%2C797&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Greeener than thou?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/riveranotario/12962976023/in/photolist-oWXR6F-if3NCb-oWixvy-kKw639-6FoD8K-9Q3h84-oDQGwC-kKuD9B-gaM3t8-kLQ2Y1-kLP9y7-kJ6HgB-f11EB7-ahi9XP-fGPHR7-p2GTRN-kiFvht-hQR4cF-f4aFdn-js8HyJ-eyprhv">RiveraNotario</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Coca Cola has begun carefully <a href="http://www.coca-colacompany.com/stories/lower-calorie-coca-cola-life-to-launch-in-great-britain">rolling out its green-labelled “Life” brand</a>, filling its iconic hour-glass bottles with a new fizzy drink which has nearly a third fewer calories than Coke Original. It is a useful win for anti-sugar campaigners but the strategy brings all kinds of risks for the Atlanta-based soft drinks giant.</p>
<p>There is a <a href="http://www.telegraph.co.uk/health/dietandfitness/10634081/John-Yudkin-the-man-who-tried-to-warn-us-about-sugar.html">rising tide against sugar consumption</a> and its links to obesity and ill-health. Mexico – one of the leading soft drinks markets, but a country where 9% of the population <a href="http://www.economist.com/blogs/americasview/2013/04/diabetes-mexico">suffer from type-2 diabetes</a> – has already implemented a sugar tax. </p>
<p>Euromonitor’s Howard Telford noted that western European and North American markets are increasingly mistrustful of sweeteners, and this is coupled with a health agenda that is trying to limit calorific consumption. Market researchers Mintel UK support this assessment, with a quarter of respondents in a survey saying they now consume fewer carbonated drinks than six months ago. Although not measuring actual behaviour, this does suggest that health campaigns such as <a href="http://www.nhs.uk/change4life/Pages/change-for-life.aspx">Change4Life</a> and <a href="https://twitter.com/actiononsugar">Action on Sugar</a> are influencing consumer demand.</p>
<p>According to Telford: “The introduction of Coca Cola Life is a slick, high profile example of the company publicly seeking to address its role in public health through innovations.” He’s right: this is a clever move on Coke’s part that should be applauded, though also a modest one that is not without problems.</p>
<h2>Bitter experience</h2>
<p>Coke’s executives have clearly learnt the lessons of <a href="http://content.time.com/time/specials/packages/article/0,28804,1913612_1913610_1913608,00.html">the New Coke</a> debacle in the 1980s. Back then, market research suggested the younger Pepsi generation would prefer a sweeter taste, and the new product was duly born. Alas, the researchers had bungled the study and unintentionally created a future marketing case study of how not to launch a new brand.</p>
<p>What taste-test research actually tends to indicate is that consumers struggle to differentiate between variations of brown fizz, regardless of sugar content. Instead, it is product branding that influences.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/59171/original/qfgvr739-1410869756.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/59171/original/qfgvr739-1410869756.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/59171/original/qfgvr739-1410869756.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=345&fit=crop&dpr=1 600w, https://images.theconversation.com/files/59171/original/qfgvr739-1410869756.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=345&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/59171/original/qfgvr739-1410869756.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=345&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/59171/original/qfgvr739-1410869756.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=433&fit=crop&dpr=1 754w, https://images.theconversation.com/files/59171/original/qfgvr739-1410869756.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=433&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/59171/original/qfgvr739-1410869756.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=433&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Original Coke near a tipping point?</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/kevinomara/3529868846/in/photolist-6nVv2G-3hst6B-fCA5Zc-4TN45e-81txkz-4TSi1s-4TN3Sr-4TN2Ux-4TSgwq-4TN3vX-4TN36K-4TN3ET-9n5Kjd-przC-nWUf1-oGhnpP-7kNo9n-JMjSj-q2EAP-t3Zk6-6btsR8-5cYddC-5cYdtw-5cTTYV-5cYcWf-4q3abj-ojYQzc-oD9ks5-6GdcZD-9KuQts-ECja2-2d1Xhn-6YuyCr-8K3LSP-jMvrHe-57Ty9S-eibS34-83Gn2h-b7Miy2-8ujo2-5uXbYs-87qvGu-94tCcR-76cPF8-FDnWT-77GqdA-kihat-5A37AF-5mpDPg-6dFoPS">Kevin O'Mara</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>The three main Coke brands – Original, Diet and Zero – are currently running a simultaneous, heavy spend, mass-market TV campaign that offers consumers personalised bottles. By contrast, the Life advertising is an outdoor-focused, push campaign. The green packaging extends the familiar red, silver, black and gold product line offerings in a way that is easily understood. </p>
<p>The company has adopted a cautious, incremental and geographic launch strategy. Life’s global launch was in Chile and Argentina, which boasts one of the highest per capita soft drink consumption levels in the world. Substantial markets such as the UK, France, Mexico and US are following. </p>
<p>There is a background to this too. Western beverage firms are experiencing significant global drops in market share as consumers increasingly choose branded water and Chinese beverage brands grow stronger. Nonetheless, the Coca Cola portfolio leads with a 21% share of the market (far ahead of second-placed PepsiCo, which has 10% of volume). Coca Cola is valued at US$79 billion and was ranked for many years as the top global brand by Interbrand (<a href="http://www.interbrand.com/en/best-global-brands/2013/Best-Global-Brands-2013.aspx">deposed in 2013 by Apple and Google</a>).</p>
<h2>A sour aftertaste?</h2>
<p>One risk for Coke is that the lower-sugar Life sub-brand may be an extension too far. Phil Caroll, a drinks sector analyst at investment firm Shore Capital, has <a href="http://www.marketingweek.co.uk/sectors/food-and-drink/news/coke-brings-coca-cola-life-to-the-uk/4010784.article">suggested that Life sits in a no-man’s-land</a> between core propositions that already serve customers well. However, substantial regional differences suggest that there is indeed life in Life. The slow take-up of Zero in the UK compared to a rapid market penetration in the more dynamic market of Australia is a useful case in point. In short, there appears to be some potential for the Life brand to do well. And even in the UK, success in reducing salt intake – <a href="http://www.dailymail.co.uk/health/article-2604761/Salt-intake-falls-15-heart-deaths-fall-40-eat-it.html">15% lower salt consumption over a decade</a> as consumer tastes adjusted with time – suggests that firms can change their products to the benefit of society while bringing their customers with them; a key commercial imperative.</p>
<h2>Social and environmental impact</h2>
<p>Coca Cola is a major producer of soft drinks: ultimately unnecessary products which use large amounts of finite resources, often in regions that can ill afford their loss. This is the <a href="http://history.howstuffworks.com/history-vs-myth/nero.htm">main charge of the “Nero” criticism</a> – that Coca Cola is fiddling at the edges with Life, without addressing the problem of burning up the planet’s resources to make it.</p>
<p>A simple internet search for “Coca Cola”, “water”, and “controversy” provide ample illustration of the criticisms. By positioning the brand as a green alternative – regardless of the health focus – Coke is in danger of being seen to mislead customers (see the <a href="http://sinsofgreenwashing.org/">useful Sins of Greenwashing tool</a>). Also, sugar’s enemies will not be satisfied with incremental change when many are pushing for <a href="http://www.bbc.co.uk/news/health-29212780">ever greater cuts to recommended consumption</a>. </p>
<h2>Supply chains and sugar substitute</h2>
<p>A supply chain issue hinges on the question of how Life is able to contain a third fewer calories. The answer <a href="http://www.bbc.co.uk/news/magazine-22758059">is Stevia, a sugar alternative</a>. Secondary Coca Cola brands Lilt, Sprite and Fanta switched completely to Stevia in 2013, without the use of a shadow brand. Did you notice? And Sprite and Fanta are respectively ranked fifth and sixth in the off-trade Euromonitor global rankings, each with 1.5% volume share: these are high net worth brands in their own right.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/59169/original/dqrny79k-1410869328.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/59169/original/dqrny79k-1410869328.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=750&fit=crop&dpr=1 600w, https://images.theconversation.com/files/59169/original/dqrny79k-1410869328.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=750&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/59169/original/dqrny79k-1410869328.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=750&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/59169/original/dqrny79k-1410869328.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=943&fit=crop&dpr=1 754w, https://images.theconversation.com/files/59169/original/dqrny79k-1410869328.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=943&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/59169/original/dqrny79k-1410869328.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=943&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Substitute for sugar: Stevia.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/rosasay/14277894055/in/photolist-nKFWta-6xTq2C-8GdcLJ-6ypXqW-nvTYbg-6ykPL2-nu8476-ncCBx7-nvTXUz-ncCvU2-bBtfim-aS1M1Z-fDeSju-oT6gPU-gkbcbt-cDWYB9-cvBG17-78BBym-7xNcJE-8KMX6R-k85GSd-dU9dqd-9yDSEX-dqZXF3-dqZMJc-dqZLrF-dqZWkG-dqZMdz-dqZVsb-8EdQBN-kFMxZ-be7KEc-6xPhaz-9JBwiz-arKQdY-5ncJMy-88NkDT-5Y7mWz-rn6ap-4xW7Hd-4PWRc3-aS1LET-bsC2Bi-PQUyh-4ZJnNx-4U1ZGM-nBqe9U-66kXzP-ccvjLs-aBa98s">Rosa Say</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Stevia is a plant-extract originating in South America. It has reportedly been used as a sweetener in Japan since the 1970s, and was more recently approved for use in the US and EU. Its emergence leaves many open questions: What are the social and environmental conditions of the agricultural workers involved? Is the manufacturing process environmentally damaging? Is there sufficient supply to meet the demand if consumers buy it in droves? What sort of land is required to grow the plants (lessons from palm oil should sound warning bells)? What is its impact on the body? And will the anti-Stevia activists (<a href="http://institutefornaturalhealing.com/2012/07/is-stevia-bad-for-you/">for they exist</a>) remain fringe groups, or will their arguments gain traction? </p>
<h2>Security of supply</h2>
<p>Finally, there is also a potential issue around security of supply: in the longer term, companies like Coca Cola may need to develop complete alternatives to traditional sugar. Climate change presents a threat to many aspects of life, and agriculture is one of these. Sugar is not immune to the changes. For example, KWS – the world market leader in sugar-beet, with substantial interests in corn/maize – <a href="http://www.kws.de/aw/KWS/company_info/Company/Research_and_Breeding/Challenges/%7Eevmz/Agriculture_and_climate_change/">has included climate-related breeding objectives</a> as a key element in its research and plant-breeding work for some time.</p>
<p>Coca Cola may have some scope to develop organic, eco and natural-brand dimensions – maybe the green labelling and Life brand suggest this is under consideration. But the company needs to tread carefully. Coca Cola seems to have made a modest and potentially useful contribution to the problem of sugar over-consumption, but Life will not deflect critics’ fire – and may be storing up problems for the future.</p><img src="https://counter.theconversation.com/content/31208/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Coca Cola has begun carefully rolling out its green-labelled “Life” brand, filling its iconic hour-glass bottles with a new fizzy drink which has nearly a third fewer calories than Coke Original. It is…Professor Justin O'Brien, MBA Programme Director, Royal Holloway University of LondonStephanos Anastasiadis, Lecturer in Sustainability, Royal Holloway University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/149282013-11-18T03:31:32Z2013-11-18T03:31:32ZHealth check: five sweeteners and what they mean for you<figure><img src="https://images.theconversation.com/files/35443/original/mrv2mzyp-1384737117.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's the quantity of sugar we consume that's bad for us.</span> <span class="attribution"><span class="source">Carol Green</span></span></figcaption></figure><p>People have been eating sweet foods for eons. Fruit (fructose), milk (lactose), cane (sucrose), and honey (fructose and glucose) provide us with energy for growth and development. </p>
<p>But in these days, we have much more energy than we need. </p>
<p>The United Nations <a href="http://faostat.fao.org/site/368/DesktopDefault.aspx?PageID=368#ancor">estimates</a> that we have 13,630 kilojoules available per person, per day; government bodies recommend we limit our intake to <a href="http://www.8700.com.au/">8,700KJ per day</a>.</p>
<p>There’s been a lot of debate over the role sugar and its substitutes play in our diet. So let’s take a look at what’s on the market and what it all means for health.</p>
<h2>Sucrose</h2>
<p>Sucrose is the most common form of sugar in Australia. It’s derived from <a href="http://www.canegrowers.com.au/page/Industry_Centre/about-australian-sugarcane/">sugar cane stalks</a>, which are juiced, dried, and processed to become raw sugar. And then it’s refined to produce white sugar.</p>
<p>White sugar doesn’t contain the molasses present in raw sugar, which explains its light colour. Brown sugar is, for the most part, white sugar with some molasses mixed back in. This makes it a little stickier. </p>
<p>Raw sugar is the least processed of the three. But nutritionally, it’s pretty much the same as white or brown sugar. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/25566/original/yxm5jqvf-1371192916.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/25566/original/yxm5jqvf-1371192916.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/25566/original/yxm5jqvf-1371192916.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/25566/original/yxm5jqvf-1371192916.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/25566/original/yxm5jqvf-1371192916.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/25566/original/yxm5jqvf-1371192916.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/25566/original/yxm5jqvf-1371192916.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There’s been a lot of debate over the role sugar and its substitutes play in our diet.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>We call sugar an “empty-kilojoule” food because it’s energy dense but contains very few other nutrients. </p>
<p>Unless you’re eating lots of food anyway, there’s no evidence that eating sugar by itself will increase your weight. But regardless of your size, eating too much sugar can be unhealthy if you use it to replace foods or drinks that have more nutrients. </p>
<p>There’s also a strong link between sugar consumption and <a href="http://ajcn.nutrition.org/content/78/4/881S.full">tooth decay,</a> and between obesity and <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1203388">sugary-drink intake</a>.</p>
<h2>Fructose</h2>
<p>Fructose is central to the sugar debate, with <a href="https://theconversation.com/what-role-does-fructose-have-in-weight-gain-7424">some suggesting</a> it has a stronger influence in obesity than other sweeteners. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/35461/original/2fjh92vq-1384738523.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/35461/original/2fjh92vq-1384738523.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=895&fit=crop&dpr=1 600w, https://images.theconversation.com/files/35461/original/2fjh92vq-1384738523.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=895&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/35461/original/2fjh92vq-1384738523.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=895&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/35461/original/2fjh92vq-1384738523.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1125&fit=crop&dpr=1 754w, https://images.theconversation.com/files/35461/original/2fjh92vq-1384738523.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1125&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/35461/original/2fjh92vq-1384738523.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1125&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Flickr/Moya_Brenn</span></span>
</figcaption>
</figure>
<p>This is not true; fructose is like any other sugar. </p>
<p>In Australia, we mostly use sucrose rather than high-fructose corn syrup, which dominates in the US food supply. So the fructose from fruit, honey, and refined fructose isn’t a significant player in our weight issues. </p>
<p>This natural sugar should be eaten in it’s original form (fruit, for example), and not in concentrated forms like juice and dried fruit if you’re watching your weight. </p>
<p>Fructose is lower in glycaemic index (GI) than other sugars, which means it’s absorbed by your body more slowly. It’s the major source of sweetness in low GI products. </p>
<h2>Honey and syrups</h2>
<p>Honey contains both fructose and glucose, another simple sugar that is easily absorbed by the body. In honey, the sugars remain separate, which is why it’s sweeter than table sugar (sucrose). </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/35446/original/2xtxfnhd-1384737409.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/35446/original/2xtxfnhd-1384737409.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=896&fit=crop&dpr=1 600w, https://images.theconversation.com/files/35446/original/2xtxfnhd-1384737409.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=896&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/35446/original/2xtxfnhd-1384737409.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=896&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/35446/original/2xtxfnhd-1384737409.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1126&fit=crop&dpr=1 754w, https://images.theconversation.com/files/35446/original/2xtxfnhd-1384737409.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1126&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/35446/original/2xtxfnhd-1384737409.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1126&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Flickr/mynameisharsha</span></span>
</figcaption>
</figure>
<p>This means that you need to add less honey than you would sugar to achieve the desired level of sweetness when cooking food. It also means that fewer kilojoules consumed. But if you replace a teaspoon of sugar with a teaspoon of honey, you’ll actually be adding about 25% extra kilojoules.</p>
<p>Honey and some other syrups such as agave (from a <a href="http://en.wikipedia.org/wiki/Agave">succulent plant</a>) contain more micronutrients than sugar. But others, like rice bran syrup, have more kilojoules and a higher GI than table sugar.</p>
<p>Although syrups contain nutrients that sugar does not, this doesn’t necessarily make them healthy - you can get these nutrients from other whole foods. </p>
<h2>Stevia</h2>
<p>Steviol glucosides are intensely sweet compounds found in a little green leaf from a shrub originating in Paraguay. After purification, the resulting powder or liquid is about 200 times sweeter than sucrose.</p>
<p>Stevia’s main benefit is its low kilojoule content. In most stevia-based sweeteners, a teaspoon contains about four kilojoules, where the same amount of sugar has 67 kilojoules. </p>
<p>Like all low-kilojoule sweeteners, teeth and blood sugar levels aren’t greatly negatively affected by its consumption. </p>
<h2>Aspartame</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/35458/original/7f9mhj4z-1384738264.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/35458/original/7f9mhj4z-1384738264.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/35458/original/7f9mhj4z-1384738264.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/35458/original/7f9mhj4z-1384738264.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/35458/original/7f9mhj4z-1384738264.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=484&fit=crop&dpr=1 754w, https://images.theconversation.com/files/35458/original/7f9mhj4z-1384738264.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=484&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/35458/original/7f9mhj4z-1384738264.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=484&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Aspartame is a key ingredient in sweeteners such as Equal.</span>
<span class="attribution"><span class="source">Flickr/Bukowsky18</span></span>
</figcaption>
</figure>
<p>Aspartame is a non-sugar sweetener that has the ability to bind to our sweet-taste receptors. It has 200 times the sweetness of sugar, which is why we can use so little in foods or drinks to get a sweet taste. </p>
<p>In rat studies, excess aspartame intake has been shown to cause lymphomas and leukemias. But despite scares from a <a href="http://web.archive.org/web/20120822004928/http://www.nurseweek.com/features/99-4/myths.html">series of hoaxes</a>, consumption of the sweetener has shown to be safe for humans.</p>
<p>Earlier this year, the European Food Safety Authority released the draft results of a comprehensive study showing that aspartame and its metabolites <a href="http://www.efsa.europa.eu/en/supporting/pub/399e.htm">pose no toxicity concern</a> for consumers at current levels of exposure, except in people who suffer from a genetic condition called phenylketonuria. </p>
<p>Logically, if aspartame contains negligible kilojoules, people who substitute it for sugar or other non-sugar sweeteners would lose weight. Unfortunately, this isn’t true. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/19056571">Studies show</a> people who consume sweeteners such as aspartame have increased appetites and tend to favour sweet foods, increasing their overall kilojoule consumption.</p>
<p>The consumption of sweeteners such as aspartame has also <a href="http://jcem.endojournals.org/content/97/8/2597.abstract">been linked</a> to metabolic syndrome and diabetes, for reasons yet to be determined.</p>
<h2>Making educated choices</h2>
<p>No sugar, in itself, is bad for health, but eating too much of it, like any other food, can cause problems.</p>
<p>It’s important to not fall into the trap of eating much higher kilojoules by replacing sugar with other macronutrients such as protein or fat. You should also be wary of increasing portion sizes as a result of consuming “sugar-free” foods.</p>
<p>Even if food packaging says “sugar free”, its overall kilojoule content may be the same if table sugar has been replaced with another kind of sugar or carbohydrate, such as syrup.</p>
<p>A good diet centres around unprocessed foods that includes the occasional planned, discretionary treat. Instead of blindly following the latest fad, stick to sound, smart eating. </p><img src="https://counter.theconversation.com/content/14928/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tara Diversi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People have been eating sweet foods for eons. Fruit (fructose), milk (lactose), cane (sucrose), and honey (fructose and glucose) provide us with energy for growth and development. But in these days, we…Tara Diversi, Assistant Professor, Nutrition & Dietetics, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/126082013-04-10T20:42:30Z2013-04-10T20:42:30ZSweet news: No evidence that artificial sweetener aspartame’s bad for you<figure><img src="https://images.theconversation.com/files/22217/original/24f38dnp-1365479189.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Aspartame contains virtually no kilojoules in the minute quantity needed to sweeten a beverage or solid food.</span> <span class="attribution"><span class="source">Pascal/Flickr</span></span></figcaption></figure><p>Everyone who works in a chemistry laboratory knows that you don’t use your taste receptors to check if an unknown chemical is safe or deadly poisonous (or if you do, you may do it only once). But if this hadn’t inadvertently happened in one lab, the most commonly used artificial sweetener today may never have been discovered. </p>
<p>In 1965, a chemist working with amino acids (the building blocks of protein) created a new chemical by combining the amino acids aspartic acid and phenylalanine. He didn’t realise that some of this novel substance had spilled onto a piece of paper lying on the laboratory bench. The chemist licked his finger to pick up the paper and inadvertently transferred some of the chemical into his mouth.</p>
<p>Luckily, he lived to tell the tale. What he had to tell was extraordinary and completely unexpected. By combining two of the building blocks of protein (which has no sweetness), he had created a substance that was about 200 times as sweet as sugar!</p>
<p>Dubbed “aspartame”, the newly-created chemical was found to provide virtually no kilojoules in the minute quantity needed to sweeten a beverage or solid food.</p>
<p>After extensive safety testing, aspartame was approved for use in Europe and the United States in the 1980s. Its use as a sweetener in a range of foods at specified levels is <a href="http://www.foodstandards.gov.au/consumerinformation/aspartame.cfm">also permitted</a> in Australia and New Zealand.</p>
<p>Indeed, it is now the most widely used artificial sweetener in the world, and is sold in Australia most commonly under the brand names NutraSweet and Equal.</p>
<p><a href="http://tinyurl.com/bbnhc">Hoax claims</a> about aspartame have been circulating on the internet for many years. They suggest it was first developed as an ant poison, and that it is broken down in the body to release formaldehyde, leading to health problems such as severe seizures, brain damage, lupus and birth defects. No credible scientific evidence has ever been found for any of these claims.</p>
<p>Of more substance is the claim that artificial sweeteners, including aspartame, may be a cause of cancer. Rat studies have shown an association between the consumption of these sweeteners and cancer incidence.</p>
<p>But, as the <a href="http://www.wcrf.org/">World Cancer Research Fund</a> (WCRF) <a href="http://www.dietandcancerreport.org/cancer_resource_center/pr_full_report_english.php">pointed out in 2007</a>, the rat studies involved intakes “far greater than humans could consume in foods and drinks”. The WCRF concluded that “The evidence … does not suggest that chemical sweeteners have a detectable effect on the risk of any cancer.”</p>
<p>Another <a href="http://informahealthcare.com/doi/abs/10.1080/10408440701516184">comprehensive review</a> of the safety of aspartame, also published in 2007, came to a similar conclusion: “The weight of existing evidence is that aspartame is safe at current levels of consumption as a non‑nutritive sweetener.”</p>
<p>In 2010, two studies reported possible associations between aspartame and a slight increase in adverse health outcomes. After carefully reviewing these studies the <a href="http://www.efsa.europa.eu/">European Food Standards Agency</a> (EFSA) <a href="http://www.efsa.europa.eu/en/press/news/ans110228.htm">concluded that these studies</a> “do not give reason to reconsider previous safety assessments of aspartame …”</p>
<p>But taking an appropriately cautious approach, the report also stated that “… the EFSA will continue monitoring the scientific literature in order to identify new scientific evidence for sweeteners that may indicate a possible risk for human health or which may otherwise affect the safety assessment of these food additives.”</p>
<p>The <a href="http://www.efsa.europa.eu/en/supporting/pub/399e.htm">most recent (March 2013) review</a> of the literature by the EFSA concludes that “There is no consistent evidence that aspartame has adverse effects, either in healthy individuals or in potentially susceptible groups …”</p>
<p>The <a href="http://www.andjrnl.org/article/S2212-2672(12)00325-5/">2012 position paper</a> of the US <a href="http://www.eatright.org/public/default.aspx">Academy of Nutrition and Dietetics</a> also endorses the safety of aspartame by stating that “… consumers can safely enjoy a range of nutritive sweeteners and non-nutritive sweeteners (NNS).” Aspartame is included in the seven non-nutritive sweeteners that are approved for use.</p>
<p>The position paper also points out that the estimated safe level of daily intake of aspartame over a lifetime is 50 milligrams per kilogram of body weight. With typical intakes estimated to be in the range 0.2 to 4.1 mg/kg, the rate of consumption of aspartame by virtually everyone is likely to be less than 10% of the maximum recommended level.</p>
<p>But there is one potential adverse health effect associated with the use of aspartame – a metabolic genetic condition called phenylketonuria (a mutation that makes an enzyme non-functional) affects about one person in 10,000. People with phenylketonuria cannot metabolise phenylalanine (which, you will recall, is one of the two protein building blocks that make up aspartame), so those people need to minimise intake of all sources of phenylalanine, including aspartame.</p>
<p>So, can I put my hand on my heart and swear that aspartame is safe for everyone other than people with phenylketonuria?</p>
<p>No, I can’t. Still, based on the evidence currently available, if I wanted to reduce my sugar intake but still enjoy sweetened tea or coffee, I would have no hesitation in using aspartame (or any of the other approved non-nutritive sweeteners).</p><img src="https://counter.theconversation.com/content/12608/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Forbes-Ewan received funding from the National Health and Medical Research Council in 2006 for his contribution to the development of Nutrient Reference Values for Australia and New Zealand. His contribution was in the area of estimated energy requirements.
</span></em></p>Everyone who works in a chemistry laboratory knows that you don’t use your taste receptors to check if an unknown chemical is safe or deadly poisonous (or if you do, you may do it only once). But if this…Chris Forbes-Ewan, Senior Nutritionist, Defence Science and Technology OrganisationLicensed as Creative Commons – attribution, no derivatives.