Chronic diseases, including respiratory diseases, diabetes, and cancer, are responsible for the deaths of 41 million people across the globe each year. Modifiable behaviours and metabolic risk factors increase the risk of developing a chronic illness (1). For example, modifiable behaviours, such as an unhealthy diet, can lead to metabolic issues, like overweight or obesity, which in turn can elevate the risk of heart disease and multiple other health conditions (1;2). Too much sugar—specifically, sugars added to food and drinks during manufacturing or at the table prior to consumption—is often suggested as a contributing factor to overweight, obesity, and the development of chronic illness. This may make us pause before adding sugar to our hot beverage in the morning or while whipping up some sweet treats.
Over the years, there has been a push to identity strategies that can help fight the obesity “epidemic”. The use of non-nutritive sugar substitutes as an alternative way of sweetening foods and drinks is one method that has caught the attention of researchers. These sugar substitutes offer no nutritional value and have little-to-no calories. They go by a variety of names, including non-nutritive sweeteners, non-caloric or very low-calorie sweeteners, or artificial sweeteners (2). These substitutes are found in some food and beverage options, such as “diet” or “sugar free” carbonated drinks, nut spreads, and breakfast cereals. Certain types are also available as table-top sweeteners (3). Interestingly, past studies have made the case for and against the use of sugar substitutes, with some finding that they may increase weight by encouraging folks to eat more, and others demonstrating that they assist with weight loss (2;4-7). A recent systematic review aimed to provide more clarity on the topic by taking a comprehensive look at the evidence, including newly published studies (2).
What the research tells us
The review compared changes in weight/body mass index in folks consuming non-nutritive sweeteners, such as aspartame, stevia, sucralose, saccharin, and rebaudioside A (Reb A), to those consuming table sugar, water, and placebo, or given nothing. Overall, the review found that the use of non-nutritive sweeteners may help reduce weight/body mass index by a small to moderate amount. But a closer look at the data shows that these benefits may only be obtained by certain individuals or under certain conditions. For instance, it appears that children or adolescents, folks considered to be at a normal weight, and those following a weight reduction diet may not see results. On the other hand, adults, folks living with overweight or obesity, and those who are following an unrestricted diet may reap the weight-related rewards. What’s more, it appears that non-nutritive sweeteners have the potential to be effective when they are a substitute for table sugar, specifically. With all this said, we do have to consider that the findings presented here are based on low to moderate quality evidence, with outcomes only measured in the short term. This means more high-quality studies with longer follow-up periods are needed to really understand what impact non-nutritive sweeteners have on weight in the short term and long term.
Only a few studies included in the review reported on side effects. Generally, both the group consuming non-nutritive sweeteners and the group not consuming them experienced similar minor side effects. These included: behavioural issues, bowel changes, allergies, and abdominal discomfort. Some studies conducted deeper investigations and found that all or some of the side effects seen were not related to the non-nutritive sweeteners used (2). Outside of this review, it is important to note that various non-nutritive and nutritive sweeteners have been approved for use at specific levels/amounts by Health Canada, meaning their safety has been assessed and that their use is strictly regulated (3). For a full list of permitted sweeteners and more information, refer to the Government of Canada’s website. If you are interested in using non-nutritive sweeteners, whether as a table-top sweetener or by focusing on foods that contain them, speak with your health care team first to assess if they are safe for you based on any existing conditions you may have and for guidance on use.