On 15 May, the World Health Organisation (WHO) published a new guideline on non-sugar sweeteners (NSS), formally recommending against their use to control body weight or reduce the risk of non-communicable diseases (NCDs).

Established in the food industry as a sugar replacement, consumers may opt for NSS over sugar as they perceive them to be healthy. Food manufacturers have therefore made the swap from sugar to sweeteners in new product developments (NPDs) to meet these needs. “NSS are not essential dietary factors and have no nutritional value,” said Francesco Branca, WHO Director for Nutrition and Food Safety, in the WHO’s press release.

Shoppers may choose NSS with the belief that they will support them with weight loss and lower the chance of developing NCDs, such as type 2 diabetes and cardiovascular diseases (CVDs). However, the evidence suggests using NSS in food products does not provide any long-term benefit in decreasing body fat in adults or children.

The results also indicate the possibility of undesirable side effects from long-term use of NSS among adults, including a rise in the likelihood of developing type 2 diabetes, cardiovascular diseases and mortality.

Conditional research

“The evidence assessed has been evaluated as low certainty by the WHO, and the recommendation is considered ‘conditional’,” says a spokesperson for the European Food Information Council (EUFIC).

Confirming this in its release, the guidance’s conditional status is in response to its findings observing that baseline characteristics of study participants and complicated patterns of NSS use might confuse the connection between NSS and disease outcomes in the evidence.

“WHO has classified the recommendation as ‘conditional’ because policy actions based on the recommendation will need to be further discussed and specifically designed to suit individual country contexts,” Dr Nina McGrath, content production area lead at EUFIC, told Ingredients Network. For example, different policy actions may be relevant for other regions or consumers from different age groups based on their levels of sweetener consumption.

“Policymakers will also need to consider this recommendation within the broader context of other public health priorities, for example, the reduction of sugar intake,” McGrath adds. As sweeteners are often used to reduce sugar intake, practical advice for consumers includes drinking mainly water for quenching thirst and choosing unsweetened foods and drinks or those containing naturally-occurring sugars such as fruit, McGrath says.

Anti-NSS media reports?

In response to the guidelines, EUFIC published an article detailing how the interpretation of WHO’s recommendation may be misleading. The guideline’s main recommendation—to avoid using non-sugar sweeteners to control body weight or reduce the risk of NCDs—is based on evidence classified as ‘low certainty’, McGrath says.

“So there is still research to be done to gather more high-quality evidence to help us understand with more certainty the potential long-term effects of sweetener use,” McGrath adds. Research in different groups of people or how this varies between individual sweeteners are examples of this.

Consumers do not need to be concerned that NSS may pose a health concern, as safety is not a factor in the findings. “The WHO recommendation is specific to weight loss and NCD risk and is not related to safety,” a EUFIC spokesperson has said.

In critiquing the recommendation, EUFIC also states that “evidence shows that sweeteners may have a role in weight management in the short-term,” says the spokesperson. “The recommendation is not relevant for people who have diabetes,” the spokesperson adds.

Industry support

Voices from within the food industry have spoken out since the WHO released its guidelines. A response by the Science Media Center states that the guidance is limited by several factors, notably its conditional status and the role of NSS as a way to lower calories in the short-term, which it says, has evidence to support it as a part of short-term weight management interventions.

The British Nutrition Foundation also published a statement on the WHO’s non-sugar sweeteners guideline, and Knowledge4Policy, the EU Commission’s platform for evidence-based policymaking, provided information on Sugars and Sweeteners. In recent years, the EUFIC has explored sweeteners to progress understanding on what they are and their links to health outcomes.

Interestingly, in their review of the evidence, the WHO did not distinguish between artificial or natural sweeteners that are naturally occurring, for example, those extracted from plants, like stevia.

In its report, WHO highlighted the need for further research to examine how individual sweeteners may be linked to long-term health outcomes, as each has its chemical structure and properties and is processed differently by the body. “Whether a sweetener is artificial or naturally occurring in itself cannot tell us anything about its potential health risks or benefits,” McGrath says.

Further research provides the opportunity to develop this awareness. “The guideline also did not consider studies looking at the use of non-sugar sweeteners by patients with diabetes, so this is another area for future work,” says McGrath.