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 The analysis, published in The BMJ, was commissioned by the World
Health Organization with the aim of developing guidelines on the use
of non-sugar sweeteners such as aspartame and stevia.
"Unfortunately, we don't have sufficient data to assess fully the
potential benefits and harms of non-sugar sweeteners," said senior
researcher Dr. Joerg Meerpohl, director of the Institute for
Evidence in Medicine at the University of Freiburg in Germany.
"While a substantial number of studies have been published, there
was not much consistency in relation to the specific
intervention/exposure evaluated and which outcomes were measured
when and how."
Moreover, Meerpohl said in an email, most of the studies were small
or brief. "Unfortunately, we need more and better research on the
topic," he added.
Meerpohl and colleagues gathered research that explored the impact
of artificial sweeteners on important health outcomes like weight
and blood sugar levels. They eventually settled on 56 studies, 35 of
which were not clinical trials.
Some of the small studies suggested non-sugar sweeteners might
slightly improve body mass index (BMI, a measure of weight relative
to height) and blood sugar.
Data on 318 participants in four randomized controlled trials showed
that daily energy intake was 254 calories lower in those who
consumed artificial sweeteners compared to those who consumed sugar.
And a study of overweight and obese individuals who were not trying
to lose weight found that the artificial sweeteners were associated
with a loss of nearly 4.5 lbs.
But artificial sweeteners did not seem to help overweight and obese
adults and children who actually were trying to lose weight.
Two studies with a total of 174 participants found a very small
improvement in blood sugar with use of non-sugar sweeteners.
One limitation is that the researchers left out studies that did not
name the sweetener being tested. Another issue, pointed out in an
editorial accompanying the new report, was that Meerpohl and his
colleagues lumped together studies comparing artificial sweeteners
to non-caloric placebos with those comparing artificial sweeteners
to sugar.
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"In experimental trials, the intended effects of (non-sugar
sweeteners) are expected to differ depending on the energy content
of the comparator," writes Vasanti Malik, a nutrition researcher at
Harvard's T.H. Chan School of Public Health in Boston. Meerpohl and
his colleagues "did not differentiate trials according to the nature
of the comparator. Among included studies, benefits on blood
pressure and body weight were observed when (non-sugar sweeteners)
were compared with sugars rather than non-calorie placebos."
The new report shows that artificial sweeteners, in and of
themselves, do not lead to improved health outcomes, said Michele
Pfarr, a clinical nutrition manager at the Magee-Womens Hospital at
the University of Pittsburgh Medical Center in Pennsylvania. What's
important when you're trying to lose weight, Pfarr said, "is a focus
on overall calorie intake and eating nutrient-rich foods like fruits
and vegetables, along with low-fat dairy, whole grains and lean
meat."
Sodas containing artificial sweeteners may aid in weight loss, "only
if you're using them to replace full-calorie drinks," Pfarr said.
"But if you see this as an opportunity to eat other foods, you're
not going to realize that impact."
"For the vast majority of people, there probably aren't any health
benefits to non-sugar sweeteners," said Dr. Aziz Alkatib, a
cardiologist at Detroit Medical Center's Harper Hospital in
Michigan. "For individuals who consume excessive amounts of sugar,
particularly in the form of sugar-sweetened beverages, perhaps a
non-calorie sweetener is a less health-damaging alternative."
A better strategy for weight loss is to switch to water, Alkatib
said in an email. "One study showed that switching from diet
beverages to water helped women lose weight," he explained. "By
consuming these sweeteners, you avoid confronting a major roadblock
to healthy eating: sugar addiction."
SOURCE: https://bit.ly/2RzWcbs and https://bit.ly/2F5D7Ij The BMJ,
online January 2, 2019.
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