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Should you stop using sugar substitutes 

Answers to common questions

Article by Dr. Layla Sade

Photography by Dr. Layla Sade

The World Health Organization just issued a startling new report urging people to cut artificial sweeteners and other sugar substitutes from their diets. But that doesn’t mean you should switch back to using real sugar, the agency said. WHO has already issued guidelines urging people to limit the amount of sugar they eat. Now the agency wants people to cut back on all sweeteners, period — whether they’re natural or artificial.

Reactions to the report have been mixed. Industry groups, including the Calorie Control Council and the International Sweeteners Association, said the safety of non-sugar sweeteners has been firmly established and that low- and no-calorie sweeteners have been proved to help with weight management and cutting back on calorie and sugar intake.

Others applauded the finding, saying people already eat too many ultra-processed foods, which have been linked to health problems, and the advice should encourage consumers to reduce their intake of both sugar and artificial sweeteners.

Here are answers to some common questions.

What sweeteners does the WHO advise against?

The WHO is advising people to stop using all artificial or non-sugar sweeteners. The guidance applies to individual sweetener packets that people may add to food and drinks as well as ultra-processed foods that contain the sweeteners. This includes:

  • Acesulfame K
  • Aspartame
  • Advantame
  • Cyclamates
  • Neotame
  • Saccharin
  • Sucralose
  • Stevia (and stevia derivatives)

Monk fruit extract isn’t on the list of sweeteners from WHO. It’s a relatively new addition to packaged foods. So, there’s less research available on its long-term effects. That said, it is likely that monk fruit extract may act the same as other sweeteners.

What sweeteners are not included on the list?

Sugar, honey, agave and sugar derivatives — including corn syrup or sugar alcohols — are not considered “non-sugar substitutes” so they were not specifically named in the new WHO guidance. But that doesn’t mean people should switch to those products. In previous guidance, the agency already has recommended cutting back on all sugars. Sugar alcohols, also know as polyols, are commonly found in processed foods and come from plant products such as fruits and berries.

What does the science show about artificial sweeteners and weight loss?

The WHO advised against using the sweeteners for weight loss. There are some rigorous clinical trials that show some short-term benefits to using artificial sweeteners for weight loss. But, when similar studies monitored participants for six to 18 months. there wasn’t the same effect on body weight.

Artificial sweeteners can help someone with weight loss if they’re eating a healthy diet. But, the key is the sugar substitute has to fit alongside a diet of fruits, vegetables and less-processed foods.

People often concluded that foods or beverages with zero calories must “positively impact” weight loss. But, the reality is that isn’t always the case. Low-calorie or zero-calorie sweeteners might be an aid in weight management, but they are by no means the management or that silver bullet in weight management tools. It comes back to still being thoughtful about your food choices.

What are the long-term health concerns about using non-sugar sweeteners?

WHO’s review of the available research found groups who regularly consume non-sugar sweeteners had an increased risk of Type 2 diabetes and cardiovascular disease.

Is it better to add sugar to my morning coffee instead?

“No, absolutely not, instead of using two spoonfuls of sugar or two packets of artificial sweetener, cut back to one and then, maybe, none over time. The goal is to eventually get used to a diet without as much added sugar or artificial sweeteners. Younger, healthier people can still enjoy sugar in their morning coffee if they enjoy it, but moderation is key.

But, advice for people with certain metabolic conditions, Type 2 diabetes or elevated risks of heart disease are more steadfast. It’s best to avoid adding any type of sugar to your beverages if possible, experts say, as it can increase the likelihood that your condition worsens over time.

Does everyone agree on banning fake sweeteners from our diet?

Artificial sweeteners are commonly found in ultra-processed foods and a growing body of research shows that cutting back on these foods can have a huge impact on our health. In a controlled clinical trial carried out by the National Institutes of Health, scientists fed a group of people a diet of ultra-processed foods for two weeks and then an equivalent diet from scratch. And, on the diet of ultra-processed foods, the participants quickly gained weight and body fat. Weaning us from sweetness is very important. We have too big a sweet tooth and, unless we cut it down, our children are going to have the same sweet tooth.

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