Health effects of the use of non-sugar sweeteners: a review and meta-analysis

https://www.who.int/publications-detail-redirect/9789240046429

by ValentineC • 4 years ago

159 242 4 years ago

"The results suggest that, in the short term, NSS use may lead to small reductions in adiposity without any significant impact on cardiometabolic risk. There is suggestion of negative health effects with long-term use, but the evidence is ultimately inconclusive."

I won't be getting rid of my Coke Zero any time soon.

BbzzbB2• 4 years ago

What a blessed day! I'll take those odds as well.. not that I haven't so far either way.

adhesive_wombat4• 4 years ago

I just wish they'd also avoided the phosphoric acid in it! Might not be full of sugar, but it's still bad for teeth.

lotsofpulp• 4 years ago

Not nursing the drink forever and rinsing your mouth afterwards with water should return the pH to normal relatively quickly, according to my dentist.

xattt2• 4 years ago

The local Pepsi bottler has been distributing Crystal Pepsi (!) in our market the last few weeks. I thought I would have never seen the day.

I would be drinking it more regularly to avoid caramel colour (possible link to microvascular damage that leads to increased likelihood for atherosclerosis, no citation at hand), but also to be ironic.

daneel_w• 4 years ago

From what I've understood, the phosphoric acid is also a problem for the gut flora. With regular daily intake it will apparently kill certain bacterial cultures over time, and with that comes a set of new problems.

halfmatthalfcat• 4 years ago

On the same topic, recently learned that erythritol (Swerve) does not contribute at all the plaque as normal sugar/other substitutes do.

nathanaldensr• 4 years ago

If my wife's caffeine withdrawal is any indication, you might want to be more concerned about your amount of caffeine intake rather than the sweeteners.

na85• 4 years ago

I just go cold turkey every few months when my caffeine tolerance gets out of hand.

verall• 4 years ago

Unless you're drinking like 6 a day it's nothing compared to regular coffee drinkers:

12oz coke zero: 34mg caffeine

12oz brewed coffee: 120-240mg depending on beans and strength

Double shot espresso: 60-180mg

I can easily do 2 12oz brewed or doubles in a day and friends drink much more.

kevinmchugh2• 4 years ago

Caffeine withdrawal is easy to avoid and not at all dangerous. It's unpleasant, sure.

stjohnswarts5• 4 years ago

The way I got past caffiene withdrawl was to control it. I did it over 4 weeks with using caffeine pills. Never got a head ache, each week I just went down 25% until I hit 0%

beached_whale2• 4 years ago

Lets add that some of these are really old food additives

* 1965/1983 - Aspartame

* 1976/1991 - Sucralose

* 1879/1884ish - 1960s - Saccharin

mountain_peak• 4 years ago

I've been reading some old (early 1900s) diabetic recipe books from archive.org and it was a bit of a surprise to see how many recipes used saccharin back then (and almond flour, bone broth, etc.). I remember seeing saccharin tablets everywhere as a youngster, then they all suddenly went away. As it turns out, researchers found a higher incidence of bladder cancer in rats fed a diet of saccharin (20x the expected human dose, I think), which caused the production of saccharin to drop off dramatically. Up until that point, it was cheap, relatively easy to produce and plentiful.

Further research eventually proved that saccharin reacted with a compound in rat urine that caused crystals to form in the urine, which 'scraped' the bladder wall, causing injury, increased cell repair, and (therefore) an increased incidence of bladder cancer in rats. The researchers proved that this compound did not exist in human urine and crystals did not form, therefore the increased incidence of cancer should not exist in humans - and analysis of bladder cancer rates for lifelong saccharin users backed-up the new findings.

Still, the damage to saccharin had been done and I think there's only one plant in Europe that still produces it. I'm not sure how large the artificial sweetener market is (it seems to be growing exponentially), but every decade an old sweetener appears to fall out of favour and is replaced by a new one (or is added in combination with others). I'm not sure we're much further ahead than we were in the early 1900s!

ralusek• 4 years ago

Drink water

ramraj07• 4 years ago

If you drink a can every two days, great.

If you get a personalized gallon sized mug with a straw filled with diet soda every day to work and are also already morbidly obese, maybe the drink won’t help.

The second statement I’ve seen so many times in Texas :(

honkdaddy• 4 years ago

Very true. But if they’re morbidly obese as it is, it’s pretty likely they have a brain chemistry which responds very positively to sugary drinks, so without the diet soda it’s possible their health would be even worse.

I’ve never met an obese person who liked being obese, but I’ve met lots who have a really challenging relationship with food which slowly brought them to the point they’re at now. I’m an addict as well, it’s just not as visible.

TheDudeMan2• 4 years ago

Do you have any evidence for the statement that 1 can every two days is OK, but ~7 cans every day is not OK (other than anecdotal)?

victor106• 4 years ago

If you drink a can every two days, great.

If you drink a can of regular Coke every two days, for most people it should be okay.

heavyset_go4• 4 years ago

There's close to an ounce of dissolved refined sugar in a can of soda. Hell, a can of ginger ale has almost 40 grams of sugar in it. Drinking that much sugar at once will spike your blood sugar levels and can potentially set you up for pre-diabetes if you make it a habit.

29athrowaway• 4 years ago

If I may suggest... you should try to get into tea. There are teas for all tastes including fermented tea, and related beverages like yerba mate, guarana, etc.

hirvi74• 4 years ago

Yerba mate puts me in the best mood. I have no idea why. Maybe the MOAIs?

Gigachad4• 4 years ago

Also my conclusion. Aspartame and other sweeteners have been researched to death now and they still can’t tell me they have found anything. While other chemicals in regular use have real and concrete health issues.

mjevans• 4 years ago

It is practically impossible to conduct a long term health study on something like an artificial sweetener. The only way I can think of to accurately remove environmental noise is to collect extensive records on a _large_ population, and then line up A / B sets where the only major difference between the sets (other exposures similar) are the sweeteners.

With a lot of samples that fulfill that criteria a historic review might be able to identify statistical anomalies towards outcomes (positive or negative) that are common to the matched A and B sides of the set.

I could see an AI administering such a data collection and comparison in an accurate and ethical way; but only the scifi grade strong / true AI.

bhk• 4 years ago

I don't think that's a balanced summary of the study.

"Results from prospective cohort studies suggest the possibility of long-term harm in the form of increased risk of obesity, type 2 diabetes, cardiovascular diseases and mortality."

And regarding the short-term weight loss, the confounding factor of reduction in sugar and overall energy intake seems to be the explanation.

The "Concluding Remarks" section of the paper is a good, and very brief, encapsulation of the results.

ipaddr• 4 years ago

Your teeth will be affected. I spent a year drinking as much coke as I wanted. The teeth issues that resulted made me never drink the stuff again.

If I could go back and tell my younger self one thing.. stay away from the coca cola.

stjohnswarts5• 4 years ago

Yes I always figured if there is something, it's on the order of 10%-20% "bad outcome" vs being a sugar teetotalar. However since I avoid as much sugar as possible and have some splenda in my coffee and coke zero pretty much guilt free.

adhesive_wombat4• 4 years ago

Large amounts of sugar are so bad for you that it would be pretty obvious statistically if sweeteners were anything like as bad and they'd be banned.

Somewhat like how if cars were invented today they'd be deemed insanely dangerous.

fredgrott• 4 years ago

Not exactly true.

If eat a whole orange, the fiber in the orange slows down sugar uptake whereas if I drink juice the sugar hits bloodstream much faster.

And generally Phenylalanaline is better than some of the others. Why? Well because it's one step away from L-DOPA which is one step away from dopamine

adhesive_wombat4• 4 years ago

Right, but "large amounts" of sugar. 250ml of juice (and yes, I know the suggest serving size of orange juice is much less than that, but it's very easy to drink a normal glass of it) is quite a few oranges.

Sugar is, like everything except plutonium, fine in moderation. But "in moderation" is not how sugar occurs in many modern diets.

polalavik• 4 years ago

By what metric is it “one step”? D2O is one step away from water, but that doesn’t make it good for you.

PragmaticPulp• 4 years ago

And generally Phenylalanaline is better than some of the others. Why? Well because it's one step away from L-DOPA which is one step away from dopamine

L-Phenylalanine is first converted to L-Tyrosine, which is then converted to L-DOPA, which is then converted to Dopamine.

However, it's very misleading to reduce the body to basic formulas like this because these pathways from dietary amino acids to neurotransmitters are all regulated within the body at many different stages, so adding a little extra Phenylalanine to a meal isn't going to give you a dopamine boost. You consume a lot of Tyrosine in a standard protein like chicken breast (multiple grams, potentially) and nobody is getting high off of standard protein. The body is very good at regulating these things.

romwell3• 4 years ago

Somewhat like how if cars were invented today they'd be deemed insanely dangerous.

The cars we have today are insanely dangerous.

Cars kill about as many people as guns in the US. That's to say, they are as effective in killing people as the tools made to kill people.

Teknoman1172• 4 years ago

To be fair, there are far, far more daily users of cars than firearms.

xvilka• 4 years ago

It's sugar that should be banned, or at least restricted content in food by the law.

TaupeRanger• 4 years ago

Everyone I know who constantly harps on aspartame, sucralose, MSG, etc. also drinks an alcoholic beverage 5 or more times per week and never exercises beyond an occasional meandering neighborhood walk. The latter is astronomically more likely to harm them, but it's easier to think that they're being "healthy" simply by avoiding artificial sweeteners.

incone123• 4 years ago

The real danger with people constantly harping on aspartame is that they bore others to death. All you can do is try to limit your exposure.

bagacrap3• 4 years ago

what's the complaint with msg? have never heard anyone complain about that, although as a kid with all the "no msg" signs at Chinese restaurants and no other context I thought of it as something similar to MDMA or LSD.

jokowueu4• 4 years ago

There is nothing bad about it. The reason why it was attacked is another story

https://youtu.be/E-POAKKH5IM

Gordonjcp3• 4 years ago

All of those taste unbelievably vile, which is why I avoid them. I don't care about the health effects, I care about them making everything taste like antifreeze.

riku_iki4• 4 years ago

Interesting, that from my reading it looks like using non-sugar sweeteners caused -570 calories daily intake reduction, but somehow just -0.71kg of body weight..

Edit: it is 570 kJ = 136 calories.

laweijfmvo• 4 years ago

You need -500 calories every day for a week in order to lose 1 pound.

riku_iki4• 4 years ago

I think it is -0.71kg of total body weight loss, not just per one week.

PuppyTailWags2• 4 years ago

* +/- up to 20% deviation (some people absorb more or less calories in their food)

* until your metabolism adapts to consistent calorie deficit, which causes up to 50% decrease in weight loss

Maintenance Phase had a fascinating episode about calories being significantly more complicated than we expected.

dmix6• 4 years ago

This is the punchline of every keto book. The whole ‘you just need to eat less calories to lose weight’ thing that has been pushed since post-WW2 despite having almost no solid evidence supporting it for long term weight loss.

The best one that destroys the woo-y history of calorie (and fat) obsessed health science (or lack of science) is the book “The Case for Keto” by the author who wrote “The Case Against Sugar” and “Good Calorie Bad Calorie”.

EMM_386• 4 years ago

The whole ‘you just need to eat less calories to lose weight’ thing

CICO, or "calories in, calories out", is obviously real.

If you don't eat food, you will lose weight and eventually starve to death.

tpush2• 4 years ago

Gary Taubes (the author of those books) is about as far from a serious scientist, or even science communicator, as one can get without being an obvious charlatan.

Saying 'the science got it all wrong!' while citing pop-sci books from Amazon is a bit ironic.

NovaVeles• 4 years ago

Yeah... nah. Simply on CICO (well more just monitoring CI) I have lost 40Kg/90 Pounds over the last 5 years. It does work.

victorvosk2• 4 years ago

Right... its more likely our bodies are probably some miraculous, fuel-less generators capable of producing energy (and fat) from thin air.

Meanwhile, in my own anecdotal, completely unscientific personal study, I went to eating one meal a day 6 weeks ago and have lost 10 pounds, despite eating all sorts of stuff you are not supposed to eat (sugar) during that one meal each day.

culopatin• 4 years ago

Why do you think there is no evidence that if you reduce calorie intake you lose weight? Are you saying that if your calorie intake was 0 you would remain fat? Why are anorexic people skinny then?

leereeves• 4 years ago

From the table on page 1?

Total energy intake (kJ/day)
Energy intake –569 (low)

It's 569 kJ, which is only 136 Calories.

riku_iki4• 4 years ago

You are right, thank you.

andrew_• 4 years ago

Glucose index effect can play a large role in weight gain and retention. A lot of the NSS products have a worse GI effect than straight cane sugar, especially the sugar alcohols.

riku_iki4• 4 years ago

Can you support your claim by any evidence? Stevia for example has 0 GI, while sugar has 80 GI: https://www.va.gov/WHOLEHEALTHLIBRARY/docs/Understanding-Swe...

tpush2• 4 years ago

I don't think there's any robust evidence for glycemic index/load mattering at all, unless you're diabetic of course.

icelancer• 4 years ago

In fact most of the evidence actually supports the opposite hypothesis: It really doesn't matter.

stjohnswarts5• 4 years ago

I think you better do some more reading if you think stressing your insulin mechanism daily with far more sugar than humans evolved to partake of is "ok". There's pretty good evidence for 30-35% of humans not handling it well at all...

Someone12342• 4 years ago

I looked it up and:

- Aspartame Glycemic Index 0

- Stevia Glycemic Index 0

- Sucralose Glycemic Index 0

- Allulose Glycemic Index 0

What are you trying to claim here?

LAC-Tech• 4 years ago

Genuine question - how well regarded are these kinds of studies from the WHO? Are they generally considered pretty solid and reliable?

greazy• 4 years ago

In general, WHO reports are highly regarded and highly read and cited by the respective fields. This report would be no different.

henearkr• 4 years ago

They analyzed all studies about any of the different non-sugar sweeteners...

I bet there are some that are bad and some that are good, I'm waiting for more precise results.

In particular, it seems that stevia based sweeteners are rather innocuous or even good (e.g. lowering blood pressure).

havblue• 4 years ago

I wonder if it's just that a single 20oz of diet/zero sugar soda doesn't make a big enough difference one way or another. Likely not so good for you but not as addictive and statistically significant as say, alcohol, nicotine or fatty and sugary foods.

neonsunset• 4 years ago

Consuming anything that has aspartame in it gives me a severe migraine.

supernova87a• 4 years ago

Have there been any solid findings on whether, even if there is no nutritional value (directly fattening/metabolic effects) in artificial sugar, it has effects on whether it triggers your hormones -- or that of your gut bacteria -- to contribute as if it were real sugar?

In my mind that is the most interesting unanswered question to help decide whether it's an effective sugar substitute.

ineedasername2• 4 years ago

You really can't get to a good understanding on this issue without an analysis of comparative harm.

The issue is only partly about whether non-sugar sweeteners have negative effects. The more important question is whether regular & processed sugars produce an overall worse impact than substitutes consumed at comparable levels, with stratification by consumption level.

E.g., non-sugar sweeteners may have a similar danger profile at both low and high levels of consumption while sugar's negative impacts may be more linear. Or so other balance. In a situation like that, the proper advice to individuals looking to become healthier may vary, especially given that immediate and rapid wholesale change if a person's behavior is not usually possible.

whoisjuan• 4 years ago

Sugar is not even in a comparable realm. By every measure, sugar is worst than any non-sugar sweetener.

Modern medical consensus is that added sugar should be avoided as much as possible.

adrianN• 4 years ago

I would be very surprised of there is consensus in nutrition science about anything as absolute as avoiding all added sugar.

adrian_b2• 4 years ago

While sugar when added to food, and especially when added to beverages, is bad, the conclusions of the study seem consistent with sweeteners being as bad as sugar.

According to this meta study, the sweeteners do not cause any cancer risk, but in the long term they significantly increase the risk of diabetes and of various cardio-vascular problems, without providing any reduction in obesity.

So they appear to be no better than sugar.

It seems that the best strategy is to satisfy one's craving for sweet things only with naturally sweet fruits and vegetables, raw or cooked, and without making juices out of them.

I have actually given up on using sugar some time ago, because both my grandfather and my father had diabetes at old age, so I do not want to repeat their fate.

Now, after becoming dis-habituated with sugar, all the fruits and also many vegetables like red bell-peppers, carrots or even red onion, feel extremely sweet, unlike during the time when I was frequently eating food with added sugar.

So I no longer crave for sweets, even if I had not expected that this is possible.

UIUC_065• 4 years ago

I'm being a killjoy here, sorry:

Just drink water. Much healthier. Carbonated, if you like. With some lemon or lime juice, maybe.

derefr• 4 years ago

Who said anything about soft drinks? They're putting artificial sweeteners in "unsweetened" sauces and condiments these days. They're getting about as hard to escape as sugar was in the "fats bad" era.

UIUC_065• 4 years ago

Good point. I say, have the regular stuff (w/sugar) but just go easy with it.

Tao3300• 4 years ago

unsweetened

Unsweetened generally still means it. The weasel words I usually see are "no added sugar". The ingredients will then list juice concentrates, stevia, or monkfruit.

idiocratic• 4 years ago

This to me seems less of a problem where I come from, Italy. It's true that most Italians indulge in sugar when drinking coffee (which it's a terrible practice, we should instead push for better specialty-grade coffee that doesn't need sugar). At the same time what Americans call "condiments" it's basically just olive oil, some salt and pepper for 95% of our dishes. A traditional mediterranean diet, made primarily of grains, legumes and vegetables with some occasional meat and fish is what me and most of my friends' families would have for dinner. Of course, there's the ice cream, the cakes, the BBQ with friends, etc. But I'm just thinking about the normal daily diet here. And the standard seems pretty healthy, with most sugars coming from seasonal fruit.

brandonmenc2• 4 years ago

Everything in moderation.

If you only drink soda, you've got problems. If you only drink water, you're not having any fun.

It's OK to pick a point somewhere in the middle.

jacob019• 4 years ago

I have fun drinking coffee, tea, and alcohol. I have no desire to drink sweet liquids. But point well taken, moderation is key to a happy life.

HellsMaddy• 4 years ago

Sweetened beverages, including no calorie, fall on the extreme end of the sweetness spectrum. If you consume such sweet things even in moderation, you are recalibrating your sense of sweetness.

Personally, I’ve avoided all added sugars and sweeteners for a few years now. I used to find apples bland and boring, but now they taste like indulgent candy. The same goes for pretty much all fruit. I can taste sweetness in vegetables that I used to find bitter. Lightly cooked carrots, beets, squash are all deliciously sweet treats. The bottom line is that I get a lot more enjoyment out of “healthy” foods now.

When I’ve recently tried “normal” sweets like cake or soda, they taste sickeningly sweet. However, I imagine that if I drank even a no calorie sweetened drink like Coke Zero “in moderation”, my sweetness scale would recalibrate and I would start gravitating more towards sweeter things, and be less able to sense the sweetness of mildly sweet things.

The same concept applies to other flavor profiles. Salty, umami, starchy, fatty. Eating processed foods even in moderation reduces your enjoyment of whole foods and consequently makes you less likely to eat them.

blitzar• 4 years ago

If you only drink water, you're not having any fun.

I have plenty of fun only drinking water thanks.

arisAlexis• 4 years ago

Drinking soda is no fun

kstenerud2• 4 years ago

If you only drink water, you're not having any fun.

That's a very strange thing to say...

It's only in the last two generations that other beverages have supplanted water. Prior to that it was a rare thing.

When I first switched to water only 7 years ago, it was actually hard because I'd had a lifetime of flavor overload, and it takes awhile for your sense of taste to adjust to normality. American food in general is over-salted, and over-flavored. Eating most things there is like a punch in the face after eating normal food again (England has the opposite problem).

Drinking carbonated water with a twist of lime helped a lot, and then after awhile I came to appreciate the subtle nuances between different water types. Tap water in San Francisco has a harsh overtone to it. Tap water in Western Oakland tastes a little muddy. Tap water in Vancouver and Leipzig is actually quite tasty. The best water I've ever had is hands down in the tiny town of Nagasasa in Japan. We actually dumped out all of our water bottles and brought 20 litres of the stuff back with us to Nagoya (where the tap water tastes terrible).

NullPrefix• 4 years ago

How much cocaine a day would still be "in moderation" ? I mean, we are talking everything, and everything includes cocaine too.

rocket_surgeron• 4 years ago

Water doesn't mix well with rum.

Sure, you can do it, the British Navy did it for centuries, but "can" isn't "should".

larsrc• 4 years ago

I tried that, but my cakes just don't come out the same.

victorvosk2• 4 years ago

The absurd amount of money and time that has been spent on studies around artificial sweeteners should tell you its probably safe. Everyone has been dying to find a smoking gun here for decades and it never happens.

Gordonjcp3• 4 years ago

It doesn't matter if they're safe or not, because they taste absolutely revolting.

I guess this is overall good for my health, because I can no longer drink soft drinks or eat most processed foods.

spacemanmatt12• 4 years ago

The politicized approval process that got sucralose and aspartame on the market should give anyone reason for concern. Remember that the beneficiaries of those approvals are people who know the most about these chemicals and are motivated to avoid learning more or disclosing what they know.

Someone12342• 4 years ago

Can you cite whatever it is you're referring to?

gruez4• 4 years ago

The politicized approval process

What do you mean by "politicized"?

Remember that the beneficiaries of those approvals are people who know the most about these chemicals and are motivated to avoid learning more or disclosing what they know.

That's basically the status quo for how every new product gets approved.

adrian_b2• 4 years ago

The conclusion of this study is that in the long term the sweeteners are not safe for adult people, because they increase the risk of diabetes and of various cardio-vascular problems, even if they do not cause any cancer risk.

The same is true for added sugar, so the sweeteners are not better than sugar.

throwaway_4ever• 4 years ago

Does the study prove causality though? By what physical mechanism does a range of different substances, with no calories, cause diabetes and cardiovascular problems?

The glaring problem is that diet sodas are often consumed as part of an unhealthy diet, alongside unhealthy fast food burgers and fries, and that best explains why you'd see the increase in diabetes and cardiovascular issues. Occam's razor.

hypertele-Xii7• 4 years ago

Why would you ever want to fool your body into thinking you're eating something you're not? If you want to taste sweet then eat sugary foods. If you don't want to eat sugary foods, why in the world are you eating artificial lab-created pretend-sugar?

As much as you should aspire to be truthful in your life, you should also be truthful in your diet. Eat actual food. Artificial sweeteners are a scam.

Gigachad4• 4 years ago

The foods are not fake sweet, they are actually sweet. Being sweet doesn’t mean being sugar.

hypertele-Xii7• 4 years ago

Sweetness is a taste we literally evolved over millenia to find sugar.

jokowueu4• 4 years ago

What makes you think you are fooling your body with artificial sweeteners ?

And whats 'actual food' ?

If artificial makes it bad then is stevia fine ?

BeetleB3• 4 years ago

Besides the obvious "Safer for diabetics": You could ask the same question regarding anything with food coloring. Or any butter substitute.

hypertele-Xii7• 4 years ago

Yes! Personally I always select to purchase food with the least fake stuff in it, be it fake taste, fake color, or unnecessary preservative.

sasaf5• 4 years ago

Refined sugars are also a scam, fooling our palates into thinking we are getting the micronutrients of fruit.

stjohnswarts5• 4 years ago

Because I'm not an automaton and I enjoy. Drinking isn't really good for you but moderate drinking isn't that bad and can be quite fun in the right company. I like having a couple of coke zeros a day and they are apparently nutritionally neutral or a slight bit bad for me. The amount of cola and sugar in coffee that I used was much worse and provably so. Also none of us get out of this alive.

FrozenVoid• 4 years ago

I'd play it safe and eat only natural sweeteners like inulin/stevia/xylitol. Gut microbes haven't evolved to expirience the whole array of artificial sweeteners.

Gordonjcp3• 4 years ago

The increased use of non-sugar sweeteners in soft drinks means that I now drink a lot more beer, because I can no longer drink soft drinks. I don't know what sort of health effect that has.

2-718-281-828• 4 years ago

That study cannot be complete if it isn't covering Xylitol - period

exabrial2• 4 years ago

If I'm not mistaken, essentially the conclusion is shit we already knew: Unless you change your eating habits (decrease volume of calories and increase quality of food), you're probably going to be stuck where you're at.

Drinking 24x cans of diet soda every day isn't going to you there.

__ryan__• 4 years ago

  decrease volume of calories

By, say, replacing 24 cans of “regular” soda (24 * ~100cal) with 24 cans of diet soda (24 * ~0cal).

I calculate about 2400cal savings, and if CICO is legit, I think that would get them there.

exabrial2• 4 years ago

This misses the point. People are using Diet soda as an excuse to consume excessively (Hence Quality of food statement above). _anything_ in excess is bad for you

Health effects of the use of non-sugar sweeteners: a review and meta-analysis

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