Sweetener showdown: ISA defends sucralose in diabetes and healthy weight management

The International Sweeteners Association (ISA) is rebutting recent research suggesting that sucralose affects brain appetite regulation. The association underscores that low- and no-calorie sweeteners like sucralose are important tools for sugar and calorie reduction, as obesity and diet-related non-communicable diseases like diabetes are a growing challenge. 

Last month, researchers found that sucralose increased activity in the hypothalamus, an appetite-regulating brain region, whereas sugar did not. 

However, Laurent Oger, ISA director general, tells Nutrition Insight that the study showed that sucralose, like water, had a neutral effect on appetite and hunger while triggering different brain responses compared to sugar-sweetened drinks. 

“This is to be expected considering sugar’s energy and carbohydrate content not present in sucralose and water.”

“When interpreting scientific evidence, it is essential to look at the overall body of available research,” he cautions. “Numerous studies have investigated the acute and long-term effects of sucralose on energy and food intake, as well as on body weight, and collectively confirm that low- or no-calorie sweeteners, including sucralose, can help reduce total caloric intake and, in turn, body weight over time when consumed instead of sugars.”

Healthy weight management

The potential of low- and no-sugar sweeteners in healthy weight management has been debated in recent years. For example, the WHO advises against non-sugar sweeteners for weight loss based on a systematic literature review, finding that long-term use does not reduce body weight. 

However, experts, including the ISA, believe the supporting evidence is insufficient and that the WHO guideline is inconsistent with a global integrated approach to addressing non-communicable diseases, such as reducing sugar intake. 

Oger points to health organizations’ recommendations to reduce free sugar consumption to less than 10% or 5% of daily energy intake. “For individuals who would like to keep a sweet taste in their diet, low- or no-calorie sweeteners can be a useful tool to help reduce excessive sugars and energy intakes and, in turn, assist with weight control.” 

Low- and no-calorie sweeteners have been shown to help people who seek to lose weight adhere to a healthy, energy-reduced, low-sugar diet.Meanwhile, in a statement on this WHO guideline, the UK Scientific Advisory Committee on Nutrition concludes: “The evidence indicates that there may be some value in using non-sugar sweeteners to help reduce weight gain in the short to medium term, but it is not essential and is not the only option.” 

Oger agrees: “While there should be no expectation that low- or no-calorie sweeteners, by themselves, would decrease body weight as they are not substances that can exert pharmacologic-like effects, their use has been shown to help people who seek to lose weight adhere to a healthy, energy-reduced, low-sugar diet.” 

For example, he refers to a year-long randomized controlled trial with 493 participants comparing non-nutritive sweetened beverages with water in a weight management program. People consuming drinks with sweeteners lost an average of 7.5 kg, while the group drinking water lost 6.1 kg. 

“People who seek to lose weight should pay attention to their overall diet quality,” he continues. “Nutritional guidelines around the world encourage individuals to follow a healthy dietary and lifestyle pattern to support overall health and well-being, including healthy body weight. Eating sensibly, choosing a high-quality, varied diet from a range of foods, and keeping active are all great ways to promote health.” 

Supporting a diabetic sweet tooth

Oger points to numerous scientific studies supporting sweeteners by people with diabetes, who have to “carefully monitor what and how much they can consume and may feel deprived when it comes to sweet taste.”

“Low- or no-calorie sweeteners, such as sucralose, are frequently recommended for, and valued by, people living with diabetes who need to manage their carbohydrate and sugar intakes to maintain good glycemic control.” 

“This is because they do not affect glucose control, both acutely, like in this new study, or after longer-term consumption, and cause a lower spike in blood glucose when consumed instead of sugar.” 

Oger notes that sweeteners like sucralose don’t affect glucose control and cause a lower glucose spike than sugar.In addition, he says that low- and no-calorie sweeteners do not affect insulin secretion or blood insulin levels.

Moreover, Oger notes that several diabetes organizations, including the American Diabetes Association, Diabetes Canada, and Diabetes UK, and European recommendations for the dietary management of diabetes support this. 

Clear consumer education

Experts highlight the benefits of sweeteners for healthier diets but also call for more transparent communication on their efficacy and safety. 

With the ongoing discussions on the safety and health benefits of low- and no-calorie sweeteners, Oger underscores that consumers should have access to science-based information to help them make informed and safe food choices. 

“All approved low- or no-calorie sweeteners are safe and may carry the benefits mentioned above as part of a healthy diet and lifestyle, irrespective of origin. Communicating their benefits remains challenging, as consumers are often unaware of their function in food and drinks or of the safety evaluations and strict regulations covering their use and may have seen conflicting headlines in the media.” 

A few years ago, the International Agency for Research on Cancer classified aspartame sweeteners as possibly carcinogenic to humans, which was leaked a week before a risk assessment by the WHO and FAO Joint Expert Committee on Food Additives reaffirmed the ingredient’s safety, confirming its existing maximum daily intake of 40 mg/kg of body weight. 

Critics of the IARC classification and leak said the conflicting evaluations confused consumers and ramped up public concern for the sweetener’s safety. 

Since then, sweeteners like aspartame and sucralose have been linked to potential microbiome health benefits. A recent study associated aspartame with heart health risks, although experts contest these findings. 

Oger says there is a need to explain alternative sweeteners’ safety and benefits carefully and, if needed, to go back to the basics of science literacy. “For example, explaining the difference between risk and hazard, or explaining that correlation does not mean causation.” 

“At ISA, we are doing our part in sharing the most up-to-date nutritional and scientific information on low- and no-calorie sweeteners, but balanced communication on this topic should come from all stakeholders, avoiding preconceived ideas,” he concludes.