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WHO’s advice on non-sugar sweeteners?

Context: Recently The World Health Organization (WHO) issued new guidelines on advising against the use of non-sugar sweeteners (NSS) like aspartame, saccharin, stevia and other derivatives as a “healthy” alternative to sugar.

What are non-sugar sweeteners?

• Non-sugar sweeteners (NSS) are marketed as low or no-calorie alternatives to free sugars which aid in weight loss, and in controlling blood glucose in individuals with diabetes.
• NSS categories studied by WHO include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia, and stevia derivatives.
• Aspartame is popularly used to sweeten diet colas that claim to have ‘no sugar, no calories.’ Saccharin is used, for instance, to sweeten tea or coffee.

How did WHO conclude its findings?

• The WHO analysed a total of 283 studies on the intake of NSS in adults and children. It included studies that compared NSS consumption with no or lower doses of NSS consumption as well as trials that compared the intervention with any type of sugar, placebo, plain water or no intervention.
• The paper, ‘Heath effects of the use of non-sugar sweeteners’, written by Magali Rios-Leyvraz and Jason Montez, states that it did not include studies that only compared one or more NSS to one another, without also comparing them with a sugar, placebo, plain water or no intervention.
• The outcome of the trials was that the WHO noted that ‘higher intake’ of NSS was associated with a 76% increase in risk of obesity and a 0.14 kg/m2 increase in BMI (Body Mass Index).
• In the final analysis, no evidence of long-term benefit on reducing body fat in adults and children was found. It warned that long-term use of NSS could lead to increased risk of Type 2 diabetes, cardiovascular diseases, chronic kidney disease and cancer.

What are the concerns?

• Health experts point out that India should take necessary steps to guide people on NSS because one in nine women and one in 25 men are obese, according to the National Family Health Survey’s fifth round conducted between 2019 and 2021.
• Obese people are more prone to suffer from diabetes. There are an estimated 25 million people living with pre-diabetes in India, according to WHO data.

Hidden sugars

Two or three decades ago, doctors never diagnosed a 20-year-old or a 25-year-old with lifestyle-related Type 2 diabetes. “This has changed.

Those who are obese in their teenage years and diabetic in their twenties have a higher chance of getting heart attacks in their thirties and forties.

What is WHO’s nutritional advice?

• WHO says it is difficult to view the role of sweeteners in isolation when it comes to weight loss studies that were analysed, so it is important to note that the quality (nutritional profile) and quantity of diet are also crucial in this matrix.
• “Simply replacing free sugars in diet with NSS means that overall quality of the diet is largely unaffected, this is because free sugars are often found in highly processed foods and beverages with undesirable nutritional profiles,” WHO says.
• It instead recommends having alternative foods which are minimally processed, unsweetened foods and beverages.
• While analysing studies, WHO has found that weight loss in certain subjects cannot entirely be attributed to switching from sugars to NSS, as it also depended on having reduced portion size or energy intake of food.

What next?

• Experts say WHO’s conditional guideline is such that it is less certain that desirable consequences of implementing this recommendation outweigh the undesirable consequences.
• This means that the Ministry of Health will have to initiate discussions among policy-makers before it decides to adopt this ‘conditional’ recommendation as a national policy.