Press Release

For Immediate Release
2013.07.10

Contact: Theresa Hedrick, MS, RD, LD
Lauren Godinez
404-252-3663

Opinion Piece on Low-Calorie Sweeteners Only Tells One Side of the Story

The views put forth in the Swithers opinion piece, “Artificial sweeteners produce the counterintuitive effect of inducing metabolic derangements,”1 are biased and highly speculative.  

“The author ignores the large body of robust scientific research that demonstrates the safety and benefits of low-calorie sweeteners,” said Haley Curtis Stevens, Ph.D. of the Calorie Control Council, whose members include manufacturers and end users of low and reduced calorie sweeteners and other ingredients. “This study adds no new data to the literature, as it is an “opinion piece,” rather than a peer reviewed study.”
 
"Dr. Swithers has focused primarily on epidemiological studies, which can suggest associations, but do not show cause and effect," said Dr. John Fernstrom, Professor of Psychiatry and Pharmacology at the University of Pittsburgh School of Medicine. "Hence, if overweight or diabetic individuals report consuming more products containing artificial sweeteners, it may be that these products are being consumed to reduce sugar and calorie intake (a good thing), and not the other way around." Dr. Fernstrom's full quote is available here.
 
This opinion piece had many flaws and limitations, including:
 
  • The author presented only the studies that supported her opinion and ignored the rest of the scientific literature. For example, the author cited two studies that found a link between the use of low-calorie sweeteners and weight gain, but ignored the over a dozen studies that demonstrated that low-calorie sweeteners could be useful tools for lowering and/or maintaining body weight.2-21  
 
  • The studies cited by the author did not prove that the consumption of low-calorie sweeteners have any undesired effects.  The author alleged that consuming low-calorie sweeteners increases the risk of gaining weight and/or developing metabolic syndrome, type 2 diabetes, hypertension, or cardiovascular disease.  However, individuals seeking to lose weight or manage their health often switch to low- and reduced-calorie foods and beverages. Low-calorie sweetener use might therefore simply be a marker for individuals already on weight-gain or unhealthy trajectories. This is the most plausible explanation of these findings, not that low calorie sweeteners caused a health issue.  Although the author noted that many studies adjusted for baseline differences including BMI, many other factors such as age, exercise, the use of medication, etc. may have influenced the findings.
 
  • Many of the studies used to support the author’s views were weakly designed. Most of the studies cited were observational or cross-sectional.  These types of studies cannot prove cause and effect, and their findings are often tainted by confounding variables.  The studies may not have taken into account other lifestyle factors that could lead to obesity and other health problems such as a diet high in saturated and trans fats and/or a lack of physical activity.

    The two interventional studies – the gold standard of study design – that were cited by the author showed that using low-calorie sweeteners did not lead to weight gain, metabolic syndrome, type 2 diabetes, hypertension, or heart disease.2,5
 
  • Many of the studies cited to support the author’s opinion were done in rodents, not humans.  There are differences between rodent and human bodily processes and it cannot be assumed that the reported results of these studies would apply in humans. 
 
Numerous studies in humans have shown that the consumption of low-calorie sweeteners does not lead to an increase in blood glucose levels,20,22-40 energy intake,7,9,16-18,20-24,26 feelings of hunger or body weight when controlling for other factors.  In fact, a 2012 review of human studies on low-calorie sweeteners and weight management by Anderson et al in the Journal of Nutrition concluded that “there is no evidence that LCS can be claimed to be a cause of higher body weights in adults.”41
 
Low- and no-calorie sweeteners can help reduce calories consumption and aid in the maintenance of a healthy weight, a position supported by both the American Diabetes Association and the Academy of Nutrition and Dietetics.
For more information about low-calorie sweeteners, visit: www.caloriecontrol.org.

 
References 
1.     Swithers, S. E. (2013). Artificial sweeteners produce the counterintuitive effect on inducing metabolic derangements. Trends in Endocrinology and Metabolism.
2.     de Ruyter, J. C., Olthof, M. R., Siedell, J. C., & Katan, M. B. (2012). A trial of sugar-free or sugar-sweetened beverages and body weight in children. New England Journal of Medicine, 367: 1397-1406.
3.     Ebbeling, C. B., Feldman, H. A., Chomitz, V. R., Antonelli, T. A., Gortmaker, S. L., Osganian, S. K., & Ludwig, D. S. (2012). A randomized trial of sugar-sweetened beverages and adolescent body weight. New England Journal of Medicine, 367: 1407-1416.
4.     Caprio, S. (2012). Calories from soft drinks – do they matter? New England Journal of Medicine, 367: 1462-1463.
5.     Tate, D. F., Turner-McGrievy, G., Lyons, E., Stevens, J., Erickson, K., Polzien, K., Diamond, M., Wang, X., & Popkin, B. (2012). Replacing calorie beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial. American Journal of Clinical Nutrition, 95: 555-563.
6.     Mozaffarian, D., Hao, T., Rimm, E. B., Willett, W. C., & Hu, F. B. (2011). Changes in diet and lifestyle and long-term weight gain in women and men. New England Journal of Medicine, 364: 2392-2404.
7.     Mattes, R. D. & Popkin, B. M. (2009). Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. American Journal of Clinical Nutrition, 89(1): 1-14.
8.     Blackburn, G. L., Kanders, B. S., Lavin, P. T., Keller, S. D., & Whatley, J. (1997).  The effect of aspartame as part of a multidisciplinary weight-control program on short- and long-term control of body weight. American Journal of Clinical Nutrition, 65(2): 409-418.
9.     Bellisle, F. &  Drewnowski, A. (2007). Intense sweetener, energy intake and the control of body weight. European Journal of Clinical Nutrition, 61(6): 691-700.
10. Bernyma, G. H., Hazel, G. R., Taylor, J. D., Sanders, P. G., & Weinburg, M. S. (1968). A case of safety of cyclamate and cyclamate-saccharin combinations. American Journal of Clinical Nutrition, 21(6): 673-687.
11. de la Hunty, A. Gibson, S. & Ashwell, M. (2006). A review of the effectiveness of aspartame in helping with weight control. British Nutrition Foundation Nutrition Bulletin, 31(2): 115-128.
12. Kanders, B. S., Lavin, P. T., Kowalchuk,  M. B., Greenberg, I., & Blackburn, G. L. (1988). An evaluation of the effects of aspartame on weight loss. Appetite, 11(supplement 1): 73-84.
13. Magnuson, B. A., Burdock, G. A., Doull, J., Kroes, R. M., Marsh, G. M., Pariza, M. V., Spencer, P. S., Waddell, W. J., Walker, R., & Williams, G. M. (2007). Aspartame: a safety evaluation based on current use levels, regulations, toxicological and epidemiological studies. Critical Reviews in Toxicology, 37(8): 629-727.
14. Morris, D. H., Mance, M. J., Bell, K. J., & Ward, A.(1989). Weight loss and consumption of artificial sweeteners among overweight women and men. Journal of the American Dietetic Association, 9(Supplement A):94.
15. Phelan, S., Lang, W., Jordan, D., & Wing, R. R. (2009). Use of artificial sweeteners and fat-modified foods in weight loss maintainers and always-normal weight individuals. International Journal of Obesity, 33(10):1183-1190.
16. Rabin, A., Vasilaras, T. H., Møller, A. C., & Astrup, A. (2002). Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in over-weight. American Journal of Clinical Nutrition, 76(4): 721-729.
17. Tordoff, M. G. & Alleva, A. M. (1990). Effect of drinking soda sweetened with asparatme or high-fructose corn syrup on food intake and body weight. American Journal of Clinical Nutrition, 51(6): 963-969.
18. Rolls, B. J.(1991). Effects of intense sweeteners on hunger, food intake, and body weight: A review. American Journal of Clinical Nutrition, 53(4): 872-878.
19. Bernstein, A. M., de Koning, L., Flint, A. J., Rexrode, K. M., & Willett, W. C. (2012). Soda consumption and the risk of stroke in men and women. American Journal of Clinical Nutrition, 95(5): 1190-1199
20. Fernstorm, J. D., Munger, S. D., Sclafani, A., de Araujo, I. E., Roberts, A., & Molinary, S. (2012). Mechanisms for sweetness. Journal of Nutrition, 142(6): 1134S-1141S.
21. Bellisle, F., Drewnowski, A., Anderson, G. H., Westerterp-Plantenga, M., & Martin, C. K. (2012). Sweetness, satiation, and satiety. Journal of Nutrition, 142(6): 1149S-1154S.
22. Abdallah, L., Chabert, M., & Louis-Sylverstre, J. (1997). Cephalic phase responses to sweet taste. American Journal of Clinical Nutrition, 65: 737-743
23. Teff, K. L., Devine, J., & Engelman, K. (1995). Sweet taste: effect on cephalic phase insulin release in men. Physiology and Behavior, 57(6): 1089-1095.
24. Bruce, D. G., Storlien, L.. H., Furler, S. M., & Chisholm, D. J. (1987). Cephalic phase metabolic responses in normal weight adults. Metabolism, 36(8): 721-725.
25. Coulston, F. & Gori, G. B. (2002). Aspartame: review of safety. Regulatory Toxicology and Pharmacology, 35(2):78-81.
26. Rodin, J. (1990). Comparative effects of fructose, aspartame, glucose, and water preloads on calorie and macronutrient intake. American Journal of Clinical Nutrition, 51(3): 428-435.
27. Carlson, H. E. & Shah, J. H. (1989). Aspartame and its constituent amino acids: effects on prolactin, cortisol, growth hormone, insulin, and glucose in normal humans. American Journal of Clinical Nutrition, 49(3): 427-432.
28. Maersk, M., Belza, A., Stødkidle-Jørgensen, H., Ringgaard, S., Chabanova, E., Thomsen, H., Pederson, S. B. Astrup, A., & Richelsen, B. (2012). Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6 month randomized intervention study. American Journal of Clinical Nutrition, 95(2): 283-289.
29. de Koning, L., Malik, V. S., Rimm, E. B., Willett, W. C., & Hu, F. B. (2011). Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men. American Journal of Clinical Nutrition, 93(6): 1321-1327.
30. Palmer, J. R., Boggs, D. A., Krishnan, S., Hu, F. B., Singer, M., & Rosenberg, L. (2008). Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Archives of Internal Medicine, 268(14): 1487-1492.
31. Ambrus, J. L., Shields, R., Mink, I. B., & Cleveland, C. (1976). Effect of galactose and sugar substitutes on blood insulin levels in normal and obese individuals. Journal of Medicine, 7: 429-438.
32. Colagiuri, S., Miller, J. J., & Edwards, R. A. (1989). Metabolic effects of adding sucrose and aspartame to the diet of subjects with noninsulin-dependent diabetes mellitus. American Journal of Clinical Nutrition, 50(3): 474-478.
33. Goldfine, I. D., Ryan, W. G., & Schwartz, T. B. (1969). The effect of glucola, diet cola, and water ingestion on blood glucose and plasma insulin. Proceedings of the Society for Experimental Biological Medicine, 131: 329-330.
34. Grotz, V. L., Henry, R. R., McGill,  J. B., Prince, M. J., Shamoon, H., Trout, J. R., & Pi-Sunyer, F. X. (2003). Lack of effect of sucralose on glucose homeostasis in subjects with type 2 diabetes. Journal of the American Dietetic Association, 103(12):1607-1612.
35. Hartel, B., Graubaum, H. J., & Schneider, B. (1993). Effect of sweetener solutions on insulin secretion and blood glucose levels. Ernahrungs-Umschau, 40(4): 152-155.
36. Horwitz, D. L., McLane, M.,&  Kobe, P.(1988). Response to single dose of aspartame or saccharin by NIDDM patients. Diabetes Care, 11(3):230-234.
37. Okuno, G., Kawakami, F., Tako, H., Kashihara, T., Shibamoto, S., Yamazaki, T., Yamamoto, K., & Saeki, M. (1986). Glucose tolerance, blood lipid, insulin and glucagon concentrations after single or continuous administration of aspartame in diabetics. Diabetes Research and Clinical Practice, 2(1): 23-27.
38. Renwick, A. G. & Molinary, S. V. (2010). Sweet-taste receptors, low-energy sweeteners, glucose absorption and insulin release. British Journal of Nutrition, 104(10):1415-1420.
39. Raben, A. & Richelson, B. (2012). Artificial sweeteners: a place in the field of functional foods? Focus on obesity and related metabolic disorders. Current Opinion in Clinical Nutrition and Metabolic Care, 15(6): 597-604.
40. Shigeta, H., Yoshida, T., Nakai, M., Mori, H., Kano, Y., Nishioka, H., Kajiyama, S., Kitagawa, Y., Kanatsuna, T., Kondo, M. et al. (1985). Effects of aspartame on diabetic rats and diabetic patients. Journal of Nutrition Science Vitaminology, 31(5): 533-540.
41. Anderson, G. H., Foreyt, J., Sigman-Grant, M., & Allison, D. B. (2012). The use of low-calorie sweeteners by adults: impact on weight management. Journal of Nutrition, 142(6): 1163S-1169S.
 

 

 
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