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.
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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.
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