COUNTERPOINT: Artificial sweeteners & obesity- better than sugary alternatives; potentially a solution.

Abstract

BACKGROUND & OBJECTIVE\nNon-nutritive, or artificial, sweeteners (NNS) are utilized in place of dietary sugars to reduce caloric and glycemic intake while providing desired sweetness, commonly for replacing sugar-sweetened beverages (SSBs) with diet or zero-calorie alternatives. Concern has developed in the scientific and nutritional community due to observational data associating NNS with obesity and adiposity-based disease. This counterpoint argues that, in general, NNS used in place of added or excess sugars in the diet is likely beneficial.\n\n\nMETHODS\nLiterature review of interventional trials using non-nutritive sweeteners and obesity or T2DM. Key words used in search include artificial sweeteners, non-nutritive sweeteners, saccharin, sucralose, aspartame, stevia/steviol, aculfame-potassium, meal replacements, T2DM, obesity, and weight.\n\n\nRESULTS\nInterventional data and indirect interventional data consistently show beneficial effects on weight and cardiometabolic health, including glycemia, when SSB or other energy-dense foods are replaced by artificially sweetened beverages or artificially-sweetened meal replacements.\n\n\nCONCLUSION\nWhile NNSs correlate observationally with obesity & adiposity-based chronic disease (ABCD), those data are fraught with confounding and error. Biological plausibility has been suggested based upon preclinical research into neuro-endocrine control of appetite, satiety, and cravings along with the gut microbiome. Interventional data, however, reveal that replacing caloric/glycemic energy intake via utilization of NNS creates an energy deficit resulting in weight loss and improvement in adiposity-based disease, especially dysglycemic disease. Intensive dietary intervention utilizing artificially sweetened meal replacements only show marked clinical benefit without detriment from their NNS. Furthermore, beverages sweetened with NNS rather than SSB has been noted to be a critical component of those succeeding in maintaining weight loss. While individual response to effects of NNS is always warranted just like any clinical situation, patients should not be advised to avoid NNS in the context of attempting dietary intervention of improved quality and energy-deficit.