Increased Non-Nutritive Sweetener Use May Be Cause for Concern, Study Suggests

Americans are buying fewer foods and beverages containing sugar, but that's being replaced with products sweetened by sugar substitutes, like aspartame, saccharin, sucralose, and rebaudioside-A, according to new research.

A study published in the Journal of the Academy of Nutrition and Dietetics looked at purchasing trends from 2002 to 2018 in U.S. households, found a decrease in sugar consumption, but a boost in what's called nonnutritive sweeteners (NNS).??

Shifting to Substitutes

Purchasing information for this particular study was obtained by using a national database, Nielsen Homescan, linked with data from the Nutrition Facts Panel, which maintains commercial nutrition and ingredient information.

The change from sugar to NNS isn't a subtle one, the study found. For example, there was a decline in the prevalence of products containing aspartame and saccharin, but products with sucralose jumped from 38% to 71%.??

Rebaudioside-A, also called reb-A or stevia, was the largest change, with an increase from 0.1% to 26%.

Beverages represented the biggest shift, the researchers noted, and another major finding was that households with children are buying more packaged foods and beverages with NNS than households without children.

The Move Away from Sugar

Declining sugar consumption is a positive step for mitigating health risks, the researchers concluded.

"With excessive sugar consumption linked to chronic cardiometabolic diseases, sugar reduction has become an important public health strategy," says lead investigator Barry Popkin, PhD, at the Gillings Global School of Public Health at The University of North Carolina at Chapel Hill. "This has resulted in greater innovation by the food industry and increased use of NNS in our food supply."

Sugar has often been linked to higher incidence of weight gain and obesity as well, says dietitian Melissa Hooper, RD, and that comes with secondary chronic diseases such as metabolic syndrome, non-alcoholic fatty liver disease, osteoarthritis, and some types of cancer.

Another significant link with sugar is inflammation, Hooper adds. This can be another source of serious ripple effects, research has suggested since chronic inflammation is associated with higher rates of dementia, stroke, respiratory diseases, heart disorders, arthritis, and diabetes.??

Are Substitutes Better? It's Complicated

Given the health implications of sugar consumption, it's not surprising to see a shift over to substitutes, but these ingredients also come with concerns. Mainly, the issue is that it's unknown what type of effect these additives have over time.

One research review listed potential adverse reactions as:??

• Headaches
• Depression
• Behavioral and cognitive effects
• Risk of preterm delivery
• Cardiovascular effects
• Risk of chronic kidney disease

However, those researchers concluded that, overall, the evidence is inconsistent and there are "numerous gaps in the evidence base."

Some short-term effects of certain NNS ingredients are known, and a few are far from sweet.

"We know some sugar alcohols such as sorbitol and xylitol can cause diarrhea and bloating," Hooper says. Stevia, derived from a plant in the same family as ragweed, can cause some allergic reactions for those with sensitivity or allergies to those plants, she adds.

But for those without reactions, natural alternatives like stevia and monk fruit are appealing, Hooper adds. For example, monk fruit has no calories and is about 100 to 500 times sweeter than cane sugar. Although it contains fructose and glucose, the sweetness comes from a naturally occurring antioxidant and doesn't have any impact on blood glucose levels.

Mixed Results with Weight Loss

Many people use NNS as a way to control or reduce weight. For example, drinking diet beverages or NNS-sweetened waters instead of drinks with high fructose corn syrup. But the research on the effectiveness of that strategy is mixed.

For example, a research review published in Obesity found that in observational studies, NNS consumption is associated with higher body weight and metabolic disease, but when used in randomized, controlled trials, it was more effective for supporting weight loss, most likely because it was used alongside behavioral weight loss counseling.??

"Unfortunately, NNS may actually increase the appetite, since the body associates 'sweet' with calories and energy, and when it doesn't get those calories, it may cause someone to consume more to get them," says Hooper.