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

Highlights:

• In its ‘conditional’ guideline, WHO says non-sugar sweeteners should not be used as a means of achieving weight control or reducing risk of diet-related non-communicable diseases.
• The spotlight on NSS intensified after 2015, when the WHO had said that high intake of free sugars is linked to weight gain and obesity, leading consumers to turn to NSS as an alternative.

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 to sweeten tea or coffee.

Types  of artificial sweeteners available on the market

• Aspartame is one of the most commonly used artificial sweeteners. It is composed of two amino acids, aspartic acid, and phenylalanine. Aspartame is widely used in diet sodas, chewing gum, and other low-calorie or sugar-free products. It is considered safe for consumption by most regulatory bodies when used within acceptable daily intake limits.
• Sucralose is another popular artificial sweetener that is derived from sugar. It is around 600 times sweeter than sugar but contains no calories. Sucralose is heat stable, making it suitable for use in cooking and baking. It is often found in a variety of products, including beverages, desserts, and processed foods.
• Saccharin was one of the first artificial sweeteners to be developed. It is approximately 300-500 times sweeter than sugar and is often used in tabletop sweeteners, canned fruit, and some diet drinks. Despite some controversy surrounding its safety in the past, saccharin has been deemed safe for consumption by regulatory agencies when used in moderation.
• Stevia is a natural sweetener derived from the leaves of the Stevia rebaudiana plant. It is intensely sweet but contains virtually no calories. Stevia has gained popularity as a sugar substitute due to its natural origin and its perceived health benefits. It is commonly used in beverages, desserts, and as a table top sweetener.

Advantages of Non-Sugar Sweeteners:

• Calorie Reduction: Non-sugar sweeteners are often low in or devoid of calories, making them beneficial for individuals seeking to reduce their calorie intake and manage their weight.
• Blood Sugar Control: Non-sugar sweeteners do not significantly affect blood sugar levels, making them suitable for people with diabetes or those who need to monitor their blood glucose levels.
• Dental Health: Non-sugar sweeteners are generally non-cariogenic, meaning they do not contribute to tooth decay or cavities like regular sugar does. This can be advantageous for maintaining good dental health.
• Versatility: Non-sugar sweeteners come in various forms, including liquids, powders, and tablets, which makes them versatile for use in different food and beverage applications.
• Alternative for Sugar Sensitivities: Non-sugar sweeteners provide an alternative for individuals who are sensitive or allergic to sugar, allowing them to enjoy sweet flavors without negative side effects.

Disadvantages of Non-Sugar Sweeteners:

• Taste Differences: Non-sugar sweeteners may have a different taste profile compared to sugar, and some individuals may find them less satisfying or detect a slight aftertaste. However, taste preferences can vary from person to person.
• Regulatory Concerns: There have been occasional debates and concerns about the safety and regulation of certain non-sugar sweeteners. However, many regulatory bodies worldwide, such as the U.S. Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA), have deemed approved non-sugar sweeteners as safe for consumption within recommended daily limits.
• Psychological Factors: Some studies suggest that the use of non-sugar sweeteners may not address the underlying psychological aspects of sugar cravings or addiction. As a result, individuals who rely heavily on non-sugar sweeteners may still have a preference for sweet flavors and potentially consume excessive amounts of sweetened foods.
• Impact on Gut Microbiota: Some research suggests that certain non-sugar sweeteners, particularly artificial sweeteners, may have an influence on gut microbiota composition and function. However, further research is needed to fully understand the implications and potential long-term effects.
• Limited Nutritional Value: Non-sugar sweeteners typically provide sweetness without contributing significant nutritional value. While they can be part of a balanced diet, it is essential to prioritize whole, nutrient-dense foods for overall health and well-being.

WHO analysis:

• The WHO analysed a total of 283 studies on the intake of NSS in adults and children. The outcome of the trials was that they noted ‘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).
• The WHO warned that long-term use of NSS could lead to increased risk of Type 2 diabetes, cardiovascular diseases, chronic kidney disease and cancer.

The need for the guidelines:

• To prevent unfettered consumption of artificially sweetened products like chocolates and colas, as consumers tend to over-indulge in these with a perception that they may be better than sugary products.

What are the concerns?

• India should take necessary steps to guide people on non-sugar sweeteners because one in nine women and one in 25 men are obese, according to the latest National Family Health Survey.
• 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.
• 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?

• It recommends having alternative foods which are minimally processed, unsweetened foods and beverages.
• The WHO recommends that with the help of this guideline, efforts should be made, with a focus on youngsters, to tweak taste preferences and eating behaviours.
• Acceptable Daily Intake (ADI): The WHO sets an ADI for each artificial sweetener. This represents the amount of a sweetener that can be consumed daily over a person's lifetime without any appreciable health risk. The ADI is expressed in milligrams per kilogram of body weight. It serves as a safety limit to protect against potential adverse effects.
• Evaluation of Safety: The safety of artificial sweeteners is assessed by organizations such as the Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives (JECFA). These evaluations consider scientific studies on toxicology, metabolism, and human consumption to determine the safety and set the ADI for each sweetener.
• Acceptance of Artificial Sweeteners: The WHO recognizes the use of artificial sweeteners as an option to reduce overall sugar intake, particularly for individuals with diabetes, those seeking weight control, and those with dental issues. They can provide sweetness without contributing significant calories.
• Public Health Concerns: While artificial sweeteners are deemed safe within the recommended ADI, concerns have been raised regarding their long-term effects on health. Some studies have suggested potential associations with conditions like obesity, diabetes, and altered gut microbiota. However, further research is needed to establish conclusive evidence.
• Balance and Moderation: The WHO emphasizes the importance of a balanced diet and encourages moderation in the use of artificial sweeteners. These substances should not replace the consumption of whole, nutrient-rich foods and should be used as part of a well-rounded diet.

What’s next?

• The Ministry of Health will have to initiate discussions among policy-makers before it decides to adopt this ‘conditional’ recommendation as a national policy.