Currently browsing posts about: Artificial-sweeteners

I am occasionally asked to comment on new studies that appear.  Practice Update: Diabetes asked for a comment on this study:

VS Malik, et al.  Long-Term Consumption of Sugar Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation. 2019;139:00–00. DOI: 10.1161/CIRCULATIONAHA.118.037401

The study concluded: “Consumption of SSBs [sugar-sweetened beverages] was positively associated with mortality primarily through CVD [cardiovascular disease] mortality and showed a graded association with dose. The positive association between high intake levels of ASBs [artificially sweetened beverages] and total and CVD mortality observed among women requires further confirmation.”

Here’s what I said:

This study is based on analyses of data from two remarkably large and long-standing investigations of diet and disease risk. The investigators looked for correlations between mortality and consumption of sugar-sweetened beverages (SSB) and found them. More than two SSB servings a day was associated with higher mortality, particularly from cardiovascular disease, and, to a lesser extent, cancer.

Thus, this study adds to the increasing body of evidence associating SSBs with poor health. SSBs provide calories, but nothing of nutritional value. Other studies correlate SSBs with obesity, type 2 diabetes, and heart disease. A further correlation with increased mortality is not surprising, but it is good to have it confirmed.

These results associate high intake of SSBs with disease risk, but cannot prove that SSBs causedisease. Epidemiological studies like these, based on self-reported dietary data, require careful interpretation. In part, this is because intake of SSBs tracks closely with other lifestyle characteristics. Heavy SSB users tend to be more sedentary, more likely to smoke, to consume more meat and calories, but to eat fewer vegetables than light users—overall, to have less healthy dietary habits in general. Still, reducing or eliminating SSB intake is harmless and could well improve health.

A study by European investigators concluded that artificial (non-sugar) sweeteners [NSS] had no particular benefits for health.

Most health outcomes did not seem to have differences between the NSS exposed and unexposed groups. Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality was limited; therefore, confidence in the reported results is limited.

However, the accompanying editorial by Vasanti Malik concludes:

Based on existing evidence including long term cohort studies with repeated measurements and high quality trials with caloric comparators, use of NSS as a replacement for free sugars (particularly in sugar sweetened beverages) could be a helpful strategy to reduce cardiometabolic risk among heavy consumers, with the ultimate goal of switching to water or other healthy drinks.

On this basis, the Calorie Control Council, the trade group that represents the makers of artificial sweeteners issued a statement rebutting the study:

In alignment with the conclusions made by Dr. Malik, the Calorie Control Council agrees that the highest quality science supports that LNCS [low- and no-calorie sweeteners] can be consumed as part of a balanced diet and can assist with the reduction of cardiometabolic risk through the management of body weight and reduced caloric intake.

Given the proven safety and benefits of LNCS, consumers should continue to be confident in including these ingredients as part of a healthy diet.

Note the conditional “could” and “can.”  Artificial sweeteners might help, but you can’t count on them for miracles.

The study: Assessing the in vivo data on low/no-calorie sweeteners and the gut microbiota.  Alexandra R. Lobacha, Ashley Roberts, Ian R. Rowland. Food and Chemical Toxicology 124 (2019) 385–399.

Its conclusion: “The sum of the data provides clear evidence that changes in the diet unrelated to LNCS [low- and no-calorie sweeteners] consumption are likely the major determinants of change in gut microbiota numbers and phyla, confirming the viewpoint supported by all the major international food safety and health regulatory authorities that LNCS are safe at currently approved levels.”

Funding disclosures: Intertek Scientific & Regulatory Consultancy (A.R.L. and A.R.) received financial support from the Calorie Control Council to assist in the preparation of the manuscript. The Calorie Control Council did not contribute to the origination, planning, implementation, or interpretation of this work. The Calorie Control Council did review the content of the complete manuscript; however, A.R. maintained responsibility for the final content.

Comment: Artificial sweeteners are widely suspected on the basis of questionable evidence to be harmful in one way or another.  The industry that makes these sweeteners wants to prove them safe and effective.  This was a literature review commissioned by the Calorie Control Council, a trade association for the makers and users of artificial sweeteners, from Intertek Scientific & Regulatory Consultancy, a group that does this kind of work.  I would be more confident in conclusions like these if they had been arrived at independently.

For months now, I haven’t posted an industry-funded studies with results favorable to the sponsor, but this one about deserves mention.

Title: Critical review of the current literature on the safety of sucralose, by BA Magnuson, A Roberts, and ER Nestmann.

Journal: Food and Chemical Toxicology 2017:106:324-355.

Conclusion: “Collectively, critical review of the extensive database of research demonstrates that sucralose is safe for its intended use as a non-caloric sugar alternative.

Financial support was provided by the Calorie Control Council, Atlanta GA, to the employers of the authors for the preparation and publication of this review.

My comment: This lengthy review of literature on the safety of sucralose (Splenda) was commissioned by the Calorie Control Council, a trade association representing “manufacturers and suppliers of low- and reduced-calorie foods and beverages, including manufacturers and suppliers of more than two dozen different alternative sweeteners, fibers and other low-calorie, dietary ingredients.”

It paid authors affiliated with Health Science Consultants, Inc and Intertek Scientific and Regulatory Consultancy to produce this review.

• The Calorie Control Council has a vested interest in demonstrating Splenda to be safe.
• The consultant groups have a vested interest in pleasing the Calorie Control Council.
• Therefore, this review has a higher-than-average likelihood of bias.

Is Splenda safe?  It very well may be safe, but some contrary evidence exists (this paper dismisses it).  It would be interesting to see how independent scientists view the matter.

Healthy Food America is a relatively new organization.  Based in Seattle, it

Acts on science to drive change in policy and industry practice so that all people can live in places where nutritious food is easy to obtain and exposure to unhealthy products is limited..  We are coordinating with other advocates to energize a national movement to roll back added sugars in food and beverages to healthful levels.​

It runs a blog, publishes a newsletter, and produces useful information.  I was particularly interested in its information on diet drinks.

It’s Policy Brief discusses whether or not artificially sweetened beverages should be included in soda tax initiatives.

Sugary drink taxes were conceived of as a strategy to prevent chronic health conditions by reducing consumption of sugar. Recently, however, some jurisdictions have included artificially sweetened, or “diet”, beverages. There is strong scientific evidence associating sugary drinks with higher rates of chronic diseases such as type 2 diabetes, heart disease, high blood pressure, liver disease and dental disease. The evidence of harm from diet drinks is less certain.  Therefore, we recommend not including diet drinks in beverage taxes.

Its Research Brief summarizes the evidence linking artificially sweetened beverages to disease risk.

This research brief summarizes:

1) reviews or meta-analyses of prospective cohort studies that analyzed the association between ASB consumption and disease risk,

2) randomized trials that studied the metabolic and health effects of ASB consumption, and

3) randomized trials that studied the effect of ASB consumption on weight loss.

Reviews and meta-analyses were restricted to those published in the last 5 years, to ensure that this brief reflected the latest science. All studies were obtained through PubMed searches.

It helps to have all this.

Two studies suggest—but most definitely do not prove—that they might.

A press release from Boston University says that daily consumption of either sugary or artificially sweetened drinks affect the brain.

Data from the Framingham Heart Study (FHS) has shown that people who more frequently consume sugary beverages such as sodas and fruit juices are more likely to have poorer memory, smaller overall brain volumes and smaller hippocampal volumes–an area of the brain important for memory. Researchers also found that people who drank diet soda daily were almost three times as likely to develop stroke and dementia when compared to those who did not consume diet soda.

The American Heart Association sent out its own press release on the stroke and dementia results. 

Framingham study participants who reported drinking one or more artificially sweetened beverage daily compared to less than one a week had almost three times the risk of developing either stroke or dementia.

The data are impressive.  This is the survival curve for dementia (the one for stroke looks much the same). Green = 0 drinks per week.  Red = 6 per week.  Blue = 7 or more per week.

Caveat: These are correlational studies showing an association between sweet drinks and loss of brain function.  They do not demonstrate that sweet drinks cause these problems—these could be due to some other dietary or behavioral factor.

As you might imagine, the studies got as lot of press attention.  One useful analysis comes from Business Insider:

First, both studies were done by some of the same researchers, including the lead scientist, Boston University neurologist Matthew Pase…For the sweet drinks and brain health research, the scientists drew from a large set of observational data taken from thousands of people from the town of Framingham, Massachusetts who were initially recruited beginning back in the 1940s as part of a study designed to learn more about heart disease called the Framingham Heart Study…of all the people in the study, the percentage of those who did go on to develop stroke or dementia was small — about 3% for stroke and about 5% for dementia.

The Guardian asks “Should link between dementia and artificial sweeteners be taken with a pinch of salt?”  It discusses some of the methodological issues, of which there are many.

The bottom line?  While waiting for researchers to sort all this out, water is an excellent choice.

Sugary drinks study

• New York Times
• Forbes
• Medical News

Diet drinks study

• US News
• Food Navigator
• Daily Mail
• The Sun
• USA Today
• Sydney Morning Herald

FoodNavigator-USA, a food-industry newsletter that I read regularly, publishes occasional “Special Editions,” meaning collections of articles it has published on specific topics.  This one is on Sweeteners and Sugar Reduction,

Food and beverage manufacturers have a far wider range of sweetening options than ever before, from coconut sugar to allulose, monk fruit and new stevia blends. This special edition looks at the latest market developments, the changing political landscape, formulation challenges and consumer research. It will also address some labeling and regulatory issues affecting the market, from new FDA requirements to list added sugar on the Nutrition Facts label and the extent to which the ‘GMO factor’ is impacting purchasing decisions for sweeteners.

• Senomyx unveils ‘natural’ sweetener breakthrough, plans GRAS notification by end of 2019: Senomyx has identified a new zero-calorie, high-potency sweetening compound found in trace levels in monk fruit, which it plans to produce on a commercial scale via fermentation… Read
• Consumers want stevia from the leaf, says PureCircle: ‘They want naturally-sourced plant-based ingredients’: As the technology around producing steviol glycosides continues to evolve, transparency in labeling will be critical if consumer trust in ‘natural’ sweeteners is to be retained, says PureCircle, which claims to be the “clear market leader in terms of production capacity and R&D” when it comes to stevia extracts… Read
• Where next for stevia? From designer glycoside blends to fermentation and enzyme modification: If high purity Reb A used to be the only game in town when it comes to stevia, the game has become a lot more sophisticated in the past couple of years as suppliers compete to provide the best-tasting combinations of steviol glycosides, and products become more application-specific, says Sweet Green Fields chief science officer Mel Jackson PhD… Read
• Allulose could change the sugar reduction game… if labeling rules are changed, says Tate & Lyle: Allulose – an ultra low-calorie sugar found naturally in jackfruit and figs that Tate & Lyle is making in commercial quantities from corn using enzymes – has got some high profile advocates including Quest Nutrition, but would gain significantly more traction if manufacturers were not required to include it as added sugar on US food labels, says Tate & Lyle… Read
• FDA issues GRAS no objection letter for Sweegen’s Bestevia Reb-M – which starts with the leaf, then undergoes ‘enzymatic conversion’: California-based SweeGen has received a GRAS no objections letter from the FDA for the use of its Bestevia branded Reb-M – manufactured from stevia leaf extracts converted to Reb M using enzymes – for use as a general purpose sweetener for food and beverage applications in the US… Read
• Big Tree Farms unveils golden coconut sugar to compete with refined white sugar: ‘This is going to be a truly disruptive sweetener’: Big Tree Farms has developed a paler, finer ‘golden’ organic Fair trade coconut sugar that can replace refined white sugar in applications where coarser, darker coconut sugars aren’t ideal, says the company, which has been selling coconut sweeteners for a decade and is still generating double digit growth year-on-year as consumers embrace their ‘unrefined’ and low-GI credentials… Read
• New kid on the block explores novel business model for stevia production: California-based B’BOX Group claims to have developed a proprietary technique for producing clean-tasting, high-purity stevia extracts that is so fast and cost-efficient that it says leading CPG manufacturers are considering buying the technology and producing their own sweeteners – a new model for the industry… Read
• ADM teams up with GLG Lifetech to add stevia and monk fruit to its portfolio: ADM is bringing two sweetener brands, SweetRight stevia and VerySweet monk fruit, to market following a tie up with Canadian high potency sweeteners specialist GLG Lifetech… Read
• Should foods high in added sugar be disqualified from making nutrient content and health claims?  High levels of added sugar should disqualify foods from being able to make health claims, or nutrient content claims such as ‘healthy’ or ‘high fiber,’ argues a citizen’s petition filed last week by the nonprofit advocacy group the Union of Concerned Scientists… Read
• Confused about added sugar? FDA issues draft guidance on Nutrition Facts changes: The FDA has attempted to clear up some of the confusion over defining and calculating added sugar, in new draft guidance designed to help firms get to grips with the key changes it is making to the Nutrition Facts panel… Read
• Sparkling ICE unveils $37m ad campaign, queries soda tax inconsistencies: ‘It’s a mess’: Talking Rain Beverage Co has unveiled a $37m national ad campaign that president Kevin Klock says will give Sparkling ICE a stronger brand identity – something it has historically lacked, despite its meteoric growth (estimated retail sales have surged from around $10m in 2011 to well over $600m today)… Read
• Ag Committee weighs whether SNAP should pay for sugary drinks: Prohibiting the purchase of sugar-sweetened beverages and other “unhealthy” foods and beverages with SNAP benefits, also known as food stamps, likely would not discourage their consumption, but would be costly and difficult for retailers to implement, industry stakeholders argued on Capitol Hill last week. .. Read
• Kellogg, Post & General Mills hit with wave of lawsuits as plaintiff’s bar turns up the heat on sugar: If a high percentage of the calories in your product are from added sugar, and you are stating or implying that it’s healthy and nutritious, are you at risk of a false advertising lawsuit? A flurry of lawsuits recently filed vs Kellogg, General Mills and Post Foods suggest the answer is yes, although legal experts predict the plaintiffs face an uphill battle… Read
• Misfit Juicery’s two-prong approach to addressing the anti-sugar trend’s threat to juice: Startup Misfit Juicery is taking a two prong approach to the growing threat to the juice category posed by consumers’ increasing concern about sugar, and in doing so is setting itself apart from the competition… Read
• Health advocates argue for a tax on sugary drinks in Canada to save lives and healthcare costs: Twenty-four public health advocates and organizations are calling on the Canadian government to levy a significant tax on manufacturers of sugary drinks to discourage consumption and help fund healthy living initiatives… Read
• In age of sugar reduction and ‘clean label,’ sweetener manufacturers adapt: A combination of shifting consumer demand for ‘clean label’ and a new FDA requirement to list added sugars on nutrition panels means sweetener manufacturers are navigating through new territory… Read
• Chicago snack start-up No Denial Foods targets low-sugar shoppers seeking indulgence: “Sugar is the new fat” when it comes to dietary villains, says No Denial Foods Founder Debbie Wood. “Sugar is going to be on a lot of people’s radar.”.. Read

I’m in Mexico City and María Verónica Flores Bello, who teaches at a university here, gave me this photo taken at a Selecto supermarket.  It, she says, is Coca-Cola’s “brand new green Coca Cola, sweetened with stevia and sugar, as healthy and fresh as eating vegetables….”

Here’s the label:

Soon to a supermarket near you?  Only if Mexicans buy it.

I’ll explain what these labels mean on Monday,

Happy weekend.