Sugar, sugar everywhere Integrating the current evidence on nonnutritive sweeteners
Nonnutritive sweeteners are used as sweetening agents in foods and beverages, replacing nutritive sweeteners, and potentially reducing energy intake. Reduction of excess added sugars is one way to reduce total energy intake and a step towards reducing global epidemics in obesity and chronic disease. Nonnutritive sweetener recommendations are reviewed from the American Heart Association, American Diabetes Association, Academy of Nutrition and Dietetics, 2010 Dietary Guidelines for Americans and the World Health Organization. Their statements all summarize that 1) public awareness of health messages needs improvement before dietary behaviors can change and 2) while there is a potential for improvement, there is inconclusive evidence for nonnutritive sweeteners to reduce overall energy intake unless used with foods and beverages that replace higher calorie choices. Education opportunities exist for health care professionals to raise public awareness and facilitate dietary changes that successfully replace higher calorie choices.
Sweetening agents are classified as nutritive sweeteners (NS), which provide energy, and non-nutritive sweeteners (NNS), providing little to no energy because they are typically used in negligible amounts given their higher intensity of sweetness per gram. Foods labelled “sugar free” may contain NS, NNS, or both. The potential benefits of using beverages and foods sweetened with NNS are reduced energy (calories and carbohydrates) as well as assistance in weight management, glycaemic control and tooth decay. NNS are regulated in the United States (US) by federal nutrition policies. The Food and Drug Administration’s rigorous approval process for NNS as safe food additives or designated Generally Recognized As Safe (GRAS) which uses the same safety standards as food additives, insuring “the reasonable certainty of no harm” (1, 2). Seven NNS are approved for use in the US, acesulfame K, aspartame, luo han guo fruit extract (FDA GRN 000301), neotame, saccharin, stevia (FDA GRN 000253) and sucralose (3). Outside the US, expert scientific committees and international independent governing bodies evaluate and regulate the safety of NNS pr ...