So, it turns out that sugar substitutes are not, after all, as much of a healthy option as the world had thought them to be. After a systematic review of available evidence, experts from the World Health Organization (WHO) have found that the use of non-sugar sweeteners do not help with weight management. To the contrary, their long-term use could pose health risks such as an increased risk of type 2 diabetes, cardiovascular diseases, and mortality in adults.
The WHO guideline on sweeteners is part of a suite of new guidelines from the organisation on ‘healthy’ diets that aim to establish lifelong healthy eating habits, improve dietary quality and decrease the risk of non-communicable diseases.
This WHO guidance will have a significant bearing on what we consider “clean” and “healthy” foods. After all, so much of daily foods, such as cereal, bread, health bars, zero sugar and diet drinks and snacks, use non-sugar sweeteners. The most commonly used non-sugar sweeteners used in our daily foods include aspartame, saccharin, sucralose, stevia and stevia derivatives. These have now been established as potentially just as risky for us as foods with sugar.
“Our bodies are 10,000 years old. Modern food is less than 100 years old. We haven’t evolved to eat stuff made in a chemistry lab. Lab-made and artificial sweeteners were invented 50 years ago, and in this time global obesity and heart disease have only gone up. So clearly, they don’t work. Now, a WHO report confirms the same,” says Shashank Mehta, founder and CEO of The Whole Truth Foods.
This finding also impacts the medical, health, fitness and nutrition fraternities. Doctors, nutritionists and dieticians all agree that this new WHO guidance impacts our perception of what is considered healthy and safe. “For a long time, non-sugar sweeteners were seen as a healthier alternative to sugar, especially for individuals looking to reduce their caloric intake or manage conditions like diabetes. However, this finding suggests that these sweeteners may not be as beneficial as previously believed. It challenges the notion that replacing sugar with non-sugar sweeteners automatically leads to improved health outcomes,” notes Dr. Nishith Chandra, principal director for interventional cardiology, Fortis Escorts Heart Institute, New Delhi.
Bhakti Samant, chief dietician at Kokilaben Dhirubhai Ambani Hospital in Mumbai, points out that there are guidelines available for the Acceptable Daily Intake (ADI) for non-sugar sweeteners and we ought to use them in moderation so as to not cause ourselves any potential harm. “While they may have the potential benefits, we must be aware that some studies have shown them to increase the risk of developing type 2 diabetes and heart disease. Sugar substitutes are not a cure-all for health issues,” warns Samant.
Zero sugar/diet drinks, no-sugar nutrition bars and healthy cereal and muesli have grown tremendously in popularity, especially in urban India, over the last decade. However, just because a product is labeled as "sugar-free" or "diet" doesn't necessarily mean it's healthy, says Samant. “These products often contain artificial sweeteners, which can still lead to health issues when consumed in excess. They may also contain other unhealthy ingredients like trans-fats or high levels of sodium. Being aware of the overall nutrient profile which is mentioned on their labels is crucial when choosing these products,” she says.
The products available to us today can be of varying degrees of healthiness, observes Chandra. “Zero-sugar sweet drinks and other artificially sweetened beverages are low in calories and sugar but studies have raised concerns about the potential adverse effects of artificial sweeteners on metabolic health, gut microbiota and even weight management. Some research suggests that they may still contribute to cravings for sweet foods, leading to overeating or making less healthy food choices. Products like nutrition bars, muesli and cereal marketed as healthy alternatives can vary greatly in their nutritional quality. Some may be highly processed, containing added sugars or unhealthy fats despite their healthy branding,” he says.
While both Chandra and Samant feel it may not be necessary to treat zero sugar sweet foods and drinks as inherently "sugary" or harmful, it would be prudent to reevaluate our perception and consume them in moderation.
However, the WHO’s director for nutrition and food safety Francesco Branca said, “Non-sugar sweeteners are not essential dietary factors and have no nutritional value. People should reduce the sweetness of the diet altogether, starting early in life, to improve their health.” The healthiest way forward would be to gradually cut down on foods containing artificial and non-sugar sweeteners by switching to natural sweeteners like honey, jaggery powder, or fruit juices.
But all these contain sugars and they too need to be consumed in moderation, notes Samant. “Choosing whole foods such as fruits, which offer natural sweetness along with fibre, vitamins, and minerals, is the better alternative. When it comes to beverages, opt for water, unsweetened tea or fresh juices without added sugar… these are the healthier choices,” she says.
Consuming whole fruits not only provides a satisfying sweet taste, this also contributes to a balanced diet, explains Chandra. Also, adding herbs like cinnamon, nutmeg, or vanilla, or spices like ginger or cardamom, can enhance the flavour of foods and drinks without relying on sweeteners, he adds. Above all, a balanced and varied diet consisting of whole, unprocessed foods should be the foundation of a healthy eating pattern and well-being. However, the hard truth is that we need to reduce our addiction to sweet food, says Mehta. “There is no magical, artificial solution that will let us have our cake and eat it too,” he adds.
Shrenik Avlani is a writer and editor and the co-author of The Shivfit Way, a book on functional fitness.