Artificial sweeteners should not be used to control body weight or reduce the risk of non-communicable diseases (NCDs), according to a World Health Organization (WHO) guideline issued on Monday. 

“Non-sugar sweeteners (NSS) are not essential dietary factors and have no nutritional value. People should reduce the sweetness of their diet altogether, starting early in life, to improve their health,” according to Francesco Branca, WHO Director for Nutrition and Food Safety. 

“Replacing free sugars with NSS does not help with weight control in the long term. People need to consider other ways to reduce free sugars intake, such as consuming food with naturally occurring sugars, like fruit, or unsweetened food and beverages,” he added. 

The recommendation applies to all people except those with pre-existing diabetes and includes all synthetic and naturally occurring or modified NSS that are not classified as sugars found in manufactured foods and beverages, or sold on their own to be added to foods and beverages by consumers. 

Common NSS include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives.

Toothpaste, skin creams excluded

“The recommendation does not apply to personal care and hygiene products containing NSS, such as toothpaste, skin cream, and medications, or to low-calorie sugars and sugar alcohols (polyols), which are sugars or sugar derivatives containing calories and are therefore not considered NSS,” according to the WHO.

The recommendation is based on the findings of a systematic review of the available evidence which suggests that the use of NSS does not confer any long-term benefit in reducing body fat in adults or children – and long-term use could potentially increase the risk of type 2 diabetes, cardiovascular diseases, and mortality in adults.

The systematic review included 64 prospective cohort studies conducted in adults, 15 cohort studies in children, one cohort study in children and adults and 17 cohort studies in pregnant women.

Although a short-term benefit of NSS use on measures of body fatness was observed in controlled experimental settings, the WHO concluded that there was little evidence that long-term use of NSS is beneficial for body weight – and the possible long-term adverse effects in the form of increased risk of death and disease offset any potential short-term health benefit resulting from the relatively small reduction in body weight and BMI observed in randomized controlled trials. 

In addition, limited evidence for the beneficial effects of NSS use on dental caries was observed in studies of children using stevia. But this was generally only observed in studies where NSS use was compared to sugars.

“This suggests that NSS do not have any inherent properties that impact the risk of dental caries; rather, the effect is a result of displacing free sugars,” the WHO noted.

But because the link between NSS and disease outcomes might be confounded by baseline characteristics of study participants and complicated patterns of NSS use, the recommendation is conditional, following WHO processes for developing guidelines. 

“This signals that policy decisions based on this recommendation may require substantive discussion in specific country contexts, linked for example to the extent of consumption in different age groups,” the WHO concluded.

Industry disappointment

However, the International Sweeteners Association contested the guideline, arguing that their products “continue to be a helpful tool to manage obesity, diabetes and dental diseases”.

The association added that it is  “disappointed that the WHO’s conclusions are largely based on low certainty evidence from observational studies, which are at high risk of reverse causality”. 

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