Spotlight on Artificial Sweeteners

I have been asked to write a blog about the use and safety of artificial sweeteners as there is so much misinformation and confusion out there, so here it is!

Artificial sweeteners contain either very few or no calories and they are chemical substances used in place of sugar in food and drinks. Their use is constantly re-evaluated by the European Food Safety Authority (EFSA) and the next re-evaluation report is due next year (2020). The EFSA have set an acceptable daily intake (ADI) of sweeteners based on the scientific evidence available and intakes up to these levels are considered safe.

There are many sweeteners that have been approved for use in the UK and they include:

● Sorbitol

● Saccharin

● Aspartame

● Acesulfame K

● Sucralose

● Stevia

● Xylitol

The ADI is an estimate of the amount of sweetener (in mg per kg of body weight) a person can safely consume every day for their lifetime without adverse health outcomes. As it is estimated, the EFSA use a 100 fold safety factor, which means the ADI is calculated at one hundredth of the amount that is safe to consume. That is a big buffer! The Bristish Dietetic Association (BDA) use this example in their Policy Statement on sweeteners and this is useful because many people who speak to me about this are worried about Aspartame in particular:

The ADI of Aspartame is 40mg per kg of body weight per day. For a 70kg adult that is 2800mg per day. That is the equivalent of 15 cans or just over 5L of diet coke every day over a lifetime before reaching the ADI.

That is a lot of diet coke! And it is highly unlikely that anyone will drink this much diet coke every day for their lifetime.

The fear of aspartame may be in part due to it being a legal requirement to label foods/drinks that contain aspartame. The label must say “contains a source of phenylalanine”. Phenylalanine is an amino acid (a building block of protein) and is a component of aspartame. People with a condition called PKU cannot metabolise phenylalanine and if dietary levels are not controlled, it can be very dangerous. So it is not the aspartame itself that can cause adverse health outcomes, it is one of its components, but only for a very specific group of people.

It is important to note that the ADI is not applicable to infants and children under the age of 3 and the addition of sweeteners in foods for these age groups is banned. One of the reasons​for this is due to the specific nutritional needs of this age group for optimum growth and development so they should not be consuming energy/protein free sweeteners in their foods.

Legally, a food has to be labelled twice if it contains sweeteners. The packaging has to state “with sweetener(s)” and also be labelled in the ingredients either by its name or by its E number. The BDA have suggested that this may be confusing for consumers as they may not be aware that the E number is a sweetener, and their thoughts for an alternative would be to name the sweetener on the side of the packaging alongside the ADI for comparison. This would be beneficial for those having a larger number of artificially sweetened foods/drinks such as those trying to lose weight or with diabetes.

Health concerns?

All artificial sweeteners that have been approved for use in the EU have undergone safety evaluations. Manufacturers are given strict guidelines on the amount of sweeteners they are safely able to add to their food and drinks and these guidelines are set by the Food and Agriculture Organisation (FAO), The World Health Organisation (WHO), Expert Committee on Food Additives and the UK Government. As can often be the case, the media create mixed messages and people have raised concerns about the health impacts of consuming sweeteners. There are fears that they can cause conditions such as cancer, multiple sclerosis, alzheimers and chronic fatigue syndrome, however, the current, substantial evidence is that these conditions are not caused by the consumption of sweeteners. Cancer Research UK have issued this statement: “Large studies looking at people have provided strong evidence that artificial sweeteners are safe for humans”.

Sweeteners can be a useful alternative to sugar for certain groups of people, such as those trying to lose weight and those with diabetes who need to keep their blood glucose levels within a healthy range. Unlike sugar, when sweeteners are consumed, they do not affect blood glucose levels. There have been suggestions that consuming sweeteners can have a stimulatory effect on appetite which means that more food may be consumed and that therefore they may play a role in weight gain and obesity. This hypothesis lies in the fact that because blood glucose levels are not increased by consuming sweeteners in place of sugar, it may actually result in hypoglycaemia (low blood glucose levels) and this may cause an increase in food intake. However, a review of the evidence does not support this line of thinking.

References: https://www.nhs.uk/live-well/eat-well/are-sweeteners-safe/ https://www.bda.uk.com/improvinghealth/healthprofessionals/policy_statements/sweetners