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expert reaction to review study looking at non-sugar sweeteners and health

A review of trials and studies published in the BMJ argues that there was little evidence that showed health benefits of non-sugar sweeteners.

Prof Tom Sanders, Professor emeritus of Nutrition and Dietetics, King’s College London, said:

“The findings of this study are not surprising and confirm the view that artificial sweeteners are not a magic bullet to prevent obesity.  Replacement of sugary drinks with artificial sweeteners helps prevent weight gain in children but is not superior to the preferred alternative – water.”

Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:

“This paper does not change my mind – non-sugar sweeteners remain far better than sugar sweetened beverages given lack of calories in the former, and the well-known harms of the latter including in particular on dental health.  Also, the two best randomised trials ever conducted did show benefits of lower weight gain in children and adolescents when comparing diet drinks to sugar sweetened beverages.

“The issue with this current study is that it also includes data from sources other than randomised trials and as soon as you do this, the quality of the evidence becomes far weaker and for this reason hard conclusions are near impossible to make from studies which mix different types of studies.  The authors recognise this to some extent and I strongly agree with them when they say there is a need for higher quality and larger randomised trials in the nutritional field (however hard they may be to conduct) as, without these, some issues will never be fully resolved.”

‘Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies’ by Ingrid Toews et al. was published in the BMJ at 23:30 UK time on Wednesday 2 January 2019.

Declared interests

Prof Tom Sanders: “Honorary Nutritional Director of HEART UK.  Scientific Governor of the British Nutrition Foundation.  He is now emeritus but when he was doing research at King’s College London, the following applied: Tom does not hold any grants or have any consultancies with companies involved in the production or marketing of sugar-sweetened drinks.  In reference to previous funding to Tom’s institution: £4.5 million was donated to King’s College London by Tate & Lyle in 2006; this funding finished in 2011.  This money was given to the College and was in recognition of the discovery of the artificial sweetener sucralose by Prof Hough at the Queen Elizabeth College (QEC), which merged with King’s College London.  The Tate & Lyle grant paid for the Clinical Research Centre at St Thomas’ that is run by the Guy’s & St Thomas’ Trust, it was not used to fund research on sugar.  Tate & Lyle sold their sugar interests to American Sugar so the brand Tate & Lyle still exists but it is no longer linked to the company Tate & Lyle PLC, which gave the money to King’s College London in 2006.  Tom also used to work for Ajinomoto on aspartame about 8 years ago.  Tom was a member of the FAO/WHO Joint Expert Committee that recommended that trans fatty acids be removed from the human food chain.  Tom has previously acted as a member of the Global Dairy Platform Scientific Advisory Panel and Tom is a member of the Programme Advisory Committee of the Malaysian Palm Oil Board.  In the past Tom has acted as a consultant to Archer Daniel Midland Company and received honoraria for meetings sponsored by Unilever PLC.  Tom’s research on fats was funded by Public Health England/Food Standards Agency.”

Prof Naveed Sattar: “No COI.”

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