The future of a successful strategy

Since the World Health Organization (WHO) published its guideline on the intake of free sugars in 2015, sugar reduction has been in the spotlight. A reduction in excess sugar consumption has become a priority of global public health recommendations for a healthy diet.

Over the last few years, there has been noteworthy progress in sugar reduction in certain food categories and especially in drinks. This is largely led by increased consumer interest for healthier sugar-reduced foods. Moreover, nutrition scientists and policy experts call stakeholders to take more actions to bring down the excess intake of sugars, in line with current public health recommendations…but there is still a long way to go.

There is also a public health call to food manufacturers to contribute to sugar reduction efforts by reformulating products to provide healthier options that are lower in sugar. In these efforts, low/no calorie sweeteners have been used as a main tool to help achieve products with less sugar and, consequently, fewer calories, helping to meet consumer demands.

However, lack of knowledge and misinformation about the safety and benefits of sweeteners persist. A UK study¹ showed that nearly half of the population are not aware of regulations about sweeteners. It also revealed that risk perception is reduced, and awareness of sweeteners’ benefits is increased, when information from trusted regulatory agencies or scientific organisations is communicated to participants. Providing accurate information to support consumer’s confidence in these food ingredients as a valuable alternative to sugar will reinforce the reformulation efforts and, ultimately, support sugar reduction.

Types of sugar alternatives

There is much confusion about the different terms used to describe sugar alternatives. By low/no calorie sweeteners, we refer to sugar alternatives that are intensely sweet and which, as such, provide sweetness with zero or almost no calories.² The most commonly used low/no calorie sweeteners are acesulfame potassium, aspartame, cyclamate, saccharin, sucralose and steviol glycosides.

Polyols are another type of alternative sweetener. These are carbohydrates but not sugars; most polyols typically provide about half of sugar’s calories. The most well-known are isomalt, lactitol, maltitol, mannitol, sorbitol, xylitol and erythritol.

Targeting misinformation about low/no calorie sweeteners

Sugar alternatives have been used in foods and beverages for more than four decades. But their history goes back a long way. The first commonly used low/no calorie sweetener, saccharin, was discovered in 1879. Since then, many new types of low/no calorie sweeteners have been developed and are used in foods and drinks worldwide.

However, while they have been made available for decades now, and although all low/no calorie sweeteners have gone through a stringent safety assessment before being approved for use in our foods and drinks, questions are still raised about their safety and benefits over sugar.

How do we know that low/no calorie sweeteners are safe?

Ensuring that the foods we eat, including the ingredients added in them, are safe is the responsibility of food safety bodies around the world. Accordingly, for a low/no calorie sweetener to be approved for use on the market, it must undergo a thorough safety assessment by the competent food safety authority which is based on an independent expert review of the collective research. Moreover, food safety agencies around the world have consistently confirmed that low/no calorie sweeteners are safe, including the Joint Food and Agriculture Organization (FAO)/WHO Expert Committee on Food Additives (JECFA), the US Food and Drug Administration (FDA), and the European Food Safety Authority (EFSA).

An important step in the approval process is the establishment of an acceptable daily intake (ADI) value, set for each sweetener. The ADI is a guideline quantity that represents the amount of a food additive, in this case of a low/no calorie sweetener, that can be safely consumed on a daily basis throughout a person’s lifetime without any appreciable health problems. Evidence at global level confirms that the intake of all approved low/no calorie sweeteners is well below the individual sweetener ADI.³

Is there a benefit in replacing sugars with sweeteners?

When low/no calorie sweeteners are used to replace sugar they result in lower-sugar foods and beverages that can be useful dietary tools in three ways: for lowering calorie intake when there is excess sugar intake; for diabetes meal planning; and for nutritional strategies for dental health.

Consuming a low/no-calorie sweetened food or beverage instead of the sugar‑sweetened version can help reduce overall daily sugar intake. In turn, when used in place of sugar and as part of a balanced diet and a healthy lifestyle, low/no calorie sweeteners can help achieve lower calorie intakes and help with lowering excess body weight.⁴

The availability of low/no calorie sweeteners can also be important to people with diabetes, who have to manage their intake of carbohydrates which affect blood glucose levels. In fact, low/no calorie sweeteners do not raise blood glucose levels or otherwise affect glycaemic control.⁵ When used instead of sugars, they cause a lower rise in blood glucose levels post-prandially (ie, after eating).⁶

Finally, low/no calorie sweeteners are not fermentable (not broken down for energy) by oral bacteria, which means that they do not contribute to tooth demineralisation, which is a contributing factor for tooth decay.⁶

Using low/no calorie sweeteners to achieve sugar reduction goals

The availability of approved low/no calorie sweeteners can be a big help to food reformulation. Being several hundred times sweeter than sugar, they are used in minute amounts to confer the desired level of sweetness, while contributing very little or no energy at all to the foods and drinks they are used in.⁷ This offers one major advantage to food manufacturers and, ultimately, consumers: providing sweet taste whilst eliminating or substantially reducing the calories in a food or drink when replacing sugars.

The use of low/no calorie sweeteners provides an easy solution for reformulation in drinks and some food categories such as yoghurts, as these categories make it relatively straightforward to substitute sugar with sweeteners. In other food categories where sugar has an additional functional role beyond sweetness, such as providing bulk or certain textural characteristics, some product recipes may need adjustments. The wide range of approved low/no calorie sweeteners, with unique taste profiles and characteristics, which can be used either alone or in blends, help to provide a wider choice of sweet‑tasting products with less sugar and fewer calories. The innovation and advances in recipe development from manufacturers and the food industry have turned sweeteners into a key tool in food reformulation efforts.

The future of sugar reduction

At a time when the rates of obesity and non-communicable diseases continue to increase worldwide, and in light of the ongoing global COVID-19 pandemic, the demand for sugar reduction shows no signs of slowing down. While consuming moderate amounts of sugar in the context of an overall healthy diet is in line with dietary guidelines, reducing excess sugar consumption is a priority from a public health perspective.

Multiple sugar reduction strategies, including reformulation of products to contain less sugar, reducing portion size and shifting sales from high sugar products to lower sugar alternatives, should be reinforced to achieve the sugar reduction goals. Sugar alternatives have been proven a key tool in reformulating food products so far and will continue to play a central role in future sugar reduction efforts.

References

1. Farhat G, Dewison F, Stevenson L. Knowledge and Perceptions of Non-Nutritive Sweeteners Within the UK Adult Population. Nutrients. 2021; 13(2): 444.
2. ISA booklet: Low calorie sweeteners: Role and benefits. September 2018. Available online: https://www.sweeteners.org/wp-content/uploads/2020/09/isa_booklet_september_2018.pdf
3. Martyn D, Darch M, Roberts A et al. Low-/No-Calorie Sweeteners: A Review of Global Intakes. Nutrients 2018; 10(3): 357
4. Rogers PJ and Appleton KM. The effects of low-calorie sweeteners on energy intake and body weight: a systematic review and meta-analyses of sustained intervention studies. Int J Obes 2021; 45(3): 464-478
5. Greyling A, Appleton KM, Raben A, Mela DJ. Acute glycemic and insulinemic effects of low-energy sweeteners: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2020;112(4):1002-1014
6. EFSA NDA (EFSA Panel on Dietetic Products Nutrition and Allergies). Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA 2011 Journal 9: 2229
7. Stanner SA and Spiro A. Public health rationale for reducing sugar: Strategies and challenges. Nutrition Bulletin 2020; 45: 253–270