A study published in the British Medical Journal entitled, “Artificial Sweeteners and Risk of Cardiovascular Diseases: Results from the Prospective NutriNet-‎Santé Cohort” sought to evaluate the association between low- and no-calorie sweetener intake and cardiovascular ‎disease risk. The study authors report an association between sweetener intake and increased risk of cardiovascular and cerebrovascular disease. Further, they report an increased risk of cerebrovascular events with aspartame intake, as well as an association between acesulfame potassium and sucralose consumption with increased coronary heart disease risk. Like the previous study conducted by this group, which investigated associations between low- and no-calorie sweeteners and cancer, these allegations are contrary to decades of scientific research showing these sweeteners are safe, as evidenced by global regulatory permissions for their use.

Due to the sample utilized in this study, the results of this study cannot and should not be extrapolated to the general population, as ‎those who volunteer to participate in such research activities often exhibit unique ‎characteristics (i.e., lifestyle and socioeconomic factors, etc.) not typical of the broader ‎population. ‎These individuals also self-reported their intake data, which subjects the ‎current study to recall bias, misreporting and under-reporting. Lastly, the observational nature of this study inhibits the ability to establish causality and the ‎likelihood of residual confounding bias must be considered when interpreting ‎these results.‎ ‎

Consumers want options when it comes to sugar reduction and low- and no-calorie sweeteners have are a proven safe and effective choice for sugar and calorie reduction. Along with exercise and a healthy diet, low- and no-calorie sweeteners are a critical tool that can help consumers manage body weight and reduce the risk of non-communicable diseases, such as cardiovascular disease and diabetes.

The post Statement from CCC on “Artificial Sweeteners and Risk of Cardiovascular Diseases: Results from the Prospective NutriNet-‎Santé Cohort” appeared first on Calorie Control Council.

The recent publication by Rios-Leyvraz and Montez, entitled “Health effects of the use of non-sugar sweeteners – a systemic review and met-analysis,” serves as an update to the 2019 systematic review by Toews, et al. and attempts to address inherent health effects of non-sugar sweeteners (NSS) as well as those effects compared to sugar or water, when consumed at safe levels as established by authoritative bodies.

The review reports favorable findings regarding NSS intake and weight management outcomes, without significant effects on other measures of adiposity or cardiometabolic health, including ‎fasting glucose, insulin, blood lipids and blood ‎pressure (very low to high certainty evidence).‎

Although long-term cohort studies suggested less favorable outcomes, the evidence certainty is very low to low. The authors note that these findings may be due to reverse causation and/or residual confounding.

Based on the lack of significant data from studies involving children, as well as largely inconclusive results in those that exist, and very low to low certainty of evidence regarding pregnant women, it is recommended more research is necessary to investigate consumption among these two population groups.

The review concluded that NSS consumption may be associated with short-term weight loss when used to reduce total energy intake. These results are largely in agreement with the findings of other systemic reviews and the current body of evidence. 

Additionally, numerous health and regulatory organizations from around the world maintain their confirmation of the safety of low- and no-calorie sweeteners for consumption by the general population. The unified position of worldwide food safety authorities is supported by robust evidence and extensive research, which contradict the recent review’s conclusions regarding long-term effects.

Given the totality of evidence and official assessments in support of low- and no-calorie sweeteners, CCC maintains that these ingredients are safe and valuable tools to aid in sugar reduction, weight management, blood glucose management and other positive outcomes.

The post CCC Statement: “Health effects of the use of non-sugar sweeteners – A systematic review and meta-analysis” appeared first on Calorie Control Council.

The study entitled, “Artificial Sweeteners and Cancer Risk: Results from the NutriNet-Sante´ Population-Based Cohort ‎Study,” attempted to evaluate any association between low- and no-calorie sweetener (LNCS) intake and cancer risk. However, the reported findings of this study are in contradiction to the totality of evidence and the numerous global health organizations who have regarded each of the named sweeteners as safe, following rigorous assessments.  

Despite its longitudinal design and large sample size, the current study has several weaknesses. Self-reported intake data subjects the study to recall bias, misreporting and under-reporting. Further, given the observational nature of this study design, causal links cannot be established and the likelihood of residual confounding bias must be considered when interpreting ‎these results.‎ Lastly, the results of this study cannot and should not be extrapolated to the general population, as ‎those who volunteer to participate in such research activities often exhibit unique ‎characteristics (i.e., lifestyle and socioeconomic factors, etc.) not typical of the broader ‎population. ‎All of these considerations significantly limit the strength of the reported findings.

In conclusion, CCC emphasizes LNCS remain safe and effective tools in weight management, sugar reduction and blood glucose management.

For more information on the safety of low- and no- calorie sweeteners, review the frequently asked questions below:

For more aspartame FAQs, click here.

For more Ace-K FAQs, click here.

The post Weaknesses of “Artificial sweeteners and cancer risk: Results from the NutriNet-Sante’ ‎population-based cohort study” appeared first on Calorie Control Council.

(Download)

McGlynn ND, Khan TA, Wang L, et al.

JAMA Network Open. 2022;5(3):e222092. doi:10.1001/jamanetworkopen.2022.2092

A recent review published in JAMA Network Open examined the association of low- and no-calorie sweetened beverages (LNCSBs) with body weight and cardiometabolic risk factors in adults with and without diabetes. Recent trials and reviews have reported inconsistent findings regarding these outcomes, and methodological considerations limit the conclusions that can be drawn from their reported results. For example, the authors note that the syntheses of randomized controlled trials (RCTs) do not fully account for the calories available to be displaced by LNCSBs, leading to an underestimation of the outcome of LNCSBs. In an effort to update the recommendations of the European Association for the Study of Diabetes, the Diabetes and Nutrition Study Group commissioned this new systematic review and meta-analysis to summarize evidence regarding the association of LNCSBs with intermediate cardiometabolic outcomes, including:

• Adiposity
• Glycemic Control
• Blood Lipids
• Blood Pressure
• Measures of Non-Alcoholic Fatty Liver Disease
• Uric Acid

Medline, Embase and the Cochrane Central Register of Controlled Trials were utilized to search RCTs with at least 2 weeks of interventions comparing LNCSBs, sugar-sweetened beverages (SSBs), and/or water (the standard of care substitution) from inception through December 2021. In contrast with the standard pairwise approach, researchers conducted a network meta-analysis, which allowed for the simultaneous assessment of three pre-specified substitutions (i.e., LNCSBs for SSBs, water for SSBs, and LNCSBs for water). This approach leverages direct and indirect comparisons with a common comparator to increase the information size, allowing for more precise estimates and the comparison of interventions that have not been previously compared.

Seventeen RCTs with twenty-four trial comparisons were included in the network meta-analysis. In total, the sample included 1733 adults with an average age of 33 years. The majority of included individuals (77.4%) were women who were overweight or obese and at-risk for or diagnosed with diabetes. In 12 of the RCTs included, LNCSBs were a substitute for SSBs, while 3 RCTs used water was a substitute for SSBs. LNCSBs were a substitute for water in 9 RCTs.

Network analyses of the prespecified substitutions yielded the following results:

• Substitution of LNCSBs for SSBs (intended substitution with caloric displacement) was associated with reduced body weight body mass index, percentage of body fat, and intrahepatocellular lipid.
• Substitution of water for SSBs (standard-of-care substitution with caloric displacement) was not associated with any outcome, although the direction of association favored water for most of the outcomes.
• Substitution of LNCSBs for water (reference substitution without caloric displacement) was associated with lower-level glycated hemoglobin A1C seen with water and decreased body weight and systolic blood pressure with LNCSBs.

Certainty of the evidence assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Network estimates of RCTs and the direct and indirect estimates that composed these network estimates started at a high certainty of evidence but were downgraded by established criteria for risk of bias, inconsistency (incoherence), indirectness, imprecision, and publication bias. As a result, for the body weight outcome, the certainty of the evidence was rated as “moderate” for the substitution of LNCSBs for SSBs, and “low” for substitutions of water for SSBs and LNCSBs for water. The certainty of evidence was generally moderate for all other outcomes across all substitutions.

The findings in this study are in agreement with those reported in other systematic reviews and meta-analyses, which have allowed for the interpretation of results by comparator. Previous analyses have also reported reduced body weight, BMI, and body fat associated with the use LNCSBs as a substitute for SSBs with caloric displacement, which is consistent with the utility of LNCSBs in reducing net energy intake. Neutral outcomes associated with the use of LNCSBs as a substitute for water without caloric displacement were reported in previous analyses. The authors note, “Although water is considered to be the standard-of-care substitution for SSBs by authoritative bodies, with many health organizations recommending against the use of LNCSBs, the existing evidence confirms the intended benefits of LNCSBs as a substitute for SSBs over the moderate term.”

In conclusion, the authors state, “There is a need for high-quality RCTs that focus on quantifying the outcome of LNCSBs using different LNCS blends as substitutes for SSBs compared with the outcome of water (the standard-of care substitution).” They note that their findings provide a good indication of the benefits of LNCSBs as an alternative replacement strategy over the moderate term for SSBs in adults with overweight or obesity who are at risk for or have diabetes. Future research using a range of designs is warranted to confirm whether the intended benefits of using LNCSBs as a substitute for SSBs are durable and extend to hard clinical outcomes.

The post Network Analysis Reinforces Benefits of Low- And No- Calorie Sweetened Beverages appeared first on Calorie Control Council.

By Dr. Berna Magnuson

Introduction 

Low- and no-calorie sweeteners (LNCS) are widely approved for use in foods and beverages to provide sweetness with no or few calories and no increase in blood glucose levels. The safety of these ingredients has been intensively investigated and assessed by authoritative bodies globally. When new toxicological assessment tools and new studies are generated, re-evaluation of safety by considering the totality of the database becomes warranted. Recently, Lea and colleagues (2021) focused on one aspect of food additive safety, the genotoxic potential of five LNCS. Their review of the literature, evaluation of the potential for genotoxic activity of these ingredients using a weight-of-evidence approach, and conclusions are reported here.  

This article provides a brief background to genotoxicity and testing methods, how quality and reliability of studies are determined, and why weight-of-evidence evaluations for overall safety assessment are conducted and are necessary.

What is genotoxicity and how is it measured?

Briefly, genotoxicity is damage to the genetic material of cells. There are different types of genotoxicity and over 100 different genotoxicity tests.  The 3 categories of genotoxicity tests are: 1) tests that measure mutations to DNA; 2) tests that measure clastogenicity (disruption or breakage of chromosomes) and/or aneugenicity (change in number of chromosomes); and 3) indicator tests that provide indirect measures of DNA damage such as single strand breaks, DNA repair response or changes in gene expression. Lea and colleagues summarize the assays used to evaluate these genotoxic effects in Table 1. Additionally, as DNA mutations are considered initiating events in cancer development, the absence of carcinogenic response in tumor studies in animals can be considered additional evidence of lack of genotoxicity potential of a compound.

How are quality and reliability of studies evaluated?

Many hundreds of various genotoxicity and carcinogenicity studies have been conducted on the 5 LNCS. If they do not all agree, how do evaluators determine which ones are providing the correct answers?

The different test protocols used to evaluate the genotoxicity of LNCS are not considered equal in their relevance for risk assessment. For example, only specific tests conducted according to internationally accepted testing guidelines are accepted by regulatory agencies for safety evaluation and approval of food ingredients. These are referred to as “guideline” studies (OECD website) and are globally recognized and accepted by regulatory agencies. Such tests are conducted according to protocols specified in the guidelines, with appropriate negative and positive controls, background control incidence and historical data on controls, and sufficient documentation of conditions and results. These guideline studies have been shown to be highly reliable, robust, and relevant for the endpoint being measured. Examples of factors that determine if a test is considered high quality and reliable include: (1) a correct test outcome for known positive and negative agents, with dose-response for positive agents; (2) the reproducibility and extent of within-test variability among laboratories (i.e. what is frequency of false positives and false negatives?); and (3) established limitations and confounders of the test  (such as cytotoxicity, apoptosis, DNA fragmentation). For further examples and discussion, visit the National Institute of Environmental Health Sciences (NIEHS) website.

What is a weight-of-evidence (WoE) approach for risk assessment and why is it used?

The results and conclusions of genotoxicity and other toxicology studies that are not conducted according to approved guidelines can be and are published in the scientific literature, often with much publicity.  Multiple reports with conflicting conclusions can pose a very confusing picture for health professionals and scientists who are not familiar with the limitations and lack of reliability of some of the studies.

WoE is a decision-making method in risk assessment that involves compiling a database of toxicology studies and assigning “weight” to each study based on the reliability of the study. Thus, the findings of those studies considered most reliable would be “weighed” more heavily in the overall assessment than findings from studies with lower or questionable reliability due to specified reasons or limitations (no dose-response, insufficient controls or replications, etc.). Thus, WoE assessments are used to review all the available data, provide clear rationales for reliability differences and weighing of results from various sources, and provide overall conclusions.

Summary of Lea et al (2021)

Lea and colleagues (2021) conducted a WoE assessment of the genotoxicity potential of each LNCS by compiling (1) reviews of genotoxicity studies by regulatory agencies, (2) recently published genotoxicity tests, (3) EPA Toxicity Forecaster database of results from high-throughput screening (HTS) for indirect measures of genotoxicity such as DNA damage and gene expression, and (4) conclusions from recent assessments of carcinogenic potential of the LNCS using Key Characteristics of Carcinogens (KCC). Overall summaries of the results from mutagenicity assays, chromosomal change assays, other DNA damage, and regulatory agency reviews are presented in very brief tables for clarity.

The overwhelming evidence from the majority of the various studies shows a lack of genotoxicity of the LNCS, with occasional reports of positive, genotoxic responses. This pattern of random “misleading” or “irrelevant” positive results among databases for non-genotoxic compounds is not uncommon, as described by an Expert Panel on the evaluation of new genotoxicity assays (Kirkland et al, 2016). To address this issue for LNCS, Lea et al. (2021) provided detailed explanations of the limitations or concerns for the studies with conflicting results. Justification is explained in detail for giving less weight in the overall genotoxicity assessment to results from unreliable studies compared to those from other high-quality guideline studies. Lea and colleagues (2021) offer further support for their conclusions regarding the non-genotoxicity of LNCS with additional and novel incorporation of mechanistic data from the emerging field of toxicology (ToxCast/Tox21) using high-throughput screening (HTS). In addition, they describe findings from the mechanistic framework using KCC that demonstrate lack of carcinogenic potential for LNCS.

Conclusion

In conclusion, the review by Lea and colleagues (2021) is a comprehensive assessment of genotoxicity potential of LNCS, using both historical and recent laboratory studies, and supported by mechanistic analyses.

Their conclusions of an overall lack of mutagenic and genotoxic activity based on the growing body of evidence further support of the safety of use of approved LNCS.

References

Kirkland D, Kasper P, Martus H-J, Müller L, van Bentheme J, Madiaf F, Corvif R (2016) Updated recommended lists of genotoxic and non-genotoxic chemicals for assessment of the performance of new or improved genotoxicity tests. Mutat Res 795:7-30.

Lea, Isabel & Chappell, Grace & Wikoff, Daniele. (2021). Overall lack of genotoxic activity among five common low- and no-calorie sweeteners: A contemporary review of the collective evidence. Mutation Research/Genetic Toxicology and Environmental Mutagenesis. 868-869. 503389. 10.1016/j.mrgentox.2021.503389.

NIEHS (National Institute of Environmental Health Sciences), Validation and Regulatory Acceptance of Toxicological Test Methods: A Report of the ad hoc Interagency Coordinating Committee on the Validation of Alternative Methods, NIH Publication No. 97-3981, NIEHS, Research Triangle Park, North Carolina, U.S.A., 1997.

https://ntp.niehs.nih.gov/iccvam/docs/about_docs/validate.pdf

OECD Test Guidelines Programme

https://www.oecd.org/chemicalsafety/testing/oecd-guidelines-testing-chemicals-related-documents.htm

The post Commentary on the Recent Review by Lea (2021) ‎Concluding Overall Lack of Genotoxic Activity for LNCS appeared first on Calorie Control Council.

Keith Ayoob, EdD, RDN, FAND —

Making an extreme dietary change makes great headlines, clickbait, and party conversation. 

I prefer the real world of small changes.  Call them “baby steps” if you like.  I prefer baby steps when dealing with lifestyle changes because baby steps are easier to make, and they are less taxing and stressful, to both our bodies and our emotions. 

Best thing about making baby steps?  Behavior research has long shown that making small, gradual changes to be the most lasting and permanent.  Ask any registered dietitian-nutritionist (RDN) who provides dietary counseling or medical nutrition therapy.  We always look for a “win-win”, and making small dietary changes is both easier and more permanent: a win-win.

Making small, gradual dietary changes also takes longer.  Progress is less dramatic, but I will swap “dramatic” for “permanent” any day.  Does it take more persistence and patience?  I would say it “teaches” patience and persistence.

When I hear someone say they are going to “cut out all the added sugars from my diet,” the first thing I want to ask is, “How long are you going to give yourself to do that?”   It does not have to be done suddenly, especially since doing it suddenly may produce failed results.  Transitioning to your dietary goals more gradually may take longer, but there is no need to rush and IU want them to enjoy the journey.

Where LCS fit into transitional diets

The single largest source of added sugars in our diets is from beverages: soda, flavored waters, iced tea, fruit-flavored drinks, etc.  These beverages don’t provide much nutrition, just calories.  You may want to switch over to just water as your primary beverage.  That’s great and I’m a huge fan of drinking water.  If you don’t drink much water, it’s time to start.

Replacing added sugar however, can start immediately, and may have to, in those newly diagnosed with diabetes or someone who is seriously overweight.  It’s unrealistic to expect someone to go “all-water” immediately, especially when there are other calorie-free options. 

Drinks with LCS, whether carbonated, non-carbonated, or hot or iced tea or coffee, also count toward your hydration, and can be considered “water-alternatives.”  Here’s why:

• They all have no calories and are sugar-free.
• They are hydrating.
• They are TOOLS for reducing total added sugars in your diet.

It is still good to drink water, but know that these are alternatives that can help make the transition to drinking more water much easier and more enjoyable. 

Variety: The Sweetness of Life

You do not have to be living with diabetes or be overweight to enjoy the benefits of beverages with LCS.  Even people who have transitioned to drinking more water and unsweetened beverages like variety sometimes.  A drink with a LCS brings that variety without any added calories.

Those with Diabetes and anyone trying to lose weight or reduce their daily calories deserve to have access to as wide a variety of tools as possible to help them achieve their goals. 

Concerned that beverages with LCS will hamper your efforts to eat a better diet or make it harder to steer away from sweets?  No worries, according to the conclusions of the C.H.O.I.C.E. (Choosing Healthy Options Consciously Everyday) study.  This study looked at groups that replaced their sugar-sweetened drinks with either water or diet beverages for six months.  Compared to the all-water drinkers, the group using diet beverages showed:

• Greater reduction in consumption of caloric drinks.
• Ate FEWER desserts than the water group.
• No evidence that the diet beverages increased a preference for sweet foods or drinks.

Bottom Line Takeaways:

• It’s great to drink water as your primary beverage. 
• Water isn’t the only way to get water or to hydrate. 
• Replacing your sugar-sweetened drinks with both water and some drinks sweetened with LCS may make your diet more palatable and enjoyable, and leave you feeling less deprived. 

Feeling less deprived may even help you avoid high-calorie snacks and desserts a little more.  Use all the tools you can to make your transition diet as easy to follow as possible.

Keith Ayoob, EdD, RDN, FAND, is an Associate Clinical Professor Emeritus at the Albert Einstein College of Medicine. As a pediatric nutritionist and registered dietitian, Dr. Ayoob is also a past national spokesperson for the Academy of Nutrition and Dietetics. Dr. Ayoob is a consultant with the Calorie Control Council Advisory Board and the Global Stevia Institute (GSI), GSI is supported by PureCircle Ltd, a global leader in purified stevia leaf extract production.

The post Using Low- and No-Calorie Sweeteners in a “Transition Diet” appeared first on Calorie Control Council.

Polyols are unique sugar-free sweeteners, offering good clean taste and special advantages for a healthy diet. While polyols are considered “sugar alcohols,” they are not sugars or alcohol. Polyols are low-digestible carbohydrates that can be used in foods as a low-calorie sugar alternative.

Unique Benefits

Polyols are not fully absorbed and metabolized by the body, which is why they have fewer calories than sugar. Polyols are also not readily converted to acids by bacteria in the mouth, meaning they won’t promote tooth decay. Some people experience an initial feeling of fullness from eating foods with polyols, but any effects are typically mild and temporary.

Advantages for Diabetics

Polyols can be an especially useful sugar alternative for people with Type 1 or Type 2 diabetes, helping to reduce calorie intake and minimize spikes in blood sugar. Polyols only contain between 0 and 3 calories per gram, whereas sugar contains approximately 4 calories per gram. Since polyols are not readily digested and only partially absorbed by the body, they are considered low-glycemic foods. This means that they will not cause a sudden increase in blood sugar levels after a meal. Despite these differences, polyols share physical similarities with sugar. Therefore, they can effectively support a diabetes-friendly diet without sacrificing taste or texture. NOTE: People with diabetes should consult their physician or other health professional for more guidance on incorporating polyols into their diet plan.

Where to Find Them

Polyols are found naturally in a variety of fruits, vegetables and plants, and are used in a wide range of products including chewing gums, candies, ice cream, baked goods, and fruit spreads. They function well in fillings and frostings, canned fruits, beverages, and yogurt and tabletop sweeteners. Polyols are also used in dental and pharmaceutical products, such as toothpastes, mouthwashes, cough syrups, and throat lozenges.

Learn the Label

To help consumers make more informed food choices, the U.S Food and Drug Administration (FDA) announced a new Nutrition Facts label in May 2016. The updated label includes a new line for added sugars, offering increased understanding around the amount of sugar added to a particular product. The FDA defines added sugars as “sugars that are either added during the processing of foods, or are packaged as such.” Therefore, despite their sweetness, polyols are not included in the added sugars line on labels.

Products in which polyols have replaced sugar may be labeled “sugar-free” or “no sugar added.” Polyols to look for on ingredients lists include erythritol, hydrogenated starch hydrolysates, isomalt, lactitol, maltitol, mannitol, sorbitol and xylitol. The grams in a serving may be shown voluntarily on the Nutrition Facts label. Per FDA regulations, the name of the specific polyol may appear on the Nutrition Facts label if only one polyol is in the food. If more than one polyol is in the food, you’ll see the term “sugar alcohols.”

The post Presenting Polyols: A Sugar Alternative with Sweet Taste & Serious Benefits appeared first on Polyols.

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By Rosanne Rust, MS, RDN, LDN

February 27, 2019 — Sucralose has been approved for use in our food supply since 1998 and its safety has been validated by several health organizations including the FDA, European Food Safety Authority, the National Cancer Institute, and Health Canada. Over 80 countries have approved sucralose for human consumption. Sucralose is six hundred times as sweet as table sugar (sucrose), and mimics the sweetness of sucrose, without the calories or glycemic effect.

Sucralose is also heat-stable, which makes it a versatile low-calorie sweetener with applications in baked goods and recipes. Often food manufacturers meet the demands for low calorie foods by combining different low- or no-calorie sweeteners to improve the taste and stability of these products.

While sucralose is derived from sucrose, it does not impact blood sugar levels because it’s not metabolized or recognized by the body as a carbohydrate. This makes it appealing to those with diabetes, as they can enjoy foods or beverages sweetened with sucralose without the added glycemic effect. However, given that some food products use sucralose as only a partial replacement for the sugar content, the total calories and carbohydrate contained still needs to be accounted for in the total glycemic affect when planning meals and snacks for someone with diabetes. The incorporation of sucralose into food and beverages to replace part of the caloric sweeteners offers appealing products that taste good. These products can be helpful for weight management, as they are lower in sugar and calories.

There have been over 100 studies demonstrating the safety of sucralose, however some continue to bring its safety into question, linking it to GI issues, headaches, cancer, or weight gain. These allegations are contrary to a large body of scientific evidence.

Gut Health

A study suggesting that Splenda® affects the gut microbiome has been disputed as well. The study, “The Artificial Sweetener Splenda Promotes Gut Proteobacteria, Dysbiosis, and Myeloperoxidase Reactivity in Crohn’s Disease–Like Ileitis” was published the March 2018 issue of Inflammatory Bowel Diseases. The mice were “predisposed to a Crohn’s disease-like condition”, and when given a solution containing sucralose in their drinking water, their gut inflammation worsened. This is a correlational affect, and the “worsening” of their gut seemed to be due to an increase in Proteobacteria in their stool or their predisposed bowel disease.  Since many studies involving sweeteners and the microbiome are poorly designed it makes it difficult to link the source of any changes in the microbiome to low calorie sweetener use. We still need more microbiome studies that are designed to accurately assess and link the source of any changes in the microbiome. What we know about how diet impacts the microbiome is limited, although there’s good research about fiber’s impact. Any health implications of these changes are still unclear, and further human research in this area is still needed.

Cancer

There is no evidence that nonnutritive sweeteners cause cancer in humans. A 2017 study conducted by the Ramazzini Institute (Soffritti et al) continues to occasionally surface in popular media, even though its conclusions have been sharply disputed.  The study’s poor methodology and lack of a dose-response relationship, does not imply any cause and effect. Global regulators do not rely on single studies, but rather the body of evidence, when determining safety of ingredients. The Soffritti study tested quantities from 500 to 16000 ppm (parts per million) which translates to 100 to 3200 times the established Acceptable Daily Intake (ADI).

Some studies question the potential for sucralose to form chlorinated byproducts under high temperatures, while others have shown its heat stable. Other studies suggest a need for further research in this area.

Other Concerns

A recent study questioned whether sucralose may accumulate in the adipose (fat) tissue of mice. The study, “Intestinal Metabolism and Bioaccumulation of Sucralose in Adipose Tissue in the Rat” conducted by Bornemann et al, was published last summer in the Journal of Toxicology and Environmental Health.

The study also tested high doses of sucralose in ten rats. The rats were given daily doses of 36.5mg sucralose per animal for the 5 male rats, and 25mg/day per animal for the 5 female rats. These doses would be equivalent to a 150 pound human consuming 800 teaspoons of sugar every day (a can of regular soda has about 9 teaspoons). In addition, this study did not include a control group, nor was it designed to test for bioaccumulation.

Summary

The studies and testing that have supported the safety of sucralose far outweigh the studies correlating sucralose to metabolic issues or otherwise. This sweetener has been used safely in food and beverages for over two decades without ill effect. Since sucralose is not absorbed by the body, it stands to reason that there is no metabolic impact.

Ingredients are tested by regulatory bodies to determine the Acceptable Daily Intake (ADI). The ADI is one hundredth of the highest amount a human could consume every day of their life with no ill effects. The ADI for sucralose is 5 milligrams per kilogram of body weight (mg/kg) per day. This would be 340 milligrams (which is more than 28 packets of Splenda or nine cans of diet soda) per day of sucralose for a 150 pound person (which is 100 times less than what was tested to be safe). So you see, the ADI is quite conservative.

Yes, animal studies are important to establishing toxicity levels, but they are not valuable when translated to typical human consumption of a substance, food or beverage. The high levels of sucralose used in the Bornemann, et al. and Soffritti, et al. studies for instance, do not represent typical human intakes at all. For example, the Ramizzini study noted adverse effects at doses starting at 240 mg/kg, an unrealistic consumer dose. When evaluating new research or topics covered in the news about low or no calorie sweeteners, keep in mind the type of study, the dose-response relationship, and match that up with the larger body of evidence.

References: 

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-46702009000400002

https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/artificial-sweeteners-fact-sheet

Rosanne Rust MS, RDN, LDN is a registered, licensed dietitian-nutritionist with over 25 years experience. Rosanne is a paid contributor to Allulose.org. As a Nutrition Communications Consultant  she delivers clear messages helping you understand the science of nutrition so you can enjoy eating for better health. Rosanne is the co-author of several books, including DASH Diet For Dummies® and the The Glycemic Index Cookbook For Dummies®. A wife, and mother of 3 boys, she practices what she preaches, enjoying regular exercise, good food and festive entertaining. Follow her on Twitter @RustNutrition.

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By Rosanne Rust MS, RDN, LDN  —

A bit of sugar in the diet is fine, but for those with diabetes, high triglycerides, or those who are working on weight maintenance – there are lots of ways to cut back on sugar and still enjoy your favorite treats.

In addition to reducing sugar itself, you can also substitute low-calorie sweeteners to replace sugar in your diet. In the nutrition world, we call calorie-free or low-calorie sweeteners “non-nutritive sweeteners,” or NNS for short. One of the newer sweeteners on the block is allulose. Allulose is a low-calorie sweetener that exists in nature and in certain fruits (including figs, raisins, maple syrup). Since allulose is less sweet than table sugar, it’s often used in combination with other sweeteners, substituting for part of the sugar content. You may be seeing more products with allulose on your grocery shelves soon, including reduced calorie baked goods, salad dressings, juices, jams, syrups, puddings and coffee mixes.

If you’re concerned about how NNS may impact your weight, you can rest easy. A meta-analysis of 15 randomized clinical trials and 9 cohort studies that evaluated research about the relationship of NNS and body weight showed no association between the consumption of NNS and increased weight or fat mass. In fact, results of the analysis indicated that substituting NNS for sugar may actually induce a modest amount of weight loss. Of course using NNS also helps control carbohydrate intake, which is important for blood sugar management in diabetes. All these health benefits are especially good news as we face the time of year known for social gatherings with indulgent foods.

During the holidays, I give you permission to treat yourself, but I don’t want you to go overboard. Try using some of my simple tips to reducing the sugar in your favorite holiday meals.

6 Simple Ways to Reduce Sugar during the Holidays

1. Enjoy a low-sugar breakfast. A nice warm bowl of oatmeal or a scrambled egg with a slice of whole grain toast is a good pregame on feast days. You don’t want to skip breakfast, but you’ll have no problem enjoying dessert later if you balance out your morning.
2. Bake from scratch. This allows you to control ingredients, and reduce the recommended amount of sugar in recipes. This will not work for some baked goods, but will work for others. You can easily reduce the sugar in your pumpkin or fruit pies by simply using less. If your apple-cranberry cobbler calls for 1/2 cup of sugar, use 1/3 of a cup. Or you can substitute a NNS for the sugar if you prefer to maintain the same level of sweetness.
3. Enjoy your vegetables. Plan lots of great vegetable-based side dishes for your holiday meal. Remember, veggies don’t have to be steamed and bland! Add olive oil, a touch of butter, spices, or chopped nuts to your veggie dishes. Roast vegetables for easy clean up and robust flavors. Adding more vegetable-based sides to your table will not only provide you with lots of vitamins and antioxidants, but will fill you up so you won’t overindulge in desserts. It’s all about balance.
4. Put together a coffee bar after dinner with dessert or the following morning for overnight guests. Swap the sugar bowl for sugar free syrups, sweeteners, and real whipped cream.
5. Make your own whipped cream. Not only does this make desserts extra special, but you can reduce the sugar in homemade whipped cream compared to store bought versions. It’s so easy: chill a medium-sized mixing bowl in the freezer for about an hour (not required, but will help the cream whip more quickly). Pour a pint of whipping cream into the bowl, add one packet of low calorie sweetener, a teaspoon of vanilla extract (if you’d like), and whip using an electric mixer. Cream will gradually thicken. Continue beating until cream thickens and forms peaks.
6. Create a low-sugar signature cocktail or “mocktail.” Offering a signature beverage when you entertain is festive, but sometimes “fancy drinks” can really be filled to the brim with sugar (and therefore higher in calories). Use sugar-free beverages such as diet ginger beer, club soda, sugar-free lemonade, or diet cranberry juice as your mixers to reduce the total sugar and calories of the cocktail.

Rosanne Rust MS, RDN, LDN is a registered, licensed dietitian-nutritionist with over 25 years experience. Rosanne is a paid contributor to Allulose.org. As a Nutrition Communications Consultant  she delivers clear messages helping you understand the science of nutrition so you can enjoy eating for better health. Rosanne is the co-author of several books, including DASH Diet For Dummies® and the The Glycemic Index Cookbook For Dummies®. A wife, and mother of 3 boys, she practices what she preaches, enjoying regular exercise, good food and festive entertaining. Follow her on Twitter @RustNutrition.

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By: Ellen Stokes, MS, RD, LD —

“Olivia loves sugar so much that if she had her way, she would live off of gummy bears and popsicles,” her frustrated mother said. “You’re a dietitian – tell me – is that normal?”

Normal? Yes.  Challenging?  Absolutely!

Concerned parents may believe their children are the only ones who seem to have been born with a sweet tooth, but the truth is, we all were.

A preference for sweetness, specifically the taste of lactose in breast milk, is crucial to an infant’s survival.  At the same time, rejecting unfamiliar substances that taste bitter is protective against eating something that could be poisonous.  Unfortunately, some vegetables, especially the leafy green ones, can have a bitter edge to them which could explain why they may be a no-go for your child.

Researchers at the Monell Chemical Senses Center tested solutions of varying sweetness on children and adults.  They found children preferred solutions that were twice as sweet as the most sugary solutions that adults could tolerate.

The good news is when most children reach adulthood, their tastes have changed. This preference shift has led researchers to speculate that while bones are still growing they send hormonal signals to the brain to eat more sugar.  Once bone growth stops, the appetite for extra helpings of sugar tends to slow down as well.

While it’s important to understand that there are biological forces involved in your child’s seemingly insatiable sweet tooth, it’s equally important not to give into his or her desire for sugar overload.

Here are three approaches to gently steer your child to a more balanced diet:

1. Patterning: Are your kids used to seeing you reach for a handful of cookies when you get home from work or eat a donut as you drive carpool in the morning? Several studies have found that if the parents have a poor diet pattern, the children tend to as well. So, if you want your children to eat more healthfully, you may need to change your own dietary habits first. But, keep in mind that successful patterning is about being a good role model, not about controlling children’s eating habits through bribes, threats, or coercion.
2. Planning: Another good way to bring balanced, sound nutrition to your family is to plan ahead. That means putting together a weekly menu, creating a shopping list, and sticking to that list at the supermarket. Planning a menu may sound like extra work, but you will actually save time and energy – and probably money — by being prepared. Also, having a weekly menu in place gives children an opportunity to look forward to eating a good dinner, instead of filling up on sugary snacks.
3. Providing. When you’re planning the menu, keep in mind your child’s taste preferences by providing a touch of sweetness here and there. This will encourage your child’s acceptance of a wider variety of nutritious foods.

Here are some suggestions to work into your menu:

• Fruit: Because of its natural sweetness from fructose, fruit is an excellent choice as a snack, side dish, salad, or dessert. It’s also a great addition to whole grain muffins, pancakes, and oatmeal.
• Green salads: With a satisfying crunch and vitamin E, romaine lettuce with just a drizzle of bottled raspberry salad dressing makes a tasty salad. A raw spinach salad with mandarin oranges and dried cranberries is another popular choice.
• Chicken: Liven up plain baked chicken with a topping of fresh fruit salsa or a fruit glaze. Also, homemade oven-baked chicken fingers are a snap to make in large batches and freeze.  Serve them with honey mustard or a homemade yogurt dip.
• Yogurt: To boost calcium and potassium intake, choose high-quality, unsweetened yogurt and offer some “fixings” for your child to stir in. Choices could include a few mini-chocolate chips, some chopped fresh fruit, granola, cinnamon, and honey.
• Carrots and dip: Ever notice that carrots are the first to go on raw vegetable trays? That’s because carrots taste sweeter than many other vegetables.  They are also an excellent source of vitamin A.
• Sweet potatoes: Mash fresh sweet potatoes with a small amount of milk, butter, and salt. Nothing more is needed except perhaps a sprinkle of cinnamon sugar on top. Or, toss cubed raw sweet potato in canola oil and roast in the oven until the natural sugars caramelize.

A final note: Except in the case of allergies, no foods – including sweets — should be completely eliminated from your child’s diet. But, portion control is key. Setting up two treat days a week and letting your child choose a small candy bar, cupcake, or cookie on those days will help satisfy even the most demanding sweet tooth.

Ellen Stokes, MS, RD, LD is an award-winning video producer, director, and writer in addition to being a registered dietitian. Ellen writes and creates videos about nutrition education, food safety, menu planning, grocery shopping, and healthful cooking on a budget. Ellen has worked with organizations and companies including WebMD, the Partnership for Food Safety Education, and the University of Georgia Food Science Department. Ellen formerly worked for CNN as a writer and producer and teaches food safety and nutrition for Georgia State University. Check her out on Twitter @EllenS_RD.

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