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What do you say when your patients ask whether low-calorie sweeteners help with weight management?

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Alex’s Notes: The question within the title seems so simple, yet it is full of controversy. The issue itself stems from the fact that reducing consumption of sugar is the most widely promoted strategy for weight loss. And although telling this to 99% of the population would result in a head and response along the lines of, “oh yah, that makes sense,” there is an intrinsic flaw in this solution. As James Hill, the author of the editorial at hand, states,

“The fact that humans are born with a strong preference for sweet taste provides a challenge to efforts to simply reduce sugar intake. Sweetness gives us pleasure, and pleasure is a strong reason for making food choices.”

No doubt, you be hard pressed to find someone who was truly disgusted by cake and ice cream in the manner resembling how a five year old hates Brussels sprouts. Given this love-affair, it seems implausible to tell people to simply reduce sugar intake. More health conscious individuals like us Super Humans can easily pass on the soda for some water, but what about everyone else? Can we rely on willpower to recondition taste buds? Can we get food companies to use less sugar? What would replace it? Should we make sugary foods cost more? Tax them?

These are all rhetorical questions. Although they are potential avenues to explore, in the long-run a reliance on willpower and regulatory policy cannot trump our evolutionary biology. There is another solution – low-calorie and zero-calorie sweeteners (LCS). As Hill rightly points out,

They were developed by the food industry to solve this exact problem: to provide sweet taste with minimal calories.”

Most LCS on the market today are relatively safe, although the degree to which has been recently questioned. However, with regard to weight-loss, their beneficial effects are clear. Back in June I talked about a meta-analysis of 15 randomized clinical trials (RCTs) and nine prospective cohort studies that examined the relationship between intake of LCS and various body-composition parameters. In the RCTs, the use of LCS was associated with lower body weight, BMI, and waist circumference. In the cohorts, the use of LCS was associated with less weight gain but a slightly greater BMI. However, this is likely reverse causation in that heavier individuals are more likely to use LCS in their dieting attempts. Perhaps the most important finding was that not a single study found the LCSs had worse weight outcomes.

So what do you say when your patients ask whether low-calorie sweeteners help with weight management? Simple; LCS are doing exactly as they were designed to do, helping reduce total caloric and sugar intake while still providing the sweet taste we enjoy. Now, there are many different types of LCS. Some such as aspartame are very controversial with evidence both for and against their use. Others, such as stevia, have actually been shown to have beneficial effects beyond the typical LCS. Regardless, as Hill so elegantly concludes,

“LCS consumption may be found to have negative health consequences on body weight down the road, but we know that obesity has negative health consequences right now. We need more tools to help people permanently reduce or avoid obesity and our best science suggests that the use of LCSs is one such tool.”

Does this mean that LCS are the end-all solution? No, because that is not how science works. However, it does mean that we need to get over the dogmatic belief that artificial sweeteners cause weight gain because the research clearly shows the opposite. This doesn’t mean that those researchers should abandon the idea entirely. Quite contrarily, they should continue to pursue it. Our research into the complexity of our bodies is in its infancy, and there is a strong change that future work will uncover some previously undetected negative effects of LCS; If not on weight, then on other aspects of our health and wellbeing.

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