[WonderBuilder]

It feels to me that this advisory was not put out sensibly. WHO advises "against [artificial sweetener] use" because they "do not help control body mass or reduce the risk of weight-related illnesses" and because long term "[may increase the risk] of type 2 diabetes and cardiovascular disease". But is that enough reason to give such a blanket statement disallowance?

What if you want to have some sweetness from time to time but you are watching your sugar levels? Surely that's better than just taking sugar. What if you are weaning yourself off so much sugar? Surely that's better too. It seems to me that artificial sweeteners are a useful product for many people and is obviously not a panacea. I mean, honestly, hardly anything is good in excess!

I feel this is so poorly communicated and almost guarantees people will take the wrong message from this.

[gizmo686]

The actual recommendation:

> WHO suggests that non-sugar sweeteners not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases (conditional recommendation)

> Conditional recommendations are those recommendations for which the WHO guideline development group is less certain that the desirable consequences of implementing the recommendation outweigh the undesirable consequences or when the anticipated net benefits are very small. Therefore, substantive discussion amongst policy-makers may be required before a conditional recommendation can be adopted as policy.

> Because the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Subgroup on Diet and Health focuses on providing guidance on the prevention of unhealthy weight gain and diet-related NCDs, providing guidance on the management of diabetes in individuals with pre-existing diabetes is beyond the scope of this guideline. Therefore, the guidance in the guideline may not be relevant for individuals with existing diabetes.

https://apps.who.int/iris/rest/bitstreams/1501485/retrieve

I don't understand the expectations some people have of the WHO. Anything more complicated than a headline is going to get oversimplified by the media.

[notfed]

Also:

> The recommendation is based on evidence of low certainty overall

[WonderBuilder]

Thanks a lot for sharing that official document. It has great evidence and addresses the concerns I had. Additionally, the statement is labelled as a "recommendation", which is much more accomodating.

[unshavedyak]

> What if you want to have some sweetness from time to time but you are watching your sugar levels?

Partly it seems the issue is that in many cases the reason for avoiding sugar and using a substitute does not actually avoid the negative consequences of sugar. I say this as someone who avoids sugar and has very little.

I agree though i'm a bit confused by this WHO post. I have difficulty determining the severity of the issue. Based on what they're saying it sounds like you should avoid both sugar and substitutes. This post makes them sound basically the same, so why hyper focus on one?

[hedora]

Artificial sweeteners have been shown to cause weight gain, since they make you hungrier, and also lower your metabolism. This was shown in follow up studies with humans, but with mice, they had three groups that each got a fixed amount of calorie counted food and a hamster wheel. They then added sugar to one group's water and artificial sweetener to another group's. The artificial sweetener groups gained the most weight and was the least physically active.

If you're trying to watch your sugar levels (and are not diabetic) then artificial sweeteners are strictly harming your progress toward whatever goal you're trying to achieve.

They also cause all sorts of other health issues (cancer, digestive problems, neurological problems), but those are mostly product specific. The above applies to all non-nutritional sweeteners that have been studied.

I hope the WHO ruling includes "organic" artificial sweeteners too.

[crazygringo]

> Artificial sweeteners have been shown to cause weight gain

That does not seem to be the scientific consensus:

"The majority of clinical studies performed thus far report no significant effects or beneficial effects of artificial sweeteners on body weight and glycemic control" [1]

"Thus, evidence from controlled studies suggests that artificial sweeteners don’t cause weight gain and may even be mildly effective for weight loss." [2]

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817779/

[2] https://www.healthline.com/nutrition/artificial-sweeteners-a...

[hedora]

The healthline story is summarizing a large number of studies, all of which have ambiguous results, or show negative side effects.

So, like tobacco (which doctors used to recommend to help with lung health to kill colds, etc), there are a lot of ambiguous "no / little effect" studies in favor of artificial sweeteners, and a lot of studies showing clear negative effects. However, there aren't any showing significant benefits.

It's easy to produce a no-effect study via lazy experimental setup, and slight positive effects via P-hacking for strange things. For example, this quote from [2] looks like P-hacking:

> However, a recent review of nine observational studies noted that artificial sweeteners were associated with a slightly higher BMI — but not with increased body weight or fat mass (17Trusted Source).

Anyway, here are some other quotes from [2] against artificial sweeteners.

I pasted in their conclusion at the bottom of this comment, which can be summarized as "they won't help much, but they might hurt. If you have the following symptoms, discontinue use":

Though artificial sweeteners provide sweet taste, many researchers believe that the lack of calories prevents complete activation of the food reward pathway.

This may be the reason that artificial sweeteners are linked to increased appetite and cravings for sugary food in some studies (8Trusted Source).

Magnetic resonance imaging (MRI) scans in five men showed that sugar consumption decreased signaling in the hypothalamus, the appetite regulator of your brain (9Trusted Source).

This response was not seen when participants consumed aspartame — suggesting that your brain may not register artificial sweeteners as having a filling effect (9Trusted Source).

...

Another argument against artificial sweeteners is that their extreme and unnatural sweetness encourages sugar cravings and sugar dependence.

...

Though observational studies cannot prove cause and effect, the results are sometimes quite staggering.

For example, one study found that a high intake of diet soft drinks was linked to a 121% greater risk of type 2 diabetes (24Trusted Source).

Another study noted that these beverages were associated with a 34% greater risk of metabolic syndrome (25Trusted Source).

This is supported by one study on the effects of artificial sweeteners on both mice and humans. It associated the sweeteners with glucose intolerance and a disruption in gut bacteria (26Trusted Source).

...

In fact, replacing sugar with artificial sweeteners may be helpful in reducing body weight — though only slightly at best.

...

However, if you experience cravings, poor blood sugar control, or other health problems, avoiding artificial sweeteners may be one of many things to consider.

[0cf8612b2e1e]

> They also cause all sorts of other health issues (cancer, digestive problems, neurological problems), but those are mostly product specific. The above applies to all non-nutritional sweeteners that have been studied.

I would love to see some support of this. Artificial sweeteners are some of the most studied food additives. If there were a definitive association at practical consumption levels, that would be huge news.

[hedora]

It is huge news, in that a new story hits the news every few months.

A couple of days ago, a study showed one of the commonly-used sweeteners causes gut perforation.

A few months ago, they showed they disrupt gut microbes, leading to various inflammatory diseases and metabolic issues.

I could keep going back for thirty years, but discussed it in a reply to one of the sibling comments instead.

[barbariangrunge]

What about for dental health? I haven't had sugary drinks regularly for a long time, but when I do, my teeth almost instantly get covered in plaque. It feels so icky. The artificial sweetners must at least be helpful for that

[barbariangrunge]

Interesting. Thanks for sharing

[ctenb]

Reference to research?

[Gibbon1]

What if I told you your gut has taste receptors?

Me as far as added sugar and artificial sweeteners is concerned, I'm out.