Should you stop using sugar substitutes? Answers to common questions.


On Monday, the World Health Organization released a startling new report urging people to eliminate artificial sweeteners and other sugar substitutes from their diets. But that doesn’t mean you should go back to using real sugar, the agency said.

WHO has already issued guidelines urging people to limit the amount of sugar they eat. Now the agency wants people to cut back on all sweeteners, whether they’re natural or artificial.


Treat them as an element of the diet that we should discourage, said Francesco Branca, director of the WHO’s department of nutrition for health and development. Sugary sweeteners do not belong in a healthy diet. This is what we mean.

Reactions to the report were mixed. Industry groups, including the Calorie Control Council and the International Sweeteners Association, have said the safety of non-sugar sweeteners has been firmly established and that low-calorie and no-calorie sweeteners have been shown to aid in weight management and diet. reduction of calories and sugar intake.

Others applauded the finding, saying people already eat too many ultra-processed foods, which have been linked to health problems, and the council should encourage consumers to reduce their intake of both sugar and artificial sweeteners.


Here are answers to some common questions.

Which sweeteners does WHO advise against?

WHO advises people to stop using all artificial or non-sugar sweeteners. The guidance applies to individual packets of sweeteners that people can add to foods and beverages, as well as ultra-processed foods that contain the sweeteners. This includes:

  • Acesulfame K
  • Aspartame
  • Advantage
  • Cyclamate yourself
  • Neotamus
  • Saccharin
  • Sucralose
  • Stevia (and stevia derivatives)

Monk fruit extract is not on the WHO list of sweeteners. It’s a relatively new addition to packaged foods. Hence, there is less research available on its long-term effects. That said, it’s likely that monk fruit extract could act in the same way as other sweeteners, Branca said.


Charles German, a preventative cardiologist at the University of Chicago Medicine who studies how physical activity and a healthy diet can improve cardiovascular health, said the new WHO guidelines are consistent with decades of research on artificial sweeteners.

I certainly agree with the guidelines, and I imagine most doctors do, German said. Most of the data and science has found that processed foods are generally not good for health and are more likely to harm it, he said.

What sweeteners are not included in the list?

Sugar, honey, agave and sugar derivatives, including corn syrup or sugar alcohols, are not considered non-sugar substitutes, so they were not specifically named in the new WHO guidance. But that doesn’t mean people should switch to those products. In previous guidance, the agency has already recommended cutting back on all sugars. Sugar alcohols, also known as polyols, are commonly found in processed foods and come from plant products such as fruits and berries.

The goal is to cut back on both sugary and non-sugar sweeteners, Branca said.

It forces people to rethink the basics of Okay, how can I have a healthier diet more broadly? Not just substituting one ingredient for another, said Allison Sylvetsky, associate professor of exercise and nutrition sciences at George Washington University’s Milken Institute School of Public Health.

What does the science show about artificial sweeteners and weight loss?

WHO has advised against the use of sweeteners for weight loss. Branca said there are some rigorous clinical studies showing some short-term benefits to using artificial sweeteners for weight loss. But, when similar studies have tracked participants for six to 18 months. there was not the same effect on body weight.

It may be in the short term that you achieve that result, and some studies show it, Branca said. We really don’t have any evidence to show that weight is controlled using the sweetener.

Barry M. Popkin, a professor in the University of North Carolina’s department of nutrition, said artificial sweeteners can help someone with weight loss if they eat a healthy diet. But the key is that the sugar substitute must fit into a diet of fruits, vegetables and less processed foods.

People have often concluded that foods or drinks with zero calories must have a positive impact on weight loss. But the reality is, that’s not always the case, said Katherine Zeratsky, a registered dietitian nutritionist at the Mayo Clinic in Rochester, Minn.

Low-calorie or zero-calorie sweeteners might be a weight management aid, but they’re not management at all or that silver bullet in weight management tools, Zeratsky said. Go back to being mindful of your food choices again.

What are the long-term health concerns of using non-sugar sweeteners?

Branca said WHO’s review of available research found that groups who regularly consume non-sugar sweeteners have an increased risk of type 2 diabetes and cardiovascular disease.

We’re not saying we’ve gathered evidence to have done harm, Branca said. But, surely, the evidence we’ve analyzed indicates that it does not produce any health benefits.

Is it better to add sugar to my morning coffee instead?

No, absolutely not, said Thomas Sherman, an associate professor of pharmacology and physiology at Georgetown University Medical Center. I think people should use less sweeteners in general, but please don’t react to this WHO announcement by switching to sugar.

Instead of using two tablespoons of sugar or two packets of artificial sweetener, cut down to one and then, maybe, none over time, experts say. The goal is to eventually get used to a diet with no added sugar or artificial sweeteners. Zeratsky said he often recommends people cut back on sugars or sweeteners for a couple of weeks to reset taste buds and try to appreciate the natural sweetness of a strawberry or carrot.

Everyone would be healthier eating less sugar, said Marion Nestle, professor emeritus of nutrition, food studies and public health at New York University. I mean, sugar really does nothing for your health. But it adds to the enjoyment of the food.

There should be plenty of room in regular diets for sugar here and there, Nestle said.

Younger, healthier people can still enjoy sugar in their morning coffee if they appreciate it, but moderation is key, said Qi Sun, an associate professor in the departments of nutrition and epidemiology at the Harvard TH Chan School of Public Health.

But the advice for people with certain metabolic conditions, type 2 diabetes, or high heart disease risks is more stark. It’s best to avoid adding any type of sugar to your drinks if possible, experts say, as it can increase the likelihood that your condition will worsen over time.

Does everyone agree to banish fake sweeteners from our diet?

The reactions were mixed.

I see the WHO recommendation just introduces fear and confusion, and that’s a shame, Sherman said.

Sherman said he doesn’t recommend consuming non-nutritive sweeteners, but they can play a role for people trying to cut calories. I don’t consume them myself. I don’t give them to my children. But I don’t fear them. I think there’s a role to using diet versions of the drinks to try to eliminate or reduce your sugar intake.

Another concern is that the WHO guidance is based in part on a review of observational studies which found an association, not causation, between a person’s consumption of artificial sweeteners and their overall health. Theoretically, other parts of someone’s diet, not just the use of non-sugar sweeteners, can be a reason for long-term health problems.

In many countries, people who consume diet sodas are often very heavy, Popkin said. The studies don’t really look at those who have good diets versus bad diets, exclusively.

Sun said there is a lot of heterogeneity among the studies included in the WHO systematic review that guided its recommendation. Sun said stronger evidence is still needed to confidently recommend banning non-sugar sweeteners from the diet. But there are much healthier beverages you can drink, he added, such as black coffee, water and tea.

Artificial sweeteners are commonly found in ultra-processed foods, and a growing body of research shows that cutting back on these foods can have a huge impact on our health, Popkin said. In a controlled clinical study conducted by the National Institutes of Health, scientists fed a group of people a diet of ultra-processed foods for two weeks and then an equivalent diet from scratch. And, on a diet of ultra-processed foods, the participants rapidly gained weight and body fat. As a public health message against all ultra-processed foods, Popkin agrees with WHO’s guidance against consuming artificial sweeteners.

Weaning ourselves off sweetness is very important, Popkin said. We have a sweet tooth, and unless we reduce it, our children will have the same sweet tooth.

Have a question about healthy eating? E-mail EatingLab@washpost.com and we may answer your question in a future column.

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