Artificial Sweeteners: Known Benefits and Apprehensions
Submitted by Jacqueline Atwood, CSULB Dietetic Intern
There is a high demand for sweet foods amongst school aged children, with studies suggesting that children, infants, and young children base many of their food choices on sweet taste (Drewnowski et al., 2012). Unfortunately, to achieve this desired sweetness food production companies must add substantial amounts of added sugars. Added sugars have been associated with increased cardiovascular disease risk, increased energy intake, and increased adiposity. Although added sugars can be a part of a healthy diet, it is recommended to keep added sugars at or below 25 grams per day (Vos et al, 2017). A solution for reducing added sugars is the use of artificial sweeteners, however there is currently a stigma and regulations reducing the use of artificial sweeteners in school food lunches. In this article both sides will be presented to create an overall view of the use of artificial sweeteners for children.
Over the years artificial sweeteners have acquired a negative reputation due to perceived risks and disadvantages. For example, one of the major concerns is that artificial sweeteners have been told to potentially be associated with cancer. This stems from studies conducted on rats, however further research has suggested that cancer-causing mechanisms in rodents are not applicable to humans (Baker-Smith et al, 2019). Additionally, the National Cancer Institute also put out a statement that there is not enough significant research to suggest an association between artificial sweeteners and cancer in humans (National Cancer Institute, 2019). Another concern is that artificial sweeteners may impact gut microbiota, which can then lead to metabolic syndrome. Studies have suggested a correlation between drinking artificially sweetened beverages and metabolic syndrome. With that said, this may be correlation, not causation as adults who drink artificially sweetened beverages may already be on a diet or have another chronic illness (Baker-Smith et al, 2019). Lastly, research also suggests that children may not prefer artificially sweetened beverages when compared to sugar sweetened beverages. For instance, one study found that although there was no significant difference in liking score initially, after 3 weeks, the sugar sweetened beverage was significantly preferred more (Remy et al., 2014). Overall, evidence does not support an association between artificial sweeteners and cancer, and although there is correlation between artificial sweeteners and metabolic syndrome, this could be vulnerable to reverse causality.
Artificial sweeteners could have some potential benefits for school-aged children. Research suggests that replacing artificially sweetened beverages with sugar sweetened beverages have been associated with reduced weight gain, reduced fat accumulation, and waist to height ratio (Miller & Perez, 2014; de Ruytner et al., 2012). This is especially critical now, as child obesity is a critical issue. One of the Healthy People 2020 goals is to reduce child obesity rates from 17.8% to 14.5% (Office of Disease Prevention and Health Promotion, n.d). Another potential benefit of using artificial sweeteners is that it can allow children with type 1 and type 2 diabetes to enjoy sweet tasting index, with a lack of glycemic response. Artificial sweeteners could potentially lessen childhood obesity and some research suggests it could also be beneficial for those with diabetes.
In conclusion, although there are some fear around artificial sweeteners, research suggests that they could be a good replacement for sugar sweetened beverages for children. First, artificial sweeteners are not associated with higher cancer prevalence in adults. Second, although artificially sweetened beverage drinking has been correlated with metabolic syndrome in adults, it could be because adults with other risk factors might gravitate towards diet sodas. Finally, there is research involving school aged children that supports the idea that replacing sugar sweetened beverages with artificially sweetened beverages could reduce weight gain and fat accumulation.
Table 1 is from the J Food Sci Technol. 2014 Apr; 51(4): 611–621.
Published online 2011 Oct 21. doi: 10.1007/s13197-011-0571-1 and posted in the National Institute of Health, US National Library of Medicine.
Baker-Smith, C. M., de Ferranti, S. D., & Cochran, W. J. (2019). The use of nonnutritive
sweeteners in children. Pediatrics, 144(5). https://doi.org/10.1542/peds.2019-2765
de Ruyter, J. C., Olthof, M. R., Seidell, J. C., & Katan, M. B. (2012). A trial of Sugar-free or
sugar-sweetened beverages and body weight in children. New England Journal of Medicine, 367(15), 1397–1406. https://doi.org/10.1056/nejmoa1203034
de Ruyter, J. C., Katan, M. B., Kuijper, L. D., Liem, D. G., & Olthof, M. R. (2013). The effect of
Sugar-free versus sugar-sweetened beverages on Satiety, liking AND Wanting: An 18 Month randomized double-blind trial in children. PLoS ONE, 8(10). https://doi.org/10.1371/journal.pone.0078039
Drewnowski, A., Mennella, J. A., Johnson, S. L., & Bellisle, F. (2012). Sweetness and food
preference. The Journal of Nutrition, 142(6). https://doi.org/10.3945/jn.111.149575
Office of Disease Prevention and Health Promotion. (n.d.). Nutrition, Physical Activity, and
Obesity. Healthy People 2020. U.S. Department of Health and Human Services. https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Nutrition-Physical-Activity-and-Obesity/data#NWS-10
Martínez, X., Zapata, Y., Pinto, V., Cornejo, C., Elbers, M., van der Graaf, M., Villarroel, L.,
Hodgson, M. I., Rigotti, A., & Echeverría, G. (2020). Intake of Non-Nutritive sweeteners in Chilean children after enforcement of a new food labeling law that REGULATES added sugar content in processed foods. Nutrients, 12(6), 1594. https://doi.org/10.3390/nu12061594
Miller, P. E., & Perez, V. (2014). Low-calorie sweeteners and body weight and composition:
A meta-analysis of randomized controlled trials and prospective cohort studies. The American Journal of Clinical Nutrition, 100(3), 765–777. https://doi.org/10.3945/ajcn.113.082826
National Cancer Institute. (2016). Artificial Sweeteners and Cancer. U.S. Department of
Health and Human Services, National Institutes of Health. https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/artificial-sweeteners-fact-sheet
Remy, E., Divert, C., Rousselot, J., Brondel, L., Issanchou, S., & Nicklaus, S. (2014). Impact of
energy density on liking for sweet beverages and caloric-adjustment conditioning in children. The American Journal of Clinical Nutrition, 100(4), 1052–1058. https://doi.org/10.3945/ajcn.114.087452
Vos, M. B., Kaar, J. L., Welsh, J. A., Van Horn, L. V., Feig, D. I., Anderson, C. A. M., Patel, M. J.,
Cruz Munos, J., Krebs, N. F., Xanthakos, S. A., & Johnson, R. K. (2017). Added sugars and cardiovascular disease risk in Children: A scientific statement from the American Heart Association. Circulation, 135(19). https://doi.org/10.1161/cir.0000000000000439