The Debate About Artificial Sweetners

By Richard Hilburn, MD, FACP

On Monday, 15 May 2023, the World Health Organization (WHO) issued a warning against using artificial sweeteners to control body weight or reduce the risk of diseases such as diabetes. The organization described certain exclusions pertaining to the warning, such as not pertaining to individuals with pre-existing diabetes.

The WHO cited a number of the most popular examples such as saccharin, stevia, acesulfame K, aspartame (non-sugar sweeteners, or “NSS”) and others. Sugar alcohols like sorbitol and erythritol were
not included in the warning. The
WHO also warned against consumption of processed and ultra-processed foods but in this article, we will focus upon the warning about artificial sweeteners.

The concerns about artificial sweeteners have long been argued both for and against in various media. Both good and bad research has frequently been cited on both sides by people with a lot or only a little expertise. This debate illustrates the complexity of good data analysis and the conundrum of knowing whom to believe. Confusion abounds and it should give us an appreciation of how and why people are so often doubt the veracity of various media sources.

With this in mind, I want to share some excerpts from an article in Cardiology News, by Dr. Melissa Walton-Shirley, MD, published 26 June 2023. Doctor Walton-Shirley pointed out that the WHO warning included the disclaimer that “The recommendation is based on evidence of low certainty.” The WHO described that “A significant difference in body weight and [body mass index] was only observed in trials that reported a reduction in energy intake…” and pointed out that weight loss was not sustained. Dr. Walton-Shirley rightly observed however that the desired effect of NSS was specifically to reduce calories (reduction of energy intake) and that “nearly every weight loss trial in history [has found that] weight loss was not sustained.”

In fact, far more studies have validated the safety of NSS at the doses humans consume than have studies indicated risks of using these sugar substitutes. In my opinion, Dr. Walton-Shirley’s rebuttal to the WHO warning is rock-solid versus the WHO’s position is based upon very poorly analyzed, conflicting data of uncertain significance and often dubious sources.

My own opinion is that using NSS instead of sugar is safe. Nevertheless using natural sources of sugar to satisfy your sweet tooth is much healthier anyway. Eating an orange is better than eating a candy bar. Duh. Meanwhile, if you’re using Splenda or Stevia in your coffee or baking instead of processed sugar (if it’s white and granulated, it’s processed) then I endorse continuing your current practice—as I will continue doing so myself.

In our weight loss clinic, we employ medications that are effective and we rely upon the FDA to have proven them to be safe. We cannot do all of the research or analysis ourselves. I trust public servants who dedicate themselves to government careers in which they get paid the same regardless of the positions they articulate.