The following is a list of publicly available statements on the use of low-calorie sweeteners. It is not intended to be a comprehensive list. When available, each entry includes both a statement published in the linked paper or report, as well as a statement from the organizational website. IAFNS does not endorse the statements shown, nor does it have an opinion on the value of the organizations listed; the website is for informational purposes only.
Global Health & Science Organization Statements on the Use of Low-Calorie Sweeteners
2018
Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes
“Non-nutritive (artificial) sweeteners are safe and may be recommended.”
Evaluation methodology: GRADE
Rating: NR
Rating interpretation: NR (not rated). Rationale: “A key aspect of current approaches to supporting people with diabetes is to encourage practice that is individualized. It is challenging to rate such recommendations using the GRADE system, particularly in situations where multiple conditions influence health and dietary approaches. In response to this, a deliberate decision was made to report these recommendations as “Not Rated.”
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Website statement: “All non-nutritive sweeteners used in foods in the EU have to undergo rigorous safety testing before being approved by the European Commission.”
Resources accessed September 2018.
2016
Artificial Sweeteners and Cancer
“Questions about artificial sweeteners and cancer arose when early studies showed that cyclamate in combination with saccharin caused bladder cancer in laboratory animals. However, results from subsequent carcinogenicity studies (studies that examine whether a substance can cause cancer) of these sweeteners have not provided clear evidence of an association with cancer in humans. Similarly, studies of other FDA-approved sweeteners have not demonstrated clear evidence of an association with cancer in humans.”
Evaluation methodology: Not applicable
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Resources accessed September 2018.
2016
The Pan American Health Organization Nutrient Profile Model
III. Principles and rationale of the PAHO Nutrient Profile Model
“In addition to critical nutrients, “other sweeteners” were included in the model. The rationale for their inclusion is that habitual use of sweet flavors (sugar-based or not) promotes the intake of sweet food and drinks, including those that contain sugars. This outcome is particularly important in young children because consumption at an early age defines lifelong consumption patterns.”
“Criteria for identifying processed and ultra-processed products…” includes “Other sweeteners” defined as “Any amount of other sweeteners.”
Methodology: Not specified
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Resources accessed April 2019.
2022
WHO Draft Guideline on Use of Non-Sugar Sweeteners
“WHO suggests that NSS not be used as a means of achieving weight control or reducing risk of noncommunicable diseases (conditional recommendation).”
Methodology: Systematic reviews
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Resources accessed September 2022
2016
Policy statement and recommended actions for lowering sugar intake and reducing prevalence of type 2 diabetes and obesity in the Eastern Mediterranean Region
“The need to help the population adapt to less sweetened foods also means that the use of sweeteners, while successful in reducing calories, does not help this adaptive process in people’s sense of appropriate sweetness.”
Methodology: Not specified
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Resources accessed September 2019.
Professional Society Statements on the Use of Low-Calorie Sweeteners
2018
Position Paper: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes
“Nutrition intervention: The RDN should individualize the nutrition prescription and implement evidence-based guidelines in collaboration with the adult with diabetes [including to] Educate on carbohydrate management strategies including fiber, glycemic index, and sweetener (nutritive and non-nutritive) recommendations…”
Evaluation methodology: Narrative review
Rating: Not applicable
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2017
Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Nutrition Intervention Evidence Reviews and Recommendations
Nutrition Practice Guideline Recommendations:
1. “RDNs should educate adults with diabetes that intake of FDA-approved nonnutritive sweeteners (such as aspartame, sucralose, and steviol glycosides) within the recommended daily intake levels established by the FDA will not have a significant influence on glycemic control. Research reports no significant influence of consuming FDA-approved nonnutritive sweeteners (such as aspartame, steviol glycosides, and sucralose), independent of weight loss, on HbA1c, fasting glucose levels, or insulin levels.”
Evaluation methodology: Systematic review
Rating: Weak; Imperative
Rating interpretation: Weak = “Quality of evidence is either suspect or well-done studies show little clear advantage to one approach vs another”; Imperative = “Applies to all members of the specified guidelines population”
2. “RDNs should educate adults with diabetes that substituting foods and beverages containing FDA-approved nonnutritive sweeteners within the recommended daily intake levels established by FDA can reduce overall calorie and carbohydrate intake; however, the other sources of calories and carbohydrates in these foods and beverages need to be considered. Use of nonnutritive sweeteners has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners without compensation by intake of additional calories from other food sources.”
Evaluation methodology: Systematic review
Rating: Fair; Imperative
Rating interpretation: Fair = “Quality of evidence is II [fair] or III [limited]”; Imperative = “Applies to all members of the specified guidelines population”
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Position Paper: Interventions for the Treatment of Overweight and Obesity in Adults
2016
“Reducing [sugar-sweetened beverages] should be helpful for weight management if compensation to the reduction in energy consumed from SSB does not occur and if energy-containing beverages are not consumed in place of SSB when SSB are reduced.” The document references two papers showing that replacement of SSBs with diet beverages resulted in weight loss of at least 2 percent and reduced subjective ratings of hunger, respectively.
Evaluation methodology: Narrative review
Rating: Not applicable
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2012
Position paper: Use of Nutritive and Nonnutritive Sweeteners
“It is the position of the Academy of Nutrition and Dietetics that consumers can safely enjoy a range of nutritive and nonnutritive sweeteners when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as individual health goals and personal preference.”
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Website statement: “Regulatory agencies set Acceptable Daily Intake (ADI) levels for each artificial sweetener. The ADI is the maximum amount of a food additive that can be safely consumed on a daily basis over a person's lifetime without any adverse effects. Although the number of diet soft drinks and other "sugar free" products we devour may seem high, the U.S. intake of sugar substitutes is actually well below the ADI even for the heaviest users, namely dieters, adults, children with diabetes and women of child-bearing age.”
Resources accessed March 2019.
2019
Healthy Beverage Consumption in Early Childood
Beverages with Low-Calorie Sweeteners, Ages 0 – 5: Not Recommended
“This recommendation is based on expert opinion given that early childhood is a critical developmental period, and there is a lack of evidence regarding the long-term health impact(s) of LCS consumption in young children.”
Evaluation methdology: Five-step methodology, including review of existing recommendations, literature review and expert panel discussion. See reference below for additional details.
Rating: Not applicable
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Resource accessed October 2019
2019
The Use of Nonnutritive Sweeteners in Children
“Guidance for Pediatricians:
Primary health care providers should discuss with parents and patients (as appropriate) the available evidence regarding the benefits and harms of NNS use in children and adolescents. The AAP recommends that pediatricians discuss the following points with families:
1. NNSs are FDA approved for use in humans or are GRAS and, thereby, approved for use under the GRAS designation.
2. The GRAS designation is based on consumption of NNSs within an ADI level; it is not possible to measure an individual’s daily intake of NNSs at this time.
3. Higher-quality data suggest that NNS use is associated with weight stabilization and/or weight loss in the short-term. Currently, there is a paucity of longterm data.
4. High-quality evidence, including meta-analysis and data from RCTs, suggests that there is no association between hyperactivity and NNS use in children.”
5. There are limited data regarding the effect of NNS use on appetite change and taste preference."
Evaluation methodology: Literature review & review of statements from authoritative organizations
Rating: Not applicable
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Resources accessed November 2019.
2015
Policy Statement from Council on School Health, Committee on Nutrition. Snacks, Sweetened Beverages, Added Sugars, and Schools.
“Additional improvements in nutrient density of sweet-tasting products could be obtained if nonnutritive sweeteners are used as a tool to replace added sugars and help lower caloric intake. Several nonnutritive sweeteners have been accepted by the US Food and Drug Administration as safe and have shown good safety over time. However, data are scarce on long-term benefits for weight management in children and adolescents or on the consequences of long-term consumption. Continued research is needed.”
Evaluation methodology: Narrative review
Rating: Not applicable
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Website statement: “Due to limited studies in children, the American Academy of Pediatrics (AAP) has no official recommendations regarding the use of noncaloric sweeteners.”
Resources accessed September 2018.
2013
Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults
“Patients with DM may safely consume artificial sweeteners within the guidelines of the U.S. Food and Drug Administration (FDA).”
Evaluation methodology: AACE Protocol for Standardized Production of Clinical Practice Guidelines – 2010
Rating: Grade D, Best Evidence Level 1
Rating interpretation: Expert opinion when there is lack of conclusive clinical evidence. Best evidence level (BEL) 1 = strong
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Website statement (2017 press release): “Low-calorie sweeteners promote fat accumulation in human fat.”
Resources accessed September 2018.
2016
Guidelines on Nutrition and Physical Activity for Cancer Prevention and Physical Activity for Cancer Prevention
“There is no proof that these sweeteners, at the levels consumed in human diets, cause cancer. Aspartame, saccharin, and sucralose are a few of the non-nutritive sweeteners approved for use by the FDA. Current evidence does not show a link between these compounds and increased cancer risk. Some animal studies have suggested that their use may be linked with an increased risk of cancers of the bladder and brain, or of leukemias and lymphomas, but studies in humans show no increased cancer risk. People with the genetic disorder phenylketonuria, however, should avoid aspartame in their diets.
Newer sugar substitutes include sweeteners such as sugar alcohols (sorbitol, xylitol, and mannitol) and naturally derived sweeteners (stevia and agave syrup). All of these sweeteners appear to be safe when used in moderation, although larger amounts of sugar alcohols may cause bloating and stomach discomfort in some people.”
Evaluation methodology: Literature and report review
Rating: Not applicable
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Website statement: “Expert agencies in the United States and elsewhere that have evaluated aspartame have found it safe for use.”
Resources accessed September 2018.
2023
Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes
"5.17 People with diabetes and those at risk are advised to replace sugar-sweetened beverages (including fruit juices) with water or low calorie, no calorie beverages as much as possible to manage glycemia and reduce risk for cardiometabolic disease. B and minimize consumption of foods with added sugar that have the capacity to displace healthier, more nutrient-dense food choices. A”
Evaluation methodology: ADA evidence-grading system
Rating: A
Rating interpretation: “Clear evidence from well-conducted, generalizable randomized controlled trials that are adequately powered, including: Evidence from a well-conducted multicenter trial, Evidence from a meta-analysis that incorporated quality ratings in the analysis;
Supportive evidence from well-conducted randomized controlled trials that are adequately powered, including: Evidence from a well-conducted trial at one or more institutions, Evidence from a meta-analysis that incorporated quality ratings in the analysis”
Rating: B
Rating interpretation: “Supportive evidence from well-conducted cohort studies: Evidence from a well-conducted prospective cohort study or registry, evidence from a well-conducted meta-analysis of cohort studies; supportive evidence from a well-conducted case-control study.”
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2020
Standards of Medical Care in Diabetes
“The use of nonnutritive sweeteners may have the potential to reduce overall calorie and carbohydrate intake if substituted for caloric (sugar) sweeteners and without compensation by intake of additional calories from other food sources. For those who consume sugar sweetened beverages regularly, a low-calorie or nonnutritive-sweetened beverage may serve as a short-term replacement strategy, but overall, people are encouraged to decrease both sweetened and nonnutritive-sweetened beverages and use other alternatives, with an emphasis on water intake.”
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Evaluation methodology: ADA evidence-grading system
Rating: B
Rating interpretation: “Supportive evidence from well-conducted cohort studies: Evidence from a well-conducted prospective cohort study or registry, evidence from a well-conducted meta-analysis of cohort studies; supportive evidence from a well-conducted case-control study.”
2019
Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report
“Replace sugar-sweetened beverages (SSBs) with water as often as possible. When sugar substitutes are used to reduce overall calorie and carbohydrate intake, people should be counseled to avoid compensating with intake of additional calories from other food sources."
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Evaluation methodology: “The 2014 position statement was used as a starting point, and a search was conducted on PubMed for studies published in English between 1 January 2014 and 28 February 2018 to provide the updated evidence of nutrition therapy interventions in nonhospitalized adults with prediabetes and type 1 and type 2 diabetes. Details on the keywords and the search strategy are reported in the Supplementary Data, emphasizing randomized controlled trials (RCTs), systematic reviews, and metaanalyses…. in select cases the authors identified relevant research to include in reaching consensus.”
Rating: Not applicable.
Rating interpretation: Not applicable.
2018
Standards of Medical Care in Diabetes
“The use of nonnutritive sweeteners may have the potential to reduce overall calorie and carbohydrate intake if substituted for caloric (sugar) sweeteners and without compensation by intake of additional calories from other food sources. Nonnutritive sweeteners are generally safe to use within the defined acceptable daily intake levels.”
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Evaluation methodology: ADA evidence-grading system
Rating: B
Rating interpretation: “Supportive evidence from well-conducted cohort studies: Evidence from a well-conducted prospective cohort study or registry, evidence from a well-conducted meta-analysis of cohort studies; supportive evidence from a well-conducted case-control study”
Position Statement: Nutrition Therapy Recommendations for the Management of Adults with Diabetes
2014
“Use of NNSs has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners without compensation by intake of additional calories from other food sources.”
Evaluation methodology: As above
Rating: B
Rating interpretation: As above
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Scientific Statement: Nonnutritive Sweeteners: Current Use and Health Perspectives
American Diabetes Association and the American Heart Association
2012
“The evidence reviewed suggests that when used judiciously, NNS could facilitate reductions in added sugars intake, thereby resulting in decreased total energy and weight loss/weight control, and promoting beneficial effects on related metabolic parameters.”
Evaluation methodology: Literature search
Rating: Not applicable
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Website statement: “Foods and drinks that use artificial sweeteners are another option that may help curb your cravings for something sweet.”
Resources accessed January 2020.
2018
Low-Calorie Sweetened Beverages and Cardiometabolic Health: A Science Advisory From the American Heart Association
“On the basis of the available evidence, the writing group concluded that, at this time, it is prudent to advise against prolonged consumption of LCS beverages by children. (Although water is the optimal beverage choice, children with diabetes mellitus who consume a balanced diet and closely monitor their blood glucose may be able to prevent excessive glucose excursions by substituting LCS beverages for sugar-sweetened beverages [SSBs] when needed.) For adults who are habitually high consumers of SSBs, the writing group concluded that LCS beverages may be a useful replacement strategy to reduce intake of SSBs. This approach may be particularly helpful for persons who are habituated to a sweet-tasting beverage and for whom water, at least initially, is an undesirable option.”
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2012
Scientific Statement: Nonnutritive Sweeteners: Current Use and Health Perspectives
American Diabetes Association and the American Heart Association
“The evidence reviewed suggests that when used judiciously, NNS could facilitate reductions in added sugars intake, thereby resulting in decreased total energy and weight loss/weight control, and promoting beneficial effects on related metabolic parameters.”
Evaluation methodology: Literature search
Rating: Not applicable
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Website statement: “Foods and beverages that contain NNSs can be included in a healthy diet, as long as the calories they save you are not added back by adding more foods as a reward later in the day, adding back calories that take you over your daily limit.”
Resources accessed September 2018.
2016
Policy Statement: The Use of Artificial Sweeteners
“The BDA believes that:
1. Artificial sweeteners available to purchase in the UK are considered safe to consume up to the ADI in the general population with the exception of foods for infants and young children, and are authorised and approved for use by EFSA.
2. Opting for an artificial sweeteners may assist in the management of weight and in the management of other health conditions such as diabetes mellitus in some individuals. A tailored individualised approach is required.
3. From a dietetic perspective, artificial sweeteners may be included as part of a dietetic intervention, though recommendation should be given on a case-by-case basis.”
Evaluation methodology: Not stated
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Resources accessed September 2018.
2018
Diabetes Canada 2018 Clinical Practice Guidelines: Nutrition Therapy
“Most [non-nutritive sweeteners] have been shown to be safe when used by people with diabetes, however, there are limited data on the newer sweeteners, such as neotame and thaumatin in people with diabetes. Although systematic reviews and meta-analyses of prospective cohort studies inclusive of people with diabetes have shown an adverse association of non-nutritive sweetened beverages with weight gain, CVD and stroke, it is well recognized that these data are at high risk of reverse causality. The evidence from systematic reviews and meta-analyses of randomized controlled trials, which give a better protection against bias, have shown a weight loss benefit when non-nutritive sweeteners are used to displace excess calories from added sugars (especially from SSBs) in overweight children and adults without diabetes…”
Evaluation methodology: Not stated
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Resources accessed September 2018.
2018
Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes
“Non-nutritive (artificial) sweeteners are safe and may be recommended.”
Evaluation methodology: GRADE
Rating: NR
Rating interpretation: NR (not rated). Rationale: “A key aspect of current approaches to supporting people with diabetes is to encourage practice that is individualized. It is challenging to rate such recommendations using the GRADE system, particularly in situations where multiple conditions influence health and dietary approaches. In response to this, a deliberate decision was made to report these recommendations as “Not Rated.”
Click here for additional detail.
Website statement: “All non-nutritive sweeteners used in foods in the EU have to undergo rigorous safety testing before being approved by the European Commission.”
Resources accessed September 2018.
2013
Sweet Advice on Sugar Substitutes
“Health Canada must approval all the artificial sweeteners that are sold in Canada. A sweetener has to undergo extensive research to show its safety and effectiveness before Health Canada will approve it for use. Once a sweetener is approved, Health Canada sets strict guidelines for how it can be used, as well as advice on Acceptable Daily Intake (ADI) levels.”
Evaluation methodology: Not stated
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Resources accessed September 2018.
2015
Use of sugars and sweeteners in children's diets.
- “Sweeteners, especially ‘‘non-caloric’’ sweeteners, can help to limit the intake of refined sugars in the diet and are useful for preventing diseases such as obesity and diabetes, in association with a moderate, balanced diet.
- In view of the recommendation not to add sweeteners to foods intended for infants and very young children, their use is not advisable in children between the ages of 1 and 3 years.
- It is recommended that health care professionals acquire the appropriate knowledge to advise on and/or choose a particular sweetener on the basis of its properties.
- There is a continuing need for specific research in order to make appropriate use of sweeteners in children.”
Evaluation methodology: Not stated
Click here for additional detail.
Resources accessed September 2018.
2013
Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults
American Association of Clinical Endocrinologists/The American College of Endocrinology and The Obesity Society
“Patients with DM may safely consume artificial sweeteners within the guidelines of the U.S. Food and Drug Administration (FDA).”
Evaluation methodology: AACE Protocol for Standardized Production of Clinical Practice Guidelines – 2010
Rating: Grade D, Best Evidence Level 1
Rating interpretation: Expert opinion when there is lack of conclusive clinical evidence. Best evidence level (BEL) 1 = strong
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Resources accessed September 2018.
Other Statements on the Use of Low-Calorie Sweeteners
2020
Dietary Guidelines Advisory Committee Report
“Taken together the current review is broadly consistent with findings from the 2015 Committee. However, recognizing that: a) mean responses may not reflect individual responses, b) robust, effective tools to manage body weight are lacking, c) individuals with overweight or obesity are at elevated risk of multiple health complications, and d) multiple national regulatory bodies agree that LNCS can be used safely, the Committee recommends these food ingredients be considered as an option for managing body weight."
Evaluation methodology: Systematic review
Insufficient evidence is available to determine the relationship between sugar-sweetened beverages compared with low- and no- calorie sweetened beverages on adiposity in children.
Rating: Grade Not Assignable
Limited evidence suggests no association between sugar-sweetened beverages compared with low- and no- calorie sweetened beverages on adiposity in adults.
Rating: Limited
Limited evidence suggests no association between low- and no-calorie sweetened beverage consumption and adiposity in children.
Rating: Limited
Limited evidence suggests that low- and no- calorie sweetened beverage consumption is associated with reduced adiposity in adults.
Rating: Limited
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2015
Dietary Guidelines Advisory Committee Report
“Moderate and generally consistent evidence from short term RCTs conducted in adults and children supports that replacing sugar-containing sweeteners with low-calorie sweeteners reduces calorie intake, body weight, and adiposity.”
Evaluation methodology: Systematic review
Rating: Moderate
“Long-term observational studies conducted in children and adults provide inconsistent evidence of an association between low-calorie sweeteners and body weight as compared to sugar-containing sweeteners.”
Evaluation methodology: Systematic review
Rating: Limited
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Resources accessed September 2018.
2018
Review of Scientific Evidence and Policies on Nutrition and Physical Activity-Objective B2: Consumption, Energy Intake and Impact of Fruit Juices and of Artificially and Sugar Sweetened Beverages, Summary Report
“There is no conclusive evidence that consumption of LCS beverages is associated with changes in body weight or body fat. However, there is some evidence that replacing SSBs with LCS beverages can reduce existing body fat. There is also evidence to suggest a link between consumption of LCS beverages and other behavioral and health impacts such as increased glucose intolerance: further research and assessment of the impact of LCS beverages on health is required.”
Evaluation methodology: Non-systematic literature review. Five steps: (1) refine research questions, (2) develop a search approach and databases, (3) conduct literature searches, (4) screen articles for inclusion, (5) abstract and synthesize relevant data.
Rating: Not applicable
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Resources accessed May 2019.
2019
Canada’s Dietary Guidelines
“Sugar substitutes do not need to be consumed to reduce the intake of free sugars.”
“…as there are no well-established health benefits associated with the intake of sweeteners, nutritious foods and beverages that are unsweetened should be promoted instead.”
Evaluation methodology: “Adapted from established methods for developing guidelines.”
Rating: Not applied
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Resources accessed April 2019.
View an overview of Regulatory Safety Assessments of the Use of Low-Calorie Sweeteners.
IAFNS intends to keep this resource up to date. If there is a document from a government agency, international health/science organization or professional society that you believe should be included, please submit the document to mlatulippe@iafns.org for consideration.