Shopping for sweetness: Addressing questions about low calorie sweeteners. Berna Magnuson, PhD, Fellow ATS

Transcription

1 Shopping for sweetness: Addressing questions about low calorie sweeteners Berna Magnuson, PhD, Fellow ATS

2 New food ingredients Extensive testing required takes many years Must show that there is no effect at levels much higher than expected consumption by humans. All ingredients will cause adverse effects if the dose is high enough, Multiple doses must be used, Want to identify dose that causes no effect, Also use extremely high doses, to increase sensitivity of testing.

3 No Observed Adverse Effect Level (NOAEL) Based on results of many studies. Is amount when consumed daily for lifetime has no effect on: Growth, development or maturation, Blood chemistry, Any organs, Any chronic disease endpoints, Cancer development, Reproduction, pregnancy or offspring. The NOAEL divided by safety factors = human ADI (Acceptable Daily Intake) or amount considered safe for the entire population to consume every day.

4 Example: Toxicity studies to assess safety during pregnancy and development Exposure before mating, throughout mating, pregnancy, lactation & lifetime Parent Generation Exposure in utero, via breast milk, and in diet for lifetime First Generation Exposure in utero, via breast milk, and diet during growth Second Generation

5 Low and No Calorie Sweeteners (LNCS) Different LNCSs are different compounds, Cannot assume to be handled the same in the body.

6 Example: Differences in LNCS chemistry Aspartame: Sucralose: Disaccharide backbone with chlorine substitutions OH Amino Acid Amino Acid Methyl Cl OH OH O O Cl OH O OH Cl Stevia extracts (steviol glycosides): Diterpene with varying # glucose additions Glucose linkages Steviol Bottom line: Handled differently in the body.

7 Example: Differences in LNCS metabolism Aspartame: Completely digested in the GIT; amino acids and methanol fully absorbed and used in the body. Sucralose: No digestion in the GIT; little absorbed most to feces; small amount absorbed not broken down for energy; quickly eliminated in urine. Stevia extracts (steviol glycosides): Glucose units on steviol backbone all clipped off in GIT; Steviol fully absorbed; no breakdown of steviol for energy; quickly eliminated in urine. Bottom line: No calories or carbohydrate to affect body weight or glucose levels. (Magnuson et al., Nutr Rev 2016)

8 So if these sweeteners are safe, why is there so much controversy?

9 In many cases, controversy because: Inaccurate information. Over-reaching and/or inappropriate conclusions. Problems with study designs, Conclusions drawn from limited information (not the collective evidence) Bad news makes the news.

10 Example: Inaccurate Information Consumption of Low-Calorie Sweeteners among Children and Adults in the United States. Sylvetsky et al., JAND False statement: Limitations of the study include the inability to calculate the absolute quantities (milligrams) of LCSs consumed. TRUE: Many publications - calculate and report LNCS intakes based on maximum permitted levels and reported concentrations in foods and beverages. Moreover: intakes of LNCS in all members of the population, remain well below the ADI. (Magnuson et al., 2007; Martyn et al., 2016; O Sullivan et al., 2016; Dewinter et al., 2016) BUT - What is the media story? The misinformation

11 Actual Regulatory Safety Assessment: NOEL, ADI and Estimated Daily Intake 4000 mg/kg/d No observed effect level in lifetime studies Magnuson et al., 2007 Sweetener: Aspartame US ADI 50 mg/kg/d High users ~15 mg/kg/d Average users 2-5 mg/kg/d NOEL ADI Highest intake Average Intake

12 Example: Over-reaching and/or inappropriate conclusions Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Suez et al., Nature 2014 Data do NOT warrant reported headline (study title): Effect of individual LNCS on glucose not assessed. Microbiota studies on saccharin only NOT relevant to ALL LNCS! Ignored huge differences in food intake and nutrients known to cause changes in microbiota types and levels. In a nutshell: Problems with study design and interpretation Moreover: Generally ignores collective evidence. Numerous human clinical studies show LNCS do not impact glycemia or have effect on gut incretins or function. (See reviews: Russell et al., 2016, Bryant and Mclaughlin, 2016). BUT - What is the media story? The negative spin

13 Finally: LNCS and Body Weight Cause of controversy: Primarily observational studies: } Positive correlations between LNCS consumption and increased body weight and/or BMI. Cause or result? (See review: Pereira, Nutr Rev 2013)

14 Systematic review and meta-analysis Rogers et al., Int. J. Obesity 40, Animal studies: 90 studies most report either no effect or decreased body weight. Prospective human cohort (observational): 12 studies inconsistent results. Short-term Randomized Clinical Trials: 129 comparisons reduced total energy intake with LNSC versus sugar sweetened food or beverage consumption before an ad libitum meal Long-term (1-40 months) RCTs: 9 studies: LNSC versus sugar - led to relatively reduced Body Wt 3 studies: LNCS versus water - similar Body Wt reduction.

15 LNCS use in successful weight loss maintainers Catenacci et al., 2014, Obesity. Surveyed 434 National Weight Control Registry members: (lost >13.6 kg and maintained weight loss for >1 yr). 53% regularly consume LNCS beverages, 78% say diet beverages help them control total calories, Changing beverage consumption very important for many for: weight loss (42%) maintenance (40%). Conclusion: Collective evidence supports utility of LNSC in management of calories from sugar in body weight control.

16 Summary on LNCS Extensive safety studies prior to approval. Useful to reduce added sugars. In combination with healthy lifestyle, beneficial for management of body weight and diabetes.

17 Thank you! Questions? If any of your questions are not addressed during Q&A, you can See me during the break! me at