by Marion Nestle

Currently browsing posts about: Artificial-sweeteners

Apr 25 2022

Conflict-of-interest disclosure of the week

A reader, Effie Schultz, sent this one, with a comment that it comes with the longest conflict of interest statement she had ever seen (I’ve noted one that was two pages long in the first item in a post in 2015).

Association of Low- and No-Calorie Sweetened Beverages as a Replacement for Sugar-Sweetened Beverages With Body Weight and Cardiometabolic Risk: A Systematic Review and Meta-analysis.  McGlynn ND, and 20 other authors.  JAMA Network Open, March 14, 2022. 2022;5(3):e222092.  doi:10.1001/jamanetworkopen.2022.2092

The research question: Are low- and no-calorie sweetened beverages (LNCSBs) as the intended substitute for sugar-sweetened beverages (SSBs) associated with improved body weight and cardiometabolic risk factors similar to water replacement?

The conclusion: This systematic review and meta-analysis found that using LNCSBs as an intended substitute for SSBs was associated with small improvements in body weight and cardiometabolic risk factors without evidence of harm and had a similar direction of benefit as water substitution. The evidence supports the use of LNCSBs as an alternative replacement strategy for SSBs over the moderate term in adults with overweight or obesity who are at risk for or have diabetes.

Comment: Research on artificial sweeteners remains controversial.  I think we will be arguing forever about their safety and efficacy in helping people lose weight.  Studies with conflict of interest disclosures like the excessively extensive one here do not help resolve the research questions.

I strongly support revealing conflicted interests that might influence any aspect of research design, conduct, and interpretation.  For this study, I would be interested in financial ties or arrangements with companies that might either gain or lose sales or marketing advantages from results showing artificial sweeteners or diet drinks to be harmless or beneficial, as these do.  At issue here is whether financial ties to companies with corporate interests in the outcome of such research bias results or interpretation, consciously or unconsciously.

You have to search through this mess of unnecessary and distracting disclosures to find the ones that matter.  They are there.  You have to search for them.

Much of what is disclosed is irrelevant and, therefore, not helpful.

You may well disagree with that assessment.  Judge for yourself.

Conflict of Interest Disclosures: Ms McGlynn reported receiving a Canadian Institutes of Health Research (CIHR)-Masters Award during the conduct of the study and being a former employee of Loblaws Companies Limited outside the submitted work. Dr Khan reported receiving grants from CIHR, International Life Science Institute, and National Honey Board outside the submitted work. Dr Chiavaroli reported being a Mitacs Elevate postdoctoral fellow and receiving joint funding from the Government of Canada and the Canadian Sugar Institute. Mr Au-Yeung reported receiving personal fees from Inquis Clinical Research outside the submitted work. Ms Lee reported receiving graduate scholarship from CIHR and the Banting & Best Diabetes Centre at the University of Toronto outside the submitted work. Dr Comelli reported being the Lawson Family Chair in Microbiome Nutrition Research at the Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, during the conduct of the study and receiving nonfinancial support from Lallemand Health Solutions, donation to research program from Lallemand Health Solutions, personal fees from Danone, sponsored research and collaboration agreement from Ocean Spray, and nonfinancial support from Ocean Spray outside the submitted work. Ms Ahmed reported receiving scholarship from the Toronto Diet, Digestive tract, and Disease Centre (3D) outside the submitted work. Dr Malik reported receiving personal fees from the City and County of San Francisco, Kaplan Fox & Kilsheimer LLP, and World Health Organization outside the submitted work and support from the Canada Research Chairs Program. Dr Hill reported receiving personal fees from General Mills and McCormick Science Institute. Dr Rahelić reported receiving personal fees from the International Sweeteners Association, Abbott, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Merck, MSD, Salvus, and Sanofi outside the submitted work. Dr Salas-Salvadó reported receiving personal fees from Instituto Danone Spain, nonfinancial support from Danone Institute International, personal fees as director of the World Forum for Nutrition Research and Dissemination from the International Nut and Dried Fruit Council Foundation, financial support to the institution from Fundación Eroski, and financial support to the institution from Danone outside the submitted work. Dr Kendall reported receiving grants and/or in-kind support from Advanced Food Materials Network, Agriculture and Agri-Food Canada, CIHR, Almond Board of California, Barilla, Canola Council of Canada, International Nut and Dried Fruit Council, Peanut Institute, Pulse Canada, Tate and Lyle Nutritional Research Fund at the University of Toronto, and Unilever; receiving nonfinancial support from General Mills, Kellogg, Loblaw Brands Limited, Oldways Preservation Trust, Quaker Oats (Pepsi-Co), Sun-Maid, White Wave Foods/Danone, International Pasta Organization, California Walnut Commission, Primo, Unico, International Carbohydrate Quality Consortium (ICQC), and Toronto Diet, Digestive tract, and Disease Centre (3D) outside the submitted work; receiving personal fees from McCormick Science Institute and Lantmannen; and being a member of the Diabetes and Nutrition Study Group (DNSG) Executive Board and Dietary Guidelines, a member of the expert committee of the DNSG Clinical Practice Guidelines for Nutrition Therapy, a member of the scientific advisory board of the McCormick Science Institute, a scientific advisor for the International Pasta Organization and Oldways Preservation Trust, a member of the ICQC, an executive board member of the DNSG, and being the director of the Toronto Diet, Digestive tract, and Disease Centre (3D) Knowledge Synthesis and Clinical Trials Foundation. Dr Sievenpiper reported receiving nonfinancial support from DNSG of the European Association for the Study of Diabetes (EASD), grants from CIHR through the Canada-wide Human Nutrition Trialists’ Network (NTN), PSI Graham Farquharson Knowledge Translation Fellowship, Diabetes Canada Clinician Scientist Award, CIHR Institute of Nutrition, Metabolism and Diabetes and the Canadian Nutrition Society (INMD/CNS) New Investigator Partnership Prize, and Banting & Best Diabetes Centre Sun Life Financial New Investigator Award during the conduct of the study; receiving grants from American Society for Nutrition, International Nut and Dried Fruit Council Foundation, National Honey Board (the US Department of Agriculture [USDA] honey checkoff program), Institute for the Advancement of Food and Nutrition Sciences (IAFNS; formerly ILSI North America), Pulse Canada, Quaker Oats Center of Excellence, United Soybean Board (the USDA soy checkoff program), Tate and Lyle Nutritional Research Fund at the University of Toronto, Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto (a fund established by the Alberta Pulse Growers), and Nutrition Trialists Fund at the University of Toronto (a fund established by an inaugural donation from the Calorie Control Council); receiving personal fees from Dairy Farmers of Canada, FoodMinds LLC, International Sweeteners Association, Nestlé, Abbott, General Mills, American Society for Nutrition, INC Nutrition Research and Education Foundation, European Food Safety Authority, Nutrition Communications, International Food Information Council, Calorie Control Council, Comité Européen des Fabricants de Sucre, International Glutamate Technical Committee, Perkins Coie LLP, Tate and Lyle Nutritional Research Fund at the University of Toronto, Danone, Inquis Clinical Research, Soy Nutrition Institute, and European Fruit Juice Association outside the submitted work; serving on the clinical practice guidelines expert committees of Diabetes Canada, EASD, Canadian Cardiovascular Society, and Obesity Canada/Canadian Association of Bariatric Physicians and Surgeons; being an unpaid scientific advisor for the Food, Nutrition, and Safety Program and the Technical Committee on Carbohydrates of IAFNS; being a member of the ICQC, executive board member of the DNSG of the EASD, and director of the Toronto Diet, Digestive tract, and Disease Centre (3D) Knowledge Synthesis and Clinical Trials Foundation; his spouse is an employee of AB InBev. No other disclosures were reported.

Reference: For a summary of research on the “funding effect”—the observations that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests and that recipients of industry funding typically did not intend to be influenced and do not recognize the influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

Oct 12 2021

The Sugar Association vs. Artificial Sweeteners

As I mentioned yesterday, the American Beverage Association represents the interests of soft drink companies that use sugars and artificial sweeteners in their products.  Its goal: to make you think both are just fine for your health.

Today, let’s take a look at a related, but different trade association, this one The Sugar Association.  Its goal: to make you not worry about sugars and to think that they are better for you than artificial sweeteners.

Here, for example, is a press release from this Association from this past summer: New Research Shows Large Majority of Consumers Understand Real Sugar Comes from Plants & That it Can Be Part of a Healthy Diet; Data reveals significant shift in perceptions of sugar and artificial sweeteners.

And here is its infographic showing data on public suspicions of artificial sweeteners.

Now, we have a new campaign from The Sugar Association: The Campaign for Sweetener Transparency.

More than 10,000 consumers across the United States have joined the fight for sweeping reform of the government’s labeling regulations covering the use of alternative sweeteners in packaged food by signing an online petition urging the U.S. Food & Drug Administration (FDA) to require food companies to place clear, complete and accurate information on food labels…it’s virtually impossible for shoppers to know what alternative sweeteners are in which packaged foods because the FDA only requires food companies to list the chemical names of sugar substitutes on food ingredient labels. So, consumers only see names like Xylitol, Hydrogenated Starch Hydrolysates, Saccharin, Acesulfame Potassium, Neotame, Isomalt and Lactitol on ingredients lists without even knowing what they are and why they are used.

The Sugar Association wants artificial sweeteners clearly labeled so customers will switch to products that have sugars instead.

  • Products containing artificial sweeteners fall in the category of ultra-processed—foods that should be avoided or eaten in small amounts.
  • Products containing added sugars also should be avoided or eaten in small amounts.

That’s why this campaign is about market share, not health.

For a basic guide to what to do about sugars, see this resource guide from Hunter’s Food Policy Center.

Oct 11 2021

Industry-funded study of the week: artificially-sweetened sodas and calorie intake

The study: Effects of Unsweetened Preloads and Preloads Sweetened with Caloric or Low-/No-Calorie Sweeteners on Subsequent Energy Intakes: A Systematic Review and Meta-Analysis of Controlled Human Intervention Studies.  Han Youl Lee, Maia Jack, Theresa Poon, Daniel Noori, Carolina Venditti, Samer Hamamji, Kathy Musa-Veloso.  Advances in Nutrition, Volume 12, Issue 4, July 2021, Pages 1481–1499.

Methods: Review and meta-analysis of previously published studies.

Conclusions: Unsweetened or LNCS-sweetened preloads appear to have similar effects on intakes when compared with one another or with CS-sweetened preloads. These findings suggest that LNCS-sweetened foods and beverages are viable alternatives to CS-sweetened foods and beverages to manage short-term energy intake.

Funder: “The American Beverage Association provided funding for the work presented herein.”

Author disclosures: MJ is a paid employee of the American Beverage Association. Intertek Health Sciences, Inc.(HYL, TP, DN, CV, SH, KMV), works for the American Beverage Association as paid scientific and regulatory consultants.”

Comment: The great puzzle about artificial sweeteners is that they are not strongly associated with reduced calorie intake in most studies, perhaps because sweet tastes encourage people to eat more calories.  This industry-funded study is designed to counter that idea.  It concludes that low- or no-calorie sweeteners have no special effect on calorie intake.  The American Beverage Association represents soft drink companies, predominantly Coke and Pepsi, most of them manufacturing drinks sweetened with sugars or high-fructose corn syrup (with calories) or chemical sweeteners (no or low-calorie).  These companies are happy to have you buy either kind, and they don’t want you worrying about all the things you’ve heard about artificial sweeteners.

The Association’s rules for research are here.   But it is unlikely to fund proposals for research that might come up with inconvenient conclusions.

Reference: For a summary of research on the “funding effect”—the observations that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests and that recipients of industry funding typically did not intend to be influenced and do not recognize the influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

Oct 19 2020

Industry-funded study of the week: Stevia

Stevia Beverage Consumption prior to Lunch Reduces Appetite and Total Energy Intake without Affecting Glycemia or Attentional Bias to Food Cues: A Double-Blind Randomized Controlled Trial in Healthy Adults.  Nikoleta S Stamataki, Nikoleta S Stamataki, Corey Scott, Rebecca Elliott, Shane McKie, Douwina Bosscher, John T McLaughlin. The Journal of Nutrition, Volume 150, Issue 5, May 2020, Pages 1126–1134.

Method: This randomized, controlled, double-blind crossover study gave 20 healthy participants water or beverages with various sweeteners before lunch.  The investigators measured how much participants ate after consuming each drink.

Conclusion:  “This study found a beneficial and specific effect of a stevia beverage consumed prior to a meal on appetite and energy intake in healthy adults.”

Conflict of interest statement: “This study was supported by funding from the UK’s Biotechnology and Biological Sciences Research Council (BBSRC) through a BBSRC Case Studentship awarded to NSS. Cargill prepared and provided the test products free of charge.  Author disclosures: DB and CS were employed by Cargill during the preparation of this manuscript, and Cargill produces stevia. The other authors report no conflicts of interest.”

Comment:  The artificial sweetener Stevia is manufactured by Cargill.  Two of the authors work for Cargill.  Cargill has a vested interest in demonstrating that consumption of Stevia helps people lose weight.  Whether artificial sweeteners help with weight loss is a question much debated.  Industry-funded studies like his one tend to find benefits.  Some independently funded studies do too but others do not.

My guess: artificial sweeteners might help some people, but their overall benefits, if any, are small.

My take: one of my food rules is not to eat anything artificial, so Stevia is off my dietary radar from the get-go.

Mar 3 2020

The food politics of Coronavirus

Food politics connects to everything and Coronoavirus is no exception.  I’ve been collecting items.

For starters,  Coca-Cola gets its artificial sweeteners from China.  Oops.  Its supply chain is now disrupted.

Production and exports have been delayed for Coke’s suppliers of sugar alternatives used in the company’s diet and zero-sugar drinks, Coca-Cola disclosed Monday as part of its annual report.

“We have initiated contingency supply plans and do not foresee a short-term impact due to these delays…However, we may see tighter supplies of some of these ingredients in the longer term should production or export operations in China deteriorate.”

The primary artificial sweeteners Coca-Cola (KO) uses in its products include aspartame, acesulfame potassium, sucralose, saccharin, cyclamate and steviol gylcosides.

In its annual report, Coca-Cola indicated that it considered sucralose a “critical raw material” sourced from suppliers in the US and China. Splenda, a sucralose product used in Diet Coke with Splenda, is made in the US and not sourced from China.

This worries you?  Join the hoarders.  Some people are trying to make sure they have a 14-day supply of food in case they get quarantined.  This situation has gotten so out of hand that stores are running out of food.

The FDA wants everyone to calm down.  It has a web page on what’s happening with supply chains.  Most of this is about the supply of pharmaceuticals made in China, but here’s what it says about food:

We are not aware of any reports at this time of human illnesses that suggest COVID-19 can be transmitted by food or food packaging. However, it is always important to follow good hygiene practices (i.e., wash hands and surfaces often, separate raw meat from other foods, cook to the right temperature, and refrigerate foods promptly) when handling or preparing foods.

It’s hard to calm down if the situation affects you.  The organizers of Food Expo West, the natural products show scheduled for Anaheim, says COVID-19 fears could cut Expo West attendance by as much as 60% (the article links to official and unofficial lists of companies that have pulled out).

But every crisis has winners as well as losers.  The possible winners here?  Food delivery companies (as long as they can get supplies).

Stay tuned.

Update 3/3: Expo West has been postponed.

Jun 28 2019

Weekend reading: FoodNavigator’s special edition on sweeteners

The industry newsletter,, which I follow for its thorough coverage of this industry, has collected a set of its articles on sweeteners in a “special edition.”

Reminder: We love sweet foods.  Sugars have calories and encourage us to eat more of sweet foods.  Food companies wish they had a reasonable alternative to sugars that tasted as good and didn’t cause health problems.

Good luck with that!  In the meantime…

Special Edition: Sweeteners and sugar reduction

Food and beverage manufacturers have a far wider range of sweetening options than ever before, from coconut sugar and date syrup to allulose, monk fruit and new stevia blends. We explore the latest market developments, formulation challenges, and consumer research.

Apr 16 2019

Comment on a study correlating sugary beverages to mortality

I am occasionally asked to comment on new studies that appear.  Practice Update: Diabetes asked for a comment on this study:

VS Malik, et al.  Long-Term Consumption of Sugar Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation. 2019;139:00–00. DOI: 10.1161/CIRCULATIONAHA.118.037401

The study concluded: “Consumption of SSBs [sugar-sweetened beverages] was positively associated with mortality primarily through CVD [cardiovascular disease] mortality and showed a graded association with dose. The positive association between high intake levels of ASBs [artificially sweetened beverages] and total and CVD mortality observed among women requires further confirmation.”

Here’s what I said:

This study is based on analyses of data from two remarkably large and long-standing investigations of diet and disease risk. The investigators looked for correlations between mortality and consumption of sugar-sweetened beverages (SSB) and found them. More than two SSB servings a day was associated with higher mortality, particularly from cardiovascular disease, and, to a lesser extent, cancer.

Thus, this study adds to the increasing body of evidence associating SSBs with poor health. SSBs provide calories, but nothing of nutritional value. Other studies correlate SSBs with obesity, type 2 diabetes, and heart disease. A further correlation with increased mortality is not surprising, but it is good to have it confirmed.

These results associate high intake of SSBs with disease risk, but cannot prove that SSBs causedisease. Epidemiological studies like these, based on self-reported dietary data, require careful interpretation. In part, this is because intake of SSBs tracks closely with other lifestyle characteristics. Heavy SSB users tend to be more sedentary, more likely to smoke, to consume more meat and calories, but to eat fewer vegetables than light users—overall, to have less healthy dietary habits in general. Still, reducing or eliminating SSB intake is harmless and could well improve health.

Mar 14 2019

Do artificial sweeteners do any good?

A study by European investigators concluded that artificial (non-sugar) sweeteners [NSS] had no particular benefits for health.

Most health outcomes did not seem to have differences between the NSS exposed and unexposed groups. Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality was limited; therefore, confidence in the reported results is limited.

However, the accompanying editorial by Vasanti Malik concludes:

Based on existing evidence including long term cohort studies with repeated measurements and high quality trials with caloric comparators, use of NSS as a replacement for free sugars (particularly in sugar sweetened beverages) could be a helpful strategy to reduce cardiometabolic risk among heavy consumers, with the ultimate goal of switching to water or other healthy drinks.

On this basis, the Calorie Control Council, the trade group that represents the makers of artificial sweeteners issued a statement rebutting the study:

In alignment with the conclusions made by Dr. Malik, the Calorie Control Council agrees that the highest quality science supports that LNCS [low- and no-calorie sweeteners] can be consumed as part of a balanced diet and can assist with the reduction of cardiometabolic risk through the management of body weight and reduced caloric intake.

Given the proven safety and benefits of LNCS, consumers should continue to be confident in including these ingredients as part of a healthy diet.

Note the conditional “could” and “can.”  Artificial sweeteners might help, but you can’t count on them for miracles.