Zero benefit for zero calorie sweeteners

By Dr. John Ditraglia

People who drink diet Pepsi often tell me they like the taste of it better than regular sugar sweetened Pepsi. I don’t know but I think it must be an acquired taste. De gustibus non disputandem est.

If you’re on the sugar-is-the-enemy bandwagon then maybe it’s good for you to drink this zero calorie stuff. People who prefer nonsugar sweetened pop probably didn’t start out that way. They must have started out as sugar calorie avoiders.

But what’s the evidence for that point of view? It turns out that the evidence of whether nonsugar sweeteners are good or bad for you is pretty much ziltch according to to a review of this question commissioned by the World Health Organization (WHO). (1) The WHO did this because they already feel the evidence is good enough to recommend that everybody reduce their sugar intake. Should they also be promoting nonsugar sweeteners (DSS) as an alternative as some already do?

The bottom line of this review of the best evidence (27 observational studies and 29 randomized or nonrandomized clinical trials) was thussly slim to zero:

-A few good, but small, studies suggest a minor reduction of body mass index and fasting glucose in average weight adults from NSS.

-In children, 2 randomized clinical trials involving 528 participants found a smaller increase in BMI among those who ate NSS than among those who consumed sugar, but there was no significant impact on body weight.

-There was no evidence that NSS helped overweight or obese adults and children lose weight.

-Although there was no evidence of harm, nobody could rule out the possibility of negative health effects. Big doses and long term effects of NSS have not been studied.

The biggest take away from this project was that more than a resolution of this question there was an important demonstration that there just isn’t any good evidence for either side of this debate. “For most outcomes, only 1 or a few studies were available, and when there was more than 1, the findings often conflicted.” (2)

So feel free to keep screaming whatever you already want to think about this. It’s certainly not going to make me stop saying that drinking diet Pepsi is stupid.

1. Meerpohl JJ. et al. Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies. BMJ 2019; 364 doi: (Published 02 January 2019) Cite this as: BMJ 2019;364:k4718

2. Abbasi J. No compelling evidence of health benefits from nonsugar sweeteners. JAMA March12, 2019;321(10):927-8.

By Dr. John Ditraglia