Sweeteners
management when they are used to replace sugar in products consumed in the diet.
The available evidence suggests no grounds for concerns about the adverse effects of LCS on sweet preference, appetite or glucose control. Indeed, LCS may improve diabetic control and dietary compliance. Regarding effects on the human gut microbiota, data is limited and does not provide adequate evidence that LCS affect gut health at doses relevant to human use. The panel identified research priorities, including collation of the totality of evidence on LCS and body weight control, monitoring and modelling of LCS intakes, impacts on sugar reduction and diet quality, and developing effective communication strategies to foster informed choices. There is also a need to reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede low-energy product development and reformulation.
The role of LCS
Members agreed that when substituted for sugars to reduce energy density of foods and drinks, LCS reduce net energy intake and assist weight management. Intervention studies have also shown that beverages containing LCS have at least a similar effect on appetite and energy intake to water. The collective evidence supports the conclusion that LCS have no adverse effect on blood glucose and insulin regulation in individuals with, and without, diabetes. In addition, the potential value of LCS in dietary management of diabetes derives from their role as substitutes for sugars, and hence carbohydrates. Regarding effects involving the human gut microbiota, data is limited. Lesser known are the long-term effects of LCS on glucose tolerance, gut function, cardiometabolic effects, gut microbiota and weight management. Alongside this, little is known about how and why these effects alter according to personal factors, such as age, sex, ethnicity, socio-economic status, health status, diet and lifestyle. An additional query is whether reducing exposure to sweetness has consequences for food choice and intake in the medium to long-term, and whether LCS can help improve long-term type two diabetes management.
In response to these findings, it was agreed that there is a need for a portfolio of well-designed, randomised, year-long controlled trials with different comparators and different carriers of LCS. The trials should be conducted by the level of ‘free sugar’ intake in different populations, and they should use multiple endpoints (diet quality, gut microbiota function and metabolomics, and wider health and quality of life measures). They should be done in the context of weight-control diets, including for type two diabetes and also in non-restrictive diets. There is also a need for population cohort studies to model changes in
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weight/cardiometabolic risk in the context of changes in LCS consumption, not baseline LCS values. Data should be made available for further analysis.
Consumption and consumer perception The consensus was that the safety of LCS is demonstrated by a substantial body of evidence, as well as the continued review by independent regulatory agencies and committees, including JECFA/Codex, FDA and EFSA. These organisations have taken into account decades of both positive and negative human and animal studies to draw their conclusions. Continual monitoring and modelling of LCS exposures is undertaken and this demonstrates that intakes of LCS, even among high consumers, are within ADI. It was also apparent that the major sources of LCS in the Western diet are beverages and table-top sweeteners, and that LCS can be used to reduce the sugar and energy content of beverages and some foods while maintaining a similar sensory profile. Moreover, consumer perceptions clearly vary with regard to LCS, with some individuals having concerns about their potential health effects.
“There is also a need to reconcile policy discrepancies between organisations and to reduce regulatory hurdles that impede low- energy product development and reformulation.”
What is still relatively unclear is which factors influence consumer perception of risks and benefits of LCS consumption. Are these the same for health professionals? To counter this, there is a need for in-depth data relating to current patterns of LCS consumption at multiple levels, and across countries and regions. There is also a need for more reliable measures of LCS exposure, such as biomarkers. Further development of these and better linkage of food composition and dietary databases are needed to help monitor changing use and consumption of LCS. There is a need to research and develop evidence- based strategies to communicate all of the above to consumers, health professionals and policy makers. The extensive body of scientific evidence that backs regulatory approval and the ongoing safety assessment of LCS can then encourage better-informed public health decisions. Invariably this requires better communications designed to foster more informed public attitudes towards LCS, for example, by emphasising the potential health gains associated with sugar (and energy) intake reduction and the role of LCS in achieving this. It is important to explain that the overall impact of LCS will depend on the amount of sugars replaced in the diet and the overall reduction
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