A bittersweet dilemma

Table sugar or sucrose has many functionalities beyond sweetness. It acts as a bulking agent in beverages, helps breads rise and brown, depresses the freezing point in ice cream, and assists with water activity stability in foods.

While table sugar has remained one of the key ingredients in food product development, non-nutritive sweeteners are widely used to meet consumer demands, especially from those who have diabetes or are looking for low-sugar or low-calorie alternatives to the conventional tabletop sweetener, soft drinks, breakfast cereals, chewing gum, desserts, etc.

In May 2023, the World Health Organization (WHO) published new guidelines on non-sugar sweeteners (NSS), such as acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia, and stevia derivatives.

WHO has recommended against the use of NSS to control body weight or reduce the risk of noncommunicable diseases (NCDs), as they do not help reduce body fat in the longer term in adults and children. WHO also noted that these sweeteners increase the risk of high blood pressure, stroke, and heart disease.

“Replacing free sugars with NSS does not help with weight control in the long term. People need to consider other ways to reduce free sugars intake, such as consuming food with naturally occurring sugars, like fruit, or unsweetened food and beverages,” said Francesco Branca, WHO director for nutrition and food safety. “NSS are not essential dietary factors and have no nutritional value. People should reduce the sweetness of the diet altogether, starting early in life, to improve their health.”

The recommendation applies to all people except individuals with pre-existing diabetes and includes all synthetic and naturally occurring or modified non-nutritive sweeteners that are not classified as sugars found in manufactured foods and beverages or sold on their own to be added to foods and beverages by consumers.

The WHO guideline on NSS is part of a suite of existing and forthcoming guidelines on healthy diets that aim to establish lifelong healthy eating habits, improve dietary quality, and decrease the risk of NCDs worldwide.

We spoke with a food scientist and a medical doctor about what these guidelines mean and how adopting them could impact food production, consumers, and beyond.

Impacts on food production

According to Lara Tiro, food scientist and owner of Rebel Botanica, a food product development consulting agency, abolishing non-nutritive sweeteners in foods would be detrimental to manufacturers and brand owners whose value proposition is eliminating sugar and zero or low calories.

“Many brands have been paving the way with better-for-you versions of our favourite sweet indulgences using non-nutritive sweeteners such as stevia, monk fruit, and erythritol, over the last 10 years,” says Tiro.

In the first half of 2018 alone, the use of stevia in food and beverages grew 23 per cent and 33 per cent, respectively, according to a study by Mintel.

Removing non-nutritive tabletop sweeteners and products from grocery store shelves would require formulation changes, which would potentially drive-up production costs. 

Impacts on consumer

Reformulating existing product lines without using non-nutritive sweeteners could also pose challenges to consumer behaviour, as some have developed strong expectations of ingredients and food products with zero calories.

Some consumers may also find trading off calories and sweetness an obstacle, especially when there are people who prefer not to reduce sugary flavours in their diet, notes Dr. Julie Wilson, M.D CCFP, a Richmond, B.C.-based family physician and owner of Terra Nova Medical Clinics.

Wilson adds that these low-sugar and sugar-free desserts, drinks and foods are essential and accessible options for people with diabetes, as well as for others who may want to use sugar replacements in their foods and drinks.

Alternate sources to consider

Health Canada has not indicated if it will adopt WHO’s guidelines, so aspartame, saccharin, sugar alcohols, and stevia remain as approved non-nutritive sweeteners in the country.

Tiro suggests food manufacturers could return to the lab bench, experiment, and embrace cane sugar, agave, date sugar, coconut sugar, and/or honey to find possible solutions while looking into other ingredient alternatives to maintain a similar flavour profile to the existing products with non-nutritive sweeteners.

D-Tagatose is a low-calorie sucrose alternative that was approved by Health Canada as a novel ingredient in May 2022. It is a carbohydrate with a chemical structure related to fructose and is about 90 per cent sweeter than fructose. It has a low glycemic load and could be used in partial replacement or in conjunction with other non-nutritive sweeteners in foods, such as soft drinks.

Everything in moderation

While Canada’s Food Guide clearly states that sugar substitutes are not a necessary part of healthy eating for the general population, Diabetes Canada says patients with diabetes could safely consume small amount of sugar substitutes.

Wilson indicates that it is too early to make sweeping changes in food production and consumer behaviours.

Since sugar substitutes could be used as an ingredient to control blood sugar levels without affecting taste preferences, removing them from foods and beverages without conducting thorough and specific research into the relationship of each type of non-nutritive sweeteners on health could prevent consumers’ access to those ingredients and may complicate one’s health management.

Often, food brands develop specific lines of products with a particular population subset in mind, such as gluten-free products for people with Celiac disease and sugar-free candies and chocolates and candies for people with diabetes.

While WHO’s recommendations do not apply to people with pre-existing diabetes, educating consumers with or without diabetes on the differences between the types and sources of naturally occurring sugars and sweeteners may change consumers’ consumption behaviour, thereby creating a shift in developing, manufacturing, and marketing products with sugar sweeteners.

Focusing our efforts on educating consumers on developing healthy relationships with whole foods and their awareness of balanced and nutritious meal patterns and food choices could also be more impactful.

Tiro advises that creating a “less sweetness” food system by following transparent harvest practices, using ingredients from sustainable sources, and being responsibly mindful of the amount of non-nutritive sweeteners used in our food products without sacrificing taste are essential.

It is valuable to consider reducing the overall sweetness in our diet by focusing on natural alternatives. The key is to keep everything in moderation.