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Canadian Diabetes Association National Nutrition Committee Technical Review: Non-nutritive Intense Sweeteners in Diabetes Management (2004)

R. Gougeon, M. Spidel, K. Lee and C. Field: Canadian Journal Of Diabetes, 2004; 28(4): 385-399.

The current Canadian Diabetes Association Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada state that up to 10% of daily calories can be derived from sugars. However, individuals with diabetes may also be relying on alternative, low-calorie sweetening agents (providing little or no calories along with sweet taste) to control carbohydrate intake, blood glucose, weight and dental health. Most low-calorie sweeteners, sometimes called intense or artificial sweeteners, are classified and regulated as food additives with set acceptable daily intake (ADI) levels. The Health Canada Health Products and Food Branch approved intense sweeteners for table-top use and as additives in products such as soft drinks, chewing gum, fruit and fruit spreads, dairy products and desserts.

This technical review summarizes the literature on the potential health benefits and risk associated with the consumption of non-nutritive intense sweeteners (excluding polyols) and the evidence for the safety of intense sweetener use among individuals with diabetes and their effects on glycemia, appetite, weight, blood lipids, blood pressure and renal function. Research investigating the potential metabolic effects, benefits and risk of intense sweetener use among individuals with diabetes, children and adolescents, and pregnant and lactating women was reviewed to draft evidence-based recommendations for their use by people with diabetes.

Current evidence does not support an earlier belief, reported in the medical literature, that low-calorie sweeteners stimulate appetite or affect mechanisms that regulate hunger and satiety. Evidence indicates that daily consumption (up to ADI levels) of aspartame, sucralose, saccharin, cyclamate and D-tagatose has no significant effect on glycemic control or blood lipids in persons with diabetes. Current evidence indicates that intense sweeteners, used as an adjunct to multidisciplinary programs, may improve weight loss and weight control in obese persons. Consumption of intense sweeteners by older children and adolescents is unlikely to exceed ADI levels. Aspartame consumption below ADI levels has no effect on behaviour in children. In pregnancy, saccharin and cyclamate are not recommended, while other intense sweeteners have not been shown to be unsafe during this time. Intense sweeteners are most beneficial when they are used to replace energy-dense and nutrient-diluted foods including sucrose, and are least beneficial when used to displace nutrient-dense foods such as milk, fruits and fruit juices.