Ben Eastick Written by Ben Eastick

Will WHO’s new draft guidance impact product formulation?

The World Health Organization (WHO) has released updated guidelines on the use of non-sugar sweeteners (NSS) in foods and beverages and has called for commentary and input on the subject. Published on 15 July 2022, the draft guidelines are important to the food and beverage industry, as any final recommendations could impact on product formulation.

The WHO draft consultation: Its purpose and key guidelines

The guidelines are a result of the WHO’s continuing work to improve public health and diet by providing guidance and legislation on the appropriate consumption of sugars as part of healthy lifestyles worldwide.

The draft currently states in part that NSS should ‘not be used as a means of achieving weight control or reducing the risk of non-communicable diseases’. It goes on to question the efficacy and safety of non-nutritive sweeteners in aiding sugar and energy adjustment and weight management.

Sugar and sugar substitute sweetener displayed against blue background

The WHO is questioning the value of non-nutritive sweeteners used to aid sugar and energy adjustments.

Citing research, of varying quality, from 283 studies, the WHO claims there to be ‘no clear consensus on whether non-sugar sweeteners are effective for long-term weight loss or if they are linked to other long-term health effects’ and calls into question the marketing of NSS ingredients as an ‘aid to weight loss’ and as a ‘means of controlling blood glucose levels/blood sugar in individuals with diabetes’.

What is the evidence of negative health impacts?

The WHO guidelines look beyond the role of NSS in eliciting sweet taste through the activation of receptors in the oral cavity and investigate the interaction on receptors newly found in areas including the gastrointestinal tract, pancreas, brain, and adipose tissue. 

The guidelines’ systematic review and meta-analyses of cohort studies find that while those consuming NSS had lower body weight than those consuming less or no NSS, higher intakes of NSS are associated with a higher BMI and a 76% increase in the risk of incident obesity.

Higher intakes of NSS were also found to be associated with a 23% increase in the risk of type-2 diabetes when consumed in NSS-sweetened drinks, and a 34% increase when consumed as a tabletop item such as those added to foods and drinks by the consumer. Further associations with higher intake of NSS included increased risk of cardiovascular disease and hypertension.

The WHO guidelines do not include any form of a mandate at this stage on the commercial manufacture, supply, and use of non-sugar sweeteners. Meaning at draft stage, food and beverage manufacturers are not facing making changes to recipes.

Doctor with gloves piercing patients finger with lancet closeup.

Non-sugar sweeteners may have a role for managing some health conditions, such as diabetes.

What is the response from industry stakeholders?

However, a critical response from industry-related organisations shows concern over the WHO portraying NSS in an unfairly negative manner, potentially impacting the sale and perceived role of sweeteners in modern diets, weight loss, and health management.

Organisations including the International Sweeteners Association (ISA) question the findings, claiming that they fail to recognise the value and utility of artificial sweeteners in adjusting sugar and energy intake as part of wider weight management and health improvement strategies.

The Calorie Control Council, which includes major suppliers of common commercial sweeteners, has responded to the WHO guideline with ‘disappointment’. The CCC notes that there is evidence that artificial sweeteners are ‘proven to assist in body weight and blood glucose level management’, and that the WHO recommendations and conclusions have the potential to ‘negatively impact public health’.

Does this mean change for food & beverage formulations?

Dr Rachel Cheatham, founder of FoodScape Group, notes in response to the WHO guidelines that ‘even after a systematic review . . .  there is a lack of scientific consensus on the benefits of non-sugar sweeteners.’

The WHO guidelines do not directly claim that the use of artificial sweeteners in small amounts has the potential for illness or weight management complications. The executive summary does, however, note that the short-term association between reduced body mass index (BMI) and NSS intake does not represent a long-term health benefit due to the need for weight loss management over a longer period. 

The guideline also notes in its conclusions that replacing sugars with NSS may leave the often nutritionally undesirable profile of highly processed foods unchanged, resulting in little alteration to the overall quality of a person’s diet. Adjusting food intake to those with healthier, more natural ingredient profiles has value. The guideline further notes that sweeteners are not the only way in which to adjust sugar intake, citing other viable methods such as the consumption of foods with naturally occurring sugars such as fruit.

Structural chemical formula of fructose with fresh fruits including apples, pears, oranges, peaches displayed behind.

The WHO states a viable alternative to using non-sugar sweeteners is to consume more naturally occurring sugar such as fructose.

At this stage of proceedings, the impact of the WHO guideline on the food and beverage industry remains unclear. With comments still being open and criticisms levied against the conclusions and recommendations made in the guideline, the final verdict – and any legislation that may follow – remain subject to potential change.

Debate continues regarding evidence that non-nutritional sweeteners may have a place in commercial food & beverage applications. Comments on the WHO guideline may be filed until 14 August 2022, 23:59 CEST and may be done so using this link.

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