In 2023, the ostensibly authoritative World Health Organization (WHO) recommended that non-sugar sweeteners “shall not be used as a means to achieve weight management or reduce the risk of non-communicable diseases.” Non-sugar sweeteners are found in diet sodas, yogurt, snack bars, and many other foods.
This guideline was amazing. After all, the very purpose of non-sugar sweeteners, which contain little or no calories, is to help consumers replace sugar to manage weight and reduce the risk of disease. Too much sugar is a major contributor to diabetes, obesity, heart disease, certain cancers, and a variety of other health problems.
In its report, WHO cited evidence that long-term use of non-sugar sweeteners is harmful. related Increased risk of type 2 diabetes, cardiovascular disease, and death. How are sweeteners like aspartame, advantame, cyclamate, neotame, saccharin, sucralose, and stevia associated with negative health effects that should be avoided?
not convincing causal But there is clearly a human explanation. That’s lazy nutrition.
Limitations of observational studies
WHO made its recommendations after reviewing hundreds of published studies. The problem is that the overwhelming majority of these studies are observational studies, where researchers track the behavior and health effects of large populations. In such studies, subjects tend to self-report their food intake, a process fraught with inaccuracies. More importantly, observational studies cannot determine cause and effect. Do non-sugar sweeteners cause diabetes, or are people at risk for diabetes simply more likely to consume sugar because they try to avoid it?Finally, these studies include There are many variables that are beyond one’s control and can skew the results.
Randomized controlled trials (RCTs) tell a different story for non-sugar sweeteners. These rigorous studies control for confounding variables and can determine cause and effect by randomly assigning people to treatment or control groups. They show that sweeteners have a modest effect on weight loss and help control blood sugar levels, without the negative effects seen in observational studies. The disadvantage of RCTs is that they are short-lived, often lasting only a few months.very negative effect did it It may occur with long-term use, but this cannot be determined from these RCTs.
But you can’t tell that from observational studies, which only measure correlation and not causation. Observational studies like this are why the public is often bombarded with hype linking almost all foods to negative health outcomes. Associations are easy to spot and can be the fodder for viral news.
Steven Novella, a Yale University neurologist and popular science communicator, is angry about this situation.
“Making large-scale dietary recommendations based on observational or preliminary data creates ‘alarm fatigue’ in the public,” he wrote. “When you’re told every week about something different to avoid, it becomes impossible to manage everything.”
encourage better research
The solution is for scientists to stop muddying the waters of knowledge with shoddy observational studies. In the case of sugar-free sweeteners, people may be being encouraged to consume more sugar, which definitely has negative health effects.
“Filling research gaps with studies that do little to understand the causal effects of actual dietary decisions does little to advance understanding; in fact, it creates confusion,” they say. Anupam B. Jena and Christopher Worsham last year. new york times. (Jenna and Worsham are both professors of health policy at Harvard Medical School.)
However, it may be difficult to break out of the current situation. RCTs are expensive and time-consuming, whereas observational trials are cheap and relatively easy to conduct. RCTs require recruiting participants, developing and managing their diet plans, and measuring their health status regularly. In observational trials, researchers can download data from existing databases such as her NHANES or UK Biobank and search for correlations. Academia typically rewards quantity rather than quality of publications, so incentives favor observational trials.
For change to happen, it may need to start at the top, where science is funded. Government agencies like the National Institutes of Health, which provides billions of dollars in research grants, should start prioritizing RCTs.
“We’ve wasted enough resources and caused enough disruption, and now we need to refocus,” John Ioannidis, a professor of epidemiology and population health at Stanford University, said in an interview. “Money, resources, and effort should be spent on fewer, better-designed randomized trials.”
