WHO warned against it but Indian study finds sucralose safe for diabetic people in small doses – Firstpost

A study by the Madras Diabetes Research Foundation (MDRF) has found that sucralose, a non-nutritive sweetener (NNS), is safe for use in small doses among adults with type 2 diabetes (T2D). The study, conducted over 12 weeks, observed no adverse impact on glycemic markers like glucose or HbA1c levels, while noting slight improvements in body weight, waist circumference, and body mass index (BMI).

The randomised controlled trial (RCT), the first of its kind in India, involved 179 adults with T2D and aimed to evaluate the effects of replacing table sugar with sucralose in daily beverages such as coffee and tea.

Participants were divided into two groups: the intervention group used a sucralose-based tabletop sweetener, while the control group continued using sucrose. Lifestyle patterns and medications remained unchanged throughout the study.

Senior diabetologist Dr V. Mohan, the chairman of the Madras Diabetes Research Foundation (MDRF), who led the study, emphasised the significance of the findings for the Indian context.

“This study is very relevant to India as the dietary habits of Indians vary significantly when compared to the rest of the world. Typically, in India, NNS is used to replace sugars in daily beverages like tea or coffee. This can help in cutting down calories, sugar intake, and increase dietary compliance. Judicious use of NNS like sucralose within the permissible ADI (Acceptable Daily Intake) in daily beverages like tea and coffee appears to be safe,” said Dr Mohan.

What were the results of the study?

The results showed no significant changes in HbA1c levels between the intervention and control groups. However, the intervention group experienced favourable changes in body mass index (BMI), waist circumference, and mean body weight. Specifically, the mean weight loss in the intervention group was 0.3 kg, BMI decreased by −0.1 kg/m², and waist circumference decreased by −0.9 cm.

This study is timely given recent World Health Organization (WHO) guidelines cautioning against the use of NNS for body weight control, which were primarily directed at individuals without diabetes. The WHO warning raised concerns among healthcare stakeholders and the public about the use of NNS, even among those with T2D. Dr Mohan highlighted that the findings of this study provide reassurance regarding the safe use of sucralose for people with diabetes.

Sucralose is a zero-calorie artificial sweetener commonly used as a sugar substitute. It is approximately 600 times sweeter than sucrose (table sugar) and is often used in a variety of food and beverage products. Sucralose is derived from sucrose through a chemical process that replaces three hydroxyl groups with chlorine atoms. This modification makes sucralose non-metabolisable by the human body, which means it passes through the digestive system without being broken down for energy, thus contributing no calories. It is widely found in products like diet sodas, sugar-free gum, baked goods, and other low-calorie or sugar-free items.

The study was funded by Zydus Wellness, which supplied the sucralose-based tabletop sweeteners in pellet, liquid, and powder forms.

But what had WHO warned about?

Even as the MDRF study reported that sucralose is okay in small doses, the World Health Organization (WHO) had warned against its usage.

The WHO has advised against using artificial sweeteners or non-nutritive sweeteners including sucralose.

In an advisory in May 2023, the WHO said that there may be potential undesirable effects from long-term use of non-nutritive sweeteners, such as an increased risk of type 2 diabetes, cardiovascular diseases, and mortality in adults. The WHO said the advice was based on a systematic review of the available evidence.

The WHO further said that the review did not suggest that the usage of non-nutritive sweeteners had any long-term benefit in reducing body fat.

“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. 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,” said Francesco Branca, WHO Director for Nutrition and Food Safety.