WHO guidelines on sugar substitute exaggerated: Docs

Chennai: The World Health Organisation's warning against the use of artificial sweeteners to control body weight or reduce the risk of non-communicable diseases has been dubbed "exaggerated" and "alarmist" by senior doctors and dieticians fron across the country. The guidelines are not supported by sufficient scientific data for a public health warning, they said.

The guidelines are based on systematic review and meta-analysis. "But we don't have large-scale studies to do this. Published research on the effect of these substitutes was done on small samples. Results from studies on rats or mice can't be immediate evidence for such health policies," said scientist B Sesikeran, former director of the ICMR-National Institute of Nutrition in Hyderabad.

Earlier this year researchers linked the popular zero-calorie sugar substitute erythritol to increased risk of cardiovascular events, including heart attack and stroke. But the scientists were not able to prove the compound led to heart attacks or strokes. They also admitted that data was skewed as participants in the study either had cardiovascular disease or had multiple risk factors.

"There are many studies that have associated such products with the risk of type 2 diabetes, hypertension and blood clots but they have not been proven in randomised studies," said New Delhi-based endocrinologist Dr Ambrish Mithal, chairman and head of endocrinology and diabetes at Max Healthcare. That's probably a reason why the guidelines have combined all substitutes such as acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives, he said.

While the guidelines do not make it obligatory for India or any other country to bring in policy decisions, they trigger needless panic, said Chennai-based diabetologist Dr V Mohan. Doctors or clinical dieticians do not recommend the use of sugar substitutes for weight loss.

"We recommend a reduction in intake of carbohydrates. One or two tablets or drops of these substitutes instead of sugar will not harm. What we tell people is not to drink ten cups of coffee or several cans of diet soda simply because it has no sugar. They add to calories. Even here the problem is not with the product, but with perception," he said.

Interim results of a study by his team on people with obesity and diabetes show that the use of these products may not be detrimental, Dr Mohan said. Details of the study will be revealed after it is presented at a conference organised by the American Diabetes Association in June, he said.