The Atlanta Journal-Constitution
How sugar substitutes affect kids’ diets
There’s not clear data on whether they help with weight control.
Even the name, “nonnutritive sweeteners,” sounds as if it were invented to avoid, well, sugarcoating the issue. We used to call them artificial sweeteners; this new term is intended to emphasize that they have no nutritional content — no vitamins, no minerals and no calories, or at least very few (that’s the whole point).
We evolved to like sugar and sweet tastes precisely because they signal the presence of calories — that is to say, food that our bodies can burn for energy.
Now, we are more likely to be worried about consuming too many calories — and whether our children are overdosing on sugar.
The American Academy of Pediatrics put out a policy statement in November on the place of these nonnutritive sweeteners in children’s diets, noting that there are now more of them in foods and other products on the market, and that therefore children and adolescents are consuming more of them — and this is happening in the absence of clear data about whether they help with weight control, or how they affect children’s tastes as they grow.
“First and foremost, the information we have regarding nonnutritive sweeteners and long-term safety is limited,” said Dr. Carissa Baker-Smith, the lead author of the statement, who is an associate professor of pediatric cardiology at the University of Maryland School of Medicine.
There have been scares in the past about whether certain nonnutritive sweeteners can be carcinogenic, especially in large doses, but in the literature that was reviewed for the policy statement, no such association has been demonstrated.
Allison Sylvetsky, an assistant professor in the department of exercise and nutrition science at George Washington University, said that “while we know that these nonnutritive sweeteners are safe from a toxicological viewpoint, we don’t know if they’re effective for lowering calories and helping kids reduce sugar intake.”
Parents are concerned about the right nutritional balance for their children, Baker-Smith said, but also often worry more specifically about making sure that their children don’t get too much sugar, and about obesity, diabetes and high cholesterol. But consuming nonnutritive sweeteners has not been shown to lead to healthier weight in children, though they may have a place in a larger weight control plan.
On the other hand, other research suggests that many people use the nonnutritive sweeteners and continue to consume sugar as well. In a study by Sylvetsky and her colleagues, using survey data, “kids that consumed low-calorie sweetened beverages actually had considerably higher total energy intake and added sugar intake compared to kids drinking unsweetened beverages,” she said. Their reported total calorie intakes were simi
lar to those of the children who reported drinking sugarsweetened drinks.
This kind of study shows an association but cannot explain cause and effect. Maybe the kids who drink the diet beverages are also eating snack foods and fast foods — that is to say, maybe drinking a lot of diet drinks is a marker for a less healthy lifestyle overall. But there have also been concerns, some connected to animal studies, that incorporating the nonnutritive sweeteners may have some biological effects on the child’s appetite or metabolism.
We also don’t know, Sylvetsky said, how different amounts of these sweeteners may affect the young, perhaps influencing their taste preferences, or the bacterial flora in their guts. Taste preferences begin to develop in utero, reflecting substances present in the amniotic fluid, and continue to develop in infancy and after.
In a 2017 article on how the perception of sweet taste develops in children, Sylvetsky and her colleagues reviewed possible mechanisms by which exposure to the nonnutritive sweeteners early in life may affect children later on, including the question of whether too much sweetness early on tends to lead children to develop unhealthy diets — and ended by concluding that much more research is needed.
Infants born to mothers who consumed diet beverages were heavier at 1 year old than those whose mothers avoided the sweeteners in a 2016 study, Sylvetsky said.
If a parent is concerned about a child’s weight, Sylvetsky said in an email: “I would encourage replacement of sugar-sweetened beverages with unsweetened alternatives such as plain water, rather than simply switching from sugar-sweetened beverages to diet beverages containing nonnutritive sweeteners. An occasional sweet beverage, whether sugar-sweetened or diet, is fine, but the focus should really be on improving the overall diet.”
Baker-Smith said: “What we want to instill is not, replace sugary food with nonnutritive sweeteners, but teach healthier behaviors. Exercise 150 minutes out of the week, choose vegetables at meals, and fruit, appropriate portion size, not an adultsize plate.” She doesn’t see the nonnutritive sweeteners as necessarily beneficial over the long term.
“We should go back to the way we thought about sweets a long time ago — as a treat,” Baker-Smith said. “One sweet, once a week, not every meal.” And in that context, stick to real sugar for the treats, and avoid all sweetened beverages. That’s what she tries to do for herself and her own kids, she said: “I have gone to avoiding nonnutritive sweeteners for my own family, and I want parents to make the choice for themselves.”