Will using sugar replacement to control weight increase the risk of diabetes and cardiovascular disease? Professor said

World Health Organization (hereinafter referred to as WHO) released Use of non-sugar sweeteners: WHO guideline on 2023-5-15. It said: "WHO recommends not to use non-sugar sweeteners as a means to control weight or reduce the risk of non-infectious diseases (recommended if conditions permit)." (Note: To be simple, I will use "sugar replacement" to represent "non-sugar sweeteners" in my next article)

On that day and in the following days, several English media reported on this news, and a few Chinese media also reported on it. Because of this, I don't think I need to publish my own article. However, yesterday I copied the reports from these media and found that they did not mention the WHO's suggestion. In fact, it belongs to Conditional Recommendation, and some news topics may be suspected of misleading, such as the World News Network published on May 18, 2023 to change to slimming and eating sugar replacement? WHO warns: Increase the risk of diabetes and cardiovascular disease.

Before I explained "conditional suggestions" and "misleading suspicion", I hope that readers will know that I have published ten articles about sugar substitutions, and in three of them I have already made suggestions similar to WHO:

"sugar substitutions" are beneficial? harmful? : "In short, for friends who choose to replace sugar, I can only say sorry, the information you bring is so negative. However, I really hope that the negative information can be converted into positive understanding. That is, exercise and balanced diet are the ever-reliable and reliable health standards."

Sweet Leaf chrysanthemum's natural sugar substitution, a blessing for diabetes? : "For everyone to reduce the sugar intake, whether it is real sugar or sugar substitute, whether it is natural or synthetic." (When I say this, I will think of Taiwan's Light Boba Milk Tea)

Red Soybean: Is sugar substitute really equivalent to myocardial infarction and middle wind? "Change sweet-loving taste buds is the long ” (Note: This is the suggestion of reader Elliot)

WHO has further explained the feasibility of implementing the proposal: “No matter what kind of interfering measures and policy actions are used to implement the proposal, it may require a certain degree of behavioral change on the personal level; The degree of this goal will depend on whether individuals who have been keen to a certain level of sweetness in food and beverages are willing to reduce the overall sweetness in their diet. ”

Okay, I'm here to explain what "conditional suggestions" are now. See these sentences in Use of non-sugar sweeteners: WHO guideline: 'WHO advice can be strong or conditional, depending on many factors, including the overall determination of supportive scientific evidence, the balance of ideal and adverse consequences, and other factors described in the "Certification of Proposals" section of the Guidelines. Strong recommendations refer to those recommendations in which the WHO Guidelines develop sub-group confirm that the favorable consequences of implementing the proposal exceed the adverse consequences. In most cases, strong suggestions can be adopted as a policy. Conditional advice is that the WHO Guidelines Development Group does not quite determine the favorable consequences of implementing the proposal exceed the adverse consequences or very small expected net gains. Therefore, before conditional suggestions are adopted as policy, practical discussions may be required among the decision-makers. '

Then, why does the WHO guideline development group "does not quite sure the favorable consequences of implementing the proposal exceed the adverse consequences or the expected net gains are very small"?

WHO has made an explanation (please see below), but if you have limited time, I will tell you first: The WHO Guidelines Development Group believes that the current relevant scientific certificates are "low quality" or "extremely low quality", so it is "not sure".

Then, since it is "not sure", it is impossible for the WHO to issue a "warning". This is why I would say that the "WHO warning: Reverse increase in diabetes and cardiovascular disease risks" in the news title may be suspected of being misleading.

The following is translated from Use of non-sugar sweeteners: WHO guideline:

In short-term random control trials (both low-certification), using sugar substitutes in any way will reduce sugar and energy intake, reduce weight and BMI, most of which last 3 months or less. The use of sugar substitutes does not significantly affect other lipid indicators or cardiac signs that are healthy, including glucose, insulin, or blood lipids (extremely low to moderately confirmatory evidence). The evidence from a few long-term trials that lasted 6-18 months did not indicate a weight impact, but it was difficult to judge because of the many differences in how and how these trials were implemented and reported.

Intake of contemporary sugars is directly compared with that of lysed sugars (i.e. one group in the experiment receives sugar substitutes and the other group receives sugar substitutes), the weight and BMI of people receiving sugar substitutes are lower, similar to the results when sugar substitutes are used in any way. However, most of these trials have other diets in addition to providing foods and beverages containing sugar substitutes or evaporations, so there is no direct measure of the effect of replacing evaporations with sugar substitutes. When contemporary sugars were compared with no/suffering agent or water (i.e., one group in the experiment received sugar substitute and the other group did not receive/suffering agent or water), no effects on weight or BMI were observed.

When contemporary sugars are specifically evaluated as alternatives to vacancies in a small number of random control trials (i.e., consumers who require habitual consumption of foods or drinks containing vacancies to replace vacancies with sugar-containing versions) the impact on weight significantly weakens (as opposed to the results observed with the use of sugar-super-in-anything) and no longer observes the impact on BMI.

The evidence from a prospective observation study visited by Changda over 10 years is as follows.

Higher sugar replacement intake is associated with higher BMI and higher obesity risks, but is not related to other lipid indicators (highly low to low confirmation).

In a long-term prospective study with average access of 13 years, higher glucose intake was associated with increased risk of type 2 diabetes, cardiovascular and cardiovascular disease mortality and all-cause mortality (very low to low quality certificates), but was not related to the difference in overall cancer incidence or mortality (very low quality certificates).

The use of sugar substitutes (mainly saccharin) is associated with increased risk of bladder cancer according to case-control studies (very low-quality evidence).

Original text: Do not use sugar replacement to control weight. World War II's conditional suggestions

Responsible editor: Gu Zihuan