Date Published: January 3, 2017
Publisher: Public Library of Science
Author(s): Maria Carolina Borges, Maria Laura Louzada, Thiago Hérick de Sá, Anthony A. Laverty, Diana C. Parra, Josefa Maria Fellegger Garzillo, Carlos Augusto Monteiro, Christopher Millett
Abstract: Christopher Millett and colleagues argue that artificially sweetened beverages should not be promoted as part of a healthy diet.
Partial Text: Dietary intake of added sugars has increased dramatically worldwide during the past few decades, coinciding with increases in obesity and noncommunicable diseases. About 75% of all processed foods and beverages contain added sugar in the United States . Consumption of sugar-sweetened beverages (SSBs), including carbonated soft drinks, fruit-flavored drinks, sports/energy drinks, and ready-to-drink coffees and teas, contribute to over 46% of added sugar in the US diet , are the second largest source in Brazilians’ diet , and constitute nearly a third of sugar intake among British adolescents . Though SSBs are a major contributor to total calorie intake, they contain few, if any, essential nutrients. There is convincing epidemiological evidence linking SSB consumption to increased risk of overweight and obesity and type II diabetes [5–7].
Transnational beverage companies recognize that addressing growing health concerns about their products is needed to guarantee share of sales, volume growth, and overall financial results. As an example, in the 2014 official annual mandatory report for the US Securities and Exchange Commission, Coca-Cola declared that “some researchers, health advocates and dietary guidelines are suggesting that consumption of sugar-sweetened beverages…is a primary cause of increased obesity rates and are encouraging consumers to reduce or eliminate consumption of such products” . In the same report, it is stated that “possible new or increased taxes on sugar-sweetened beverages by government entities to reduce consumption or to raise revenue; additional governmental regulations concerning the marketing, labeling, packaging or sale of our sugar-sweetened beverages; and negative publicity resulting from actual or threatened legal actions against us or other companies in our industry relating to the marketing, labeling or sale of sugar-sweetened beverages may reduce demand for or increase the cost of our sugar-sweetened beverages, which could adversely affect our profitability” .
ASBs are marketed as healthy alternatives to SSBs based on their characteristic of mimicking the sensory properties of SSBs while providing null (or low) energy content. The potential benefits from ASBs rely on the assumption that they elicit no (or incomplete) energy compensation. However, there are long-standing concerns that ASBs may trigger compensatory mechanisms [32,33], which could offset a reduction in energy and sugar intake provided by their replacement of SSBs. The main proposed mechanisms are that ASBs stimulate sweet taste receptors—which could theoretically increase appetite, induce preference for sweet taste, and modulate gut hormone secretion—or result in overconsumption of solid foods due to awareness of the low calorie content of ASBs .
The environmental consequences of ASBs and SSBs should also be closely scrutinized given their negligible nutritional benefits and potential detrimental health impacts. High consumption of sweetened beverages leads to high generation of solid waste and cumulative chemical pollution, affecting marine life and contaminating the food chain, which raise concerns regarding food safety for human health [57–59]. The volume of water required to produce a 0.5 L plastic bottle of carbonated soft drink is estimated to range from 150 up to 300 L of water . In the UK, the consumption of soft drinks in 2011 (14.685 billion L) contributed about 4.5 million tonnes CO2e in the atmosphere , or approximately 300 g of CO2e per L. In addition, artificial sweeteners have been recently recognized as an emerging environmental contaminant of the aquatic environment. Households, small business enterprises, and industry contribute to releasing sweeteners into the aquatic environment, with scarce research on their ecotoxicological profile and consequences for planetary health [62,63].
Although current guidelines developed for public health authorities and consumers consistently recommend that SSB consumption should be discouraged [8,64–66], they provide contrasting recommendations regarding ASB intake. As an example, the American Heart Association (AHA) and the American Diabetes Association (ADA) guidance states that replacing sugar for artificial sweeteners in foods and drinks may result in modest weight loss, although it is acknowledged that supporting evidence may be insufficient , while the Pan-American Health Organization (PAHO) indicates that both beverages with excessive free sugar (≥10% of total energy) and beverages with any amount of other sweeteners (“food additives that impart a sweet taste to a food”) should be subjected to regulatory measures [64,67].
The absence of evidence to support the role of ASBs in preventing weight gain and the lack of studies on other long-term effects on health strengthen the position that ASBs should not be promoted as part of a healthy diet. The promotion of ASBs must be discussed in a broader context of the additional potential impacts on health and the environment. In addition, a more robust evidence base, free of conflicts of interest, is needed. Far from helping to solve the global obesity crisis, characteristics related to ASB composition (low nutrient density and food additives), consumption patterns (potential promotion of sweet taste preference), and environmental impact (misuse of natural resources, pollution, or ecotoxicity) make them a potential risk factor for highly prevalent chronic diseases.