Do Not Replace Your Sugar, Simply Eat Less!
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Excessive consumption of simple carbohydrates, added sugars in particular, poses significant health risks and contributes to the development of metabolic diseases. A substantial body of evidence has demonstrated their harmful effects on various cardiometabolic outcomes [1]. Non-sugar sweeteners (NSS) are alternatives to added sugars, providing sweetness without the associated caloric burden [2]. The United States market for sugar substitutes is projected to reach 10 billion United States dollar (USD) by the end of this decade [3]. NSS have gained wide consumer acceptance, as beverages and snacks labeled ‘zero’ or ‘diet’ are often perceived as healthier alternatives to sugar-sweetened beverages (SSBs) [2]. Among products containing NSS, beverages account for the largest share of global consumption, and the use of artificially sweetened beverages (ASBs) has increased, particularly among adolescents [4]. Over the past 25 years, the understanding of the metabolic effects of NSS has evolved substantially. The World Health Organization (WHO) recently issued guidelines advising against the use of NSS as a strategy for weight management or chronic disease prevention in the general population [5]. This recommendation has fueled further debate regarding the role of NSS in reducing added sugar intake.
In this issue, the Korean Diabetes Association and the Korean Nutrition Society present a joint consensus statement on the health effects of SSBs and ASBs, based on a structured review of the evidence [6]. Based on this analysis, replacing SSBs with ASBs can lead to short-term improvements in body weight and fat mass. Dose-response analyses indicate that higher SSB intake is consistently associated with increased risks of mortality, type 2 diabetes mellitus, and adverse metabolic outcomes, while ASBs show similar associations in observational studies. Consequently, both societies recommend that ASBs be only used as a short-term substitution for SSBs, particularly in individuals at high cardiometabolic risk.
For adults accustomed to sweet tastes—particularly those with overweight or obesity—the use of ASBs can serve as a practical transitional strategy to reduce dependence on SSBs, functioning as a temporary bridge toward healthier beverage choices such as water or unsweetened tea. Importantly, such substitutions are beneficial only when performed within the framework of an overall balanced and healthy dietary pattern [7]. In addition, regular use of ASBs is not advised for long-term prevention and management of cardiometabolic diseases. While ASBs can assist some individuals in reducing caloric intake, the evidence regarding their long-term metabolic safety remains fragmentary and inconclusive due to distinctive physiological effects of various NSS with individual difference. Furthermore, the potential benefits of ASBs can be further offset if their use leads to compensatory increases in energy intake from other dietary sources. Thus, caution is warranted when using product labels intended to promote weight control or reduced energy intake, as terms such as ‘light,’ ‘zero,’ or ‘diet’ can unintentionally encourage overconsumption.
From a public health perspective, we agree with the authors that prioritizing water and unsweetened beverages is the most appropriate substitution strategy, particularly for individuals with diabetes or obesity [8]. Authors also stressed the importance of a supportive environment in reduction of SSBs, carrying clear policy implications. The present environment with a plethora of sweet options should be changed to decrease the consumption of added sugar and, ultimately, to lower the preferred sweetness intensity. Commercially, complete or partial replacement of sugar using NSS became popular in response to excessive added sugar consumption and its associated health risk. However, reduction of ‘sweetness’ was not considered. Thus, sweetness level of the current food market remained high even when NSS replaced sugar in some ASBs.
In addition, childhood overweight and obesity represent a significant global health challenge. Alongside the increasing prevalence of this issue is SSB consumption, a key contributor to excessive caloric intake and poor diet quality. Dietary preferences formed during childhood often persist into adulthood [9]. Thus, as recommended by WHO [5], government policies should consider children and adolescents as vulnerable groups with regard to food consumption and marketing. Immediate public health initiatives are imperative to reverse this trend of regular usage of ASBs. This review provides evidence-based recommendations that healthcare professionals can utilize regarding the role of ASBs in the general population in strategies to curb SSB consumption [6]. Nevertheless, many questions concerning the health effects of NSS remain unresolved. Further well-designed studies are needed to elucidate the long-term effects of NSS on weight regulation, appetite control, and sweetness perception.
Excess sugar can have negative health effects but is used often to increase the sweetness and enjoyment of beverages and food. The total amount of added sugar consumed is important to health and wellbeing. Therefore, public health messaging should focus on lowering total sugar intake by fostering environments that support healthier choices—initially through smaller SSB package sizes and, over time, through progressive reductions in sweetness—rather than relying on NSS that ultimately preserve a high preference for sweetness. Simply put, ‘Do not replace your sugar, just eat less!’
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CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.