Effects of intense sweeteners on hunger, food intake ...

Effects of intense sweeteners and body weight: a review13 Barbara

food intake,

J Rolls

ABSTRACT

The

acesulfame-K has and, after saccharin ever,

on hunger,

most

investigators

have

that

aspartame

or unchanged increases has

little

weight.

Aspartame

intake;

indeed,

both

shown

foods or drinks in food intake.

that

with

Preliminary

clinical

ratings of hunger. ratings of hunger in on the

has

not

short-term

consumption

is associated

either

and

consumption

impact

and body

food

saccharin,

ratings of hunger food intake. How-

and

on various

in a group

found

for body

weight

reported

to decrease

self-rated increase

stomach self-rated

long-term

adox”

in their

suggest

that aspartame

ratings ratings

with consumption of the pleasantness

trials

program

in

sweeteners

have

never

been

compared

Am

J Clin

Nutr

portant

maintenance.

found to cause 199 1;53:872-8.

Intense

weight

in humans.

gain

or

not

offered

WORDS

food

intake,

Appetite, hunger,

aspartame,

intense

body

sweeteners,

weight,

dieting,

Although

be dissociated,

be ignored.

presumably

intense

sweeteners

such as aspartame

charm,

and saccharin

and

pared

intake,

and body much

weight. This uncertainty play in the popular press

only of no benefit in calorie control, but appetite. There have been several recent of intense

propriate,

sweeteners

in view

and

Effects

food

on eating

ofboth

of this issue, to review knowledge concerning petite

is fueled by suggestions that intense sweeteners

the popular

that they may studies on the

behavior. and

Thus,

scientific

it is

ap-

state of on ap-

sweeteners

on

hunger,

appetite,

subjects

Reports The

controversy

ofaspartame

compared sumed.

increase

began

in

in a preliminary in water

with Specifically,

Id, or 188 kcal),

872

ratings

intake

were

not

is extremely

im-

is an unintended

side

group has provided sweeteners aspartame,

further sac-

consumption.

can

all increase in food

intake

ofsolutions ofsweeteners is not only unfamiliar but the

personal unflavored

but

increased

consumption

was not associated

compared

with

aspartame

in solution

do diet

water.

drinks,

1 h later

could

He found appetite

drinks

There

are have

including

possible robust

differences

a key

compared

effect

sowith

with

increase

several a more

been

unflavored

sweetened

with a significant

may

has data of having

have

that

ratings

of soft

(3).

1990) condition

aspartame

ratings.

com-

of these

in water with no other also may be unpleasant.

experimental

appetite

ratings

communication,

unnatural

of aspartame water,

hunger

that solutions

as-

in appetite reasons

why

on appetite

in perceived

sweetness

intake that sweeteners

suggested

hunger

were decreases in The subjects were

so these

be unpleasant)

to an increase

consume

lutions

than

and food

aspartame The “par-

the increased

but they have not found

(M Tordoff,

partame

consumption.

of intense

lead

suggest

plain

to in both

that

ratings ofhunger are not always (2). Although hunger and food this does not mean that reported hunAt issue is whether increased hunger

acesulfame-K

to the increased

importance

this literature and to clarify the the effects of intense sweeteners

Tordoff that

were

to increase

referred

there taste.

Measuring

sweetener

with water,

Consumption added flavor

effects

despite

Since their initial report, Blundell’s results suggesting that the intense

sweeteners

are not increase

effect

preloads,

would

of intense

are widely used, some consumers may feel bewildered about the effects that these sweeteners will have on their appetite, food receiving

the intake.

can

effect

Introduction

to eat and

ofaspartame, of the sweet

after

screened

of glucose

has come to mean food consumption.

was that

actual

ger should (which

saccharin

preloads

in such studies, because index of energy intake

a valid intake

KEY

food

not

The

paradoxical

findings

with

consumption

were

motivation

popular press and, therefore,

or a reduction

after

who

whereas aspartame was reported to to eat and to decrease such ratings

so-called

of aspartame-sweetened

the hour

students

status.

fullness, motivation

The

over

female

self-rated

no change

diet-and-exercise

ratings

and

or dieting

the scientific and increases hunger

may be a useful aid in a complete weight

appetite

of male

of fullness.

controls

been

water

1986

report resulted

the control they

aspartame

t

appetite

that

when

Blundell

in an increase

condition, compared

solutions

and

consumption in ratings

in which the

ofa

effects

water

Hill

of appetite

was con-

of glucose

(I 3 Id, or 3 kcal),

(1)

solution

(786

and plain

Am J C/in Nutr

Johns 2

From

the Department

Hopkins Supported

of Psychiatry

University by NIDDK

School grants

and

Behavioral

Sciences,

The

of Medicine, Baltimore. DK39177 and DK40968.

3 Address reprint requests to BJ Rolls, Department of Psychiatry and Behavioral Sciences, Meyer 1-108, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21205. Received April 25, 1990. Accepted for publication August 29, 1990.

l991;53:872-8.

Printed

in

USA.

© 1991 American

Society

for Clinical

Nutrition

Downloaded from www.ajcn.org at Institute of Atmospheric Physics,CAS on July 10, 2011

studies

of aspartame,

to increase to increase

found

it apparently

intake

to increase

have decreased consumption

situations,

of food

taste

reported consumption,

is associated with Even if aspartame some

sweet

been

SWEETENERS or the

expectation

of drinks

based

the explanation, familiar and and

subjects on their

such palatable

intake

food

might

have

previous

findings foods

if the data

from

hunger

They

through

suggest

satiety

value

No

matter

what

studies

that

an

that the sweet taste

cephalic-hepatic

reflexes.

This

increased related

might

not be involved

since

not

increase

plasma

not

measure

food

intake,

in some

situations,

ratings

it is not

clear

that

it has

data

have

in drinks and

should

ofsome

intense

this

practical

with intense been

thought

an effect

of the

sweet

It is appropriate,

therefore,

foods

with

intense

however,

we

and

intake.

drinks

First,

sweeteners

affect

taste

on

appetite

in terms that

the

should

Blundell

and

sweeteners

and

suggest

that

this

“residual

food

intake,

they

also

food

intake

because

of the

they

suggested

that

aspartame,

argue

that

intake,

Blundell 235

or food

and

food

on the

intake. and

rats of

food

intense

the

lead

sweeteners effects.

the

ester

or 470

mg

sweet

taste

argued

that

sweet

taste

to increased can decrease For

ofthe

in capsules,

However,

much

higherdoses

(5.04

had

no significant

effect

1 3).

Also,

investigators and

weight

in

108

point

to note

ofdoses

ofaspartame

ratings,

food

intake,

(75 male

mg

and

is that have or body

that

ratings safety

.

kg

female

capsules

never

to the dose

been

weight.

of the

.

the

ingestion

or food had

volunteers

of

intake

large

(10,

doses

of

no effects

on

(14).

containing shown

fuels

The

a wide

to increase

im-

range hunger

animal

taste

did

not

these

in a 2-h test,

storage

to see how

intake

and

drinking

explanation alters

and away

only

be

which

sacthey the dis-

from

systematic

oxi-

investigaintense

sweet-

food intake. Equivalent aspartame or cyclamate has

it is still

studies because

robust

declined

important

the effects

drinks

sweetened

since

to follow

ofsaccharin

are in other laboratories. Most of the recent sweeteners have concentrated on aspartame. offoods

(sweet

it should

that an unflavored However, Tordoff

in rats. The temporarily

of saccharin

these

onfood

the en-

as sweet.

of aspartame,

Effects

to greater

Thus,

Also,

through

and with

yogurt. However,

lead

yogurt.

are the

mechanisms

plain

on intake.

saccharin.

toward

consumption

findings

the

at

of the

to the palatability

that

studies

introduction

in humans

studies

with

the up on

of intense

aspartame

A summary ofthe short-term studies ofthe effects of aspartame on hunger and food intake is shown in Table 1. Effects ofaspartame in children. Studies ofthe effects of conofaspartame that

intake.

Birch

ferent

this

in familiar sweetener

et al (24)

sweeteners

children

ened kcal),

consumed

the

effects

intake

volume

and

increase

drinks

30- and

offour

after

different

dif-

The drinks

foods (Table 1). beverages sweet(13 Id, or 3 (376 kJ, or

no delay

60-mm-delay

with

children.

a set of seven snack water or fruit-flavored

ate ad libitum the

or food

of drinks

of 2-5-y-old ofone

by children

appetite

(376 kJ, or 90 kcal), aspartame plus low-glucose maltodextrin

Children For

foods not

compared

a fixed

with sucrose or aspartame delays.

does

on the food

before freely consuming The drinks were either

mm

aspartame

study,

d’)

1) reported

both

consumption

with

related

amounts

greater

after

starch

to the

( 17). Sub-

ate fixed

et al (3) had not found increased food intake.

possible

do not

90 kcal).

of aspar-

g)ofencapsulated

(24-wk)

aspartame

portant

found

10.08

on hunger

in a long-term

encapsulated body

other

Rogers

Although

indicate

ingestion

have

than

of metabolic

sumption

reduction in food intake with taking a placebo

was not related

rather

These

example,

bypassing

plus

generaliza-

or glucose, with no and were then given

effects

led to increased food intake is that drinking saccharin

dipeptide

Nevertheless,

that

therefore

but significant when compared

but this reduction

tame.

(10).

(1 1, 12) reported

aspartame

sweet taste, caused a small in a subsequent test meal

capsule,

men

that

position

effects

whether

could

in young

recalled

may

could affect hunger not been conducted

intense

selection

of intake yogurt)

(15)

glucose-sweetened

of the

postingestive

his colleagues

saccharin

of

aspartylphenylalanine, could affect appetite because phenylalanine stimulates the release of cholecystokinin (CCK) (8). The gut peptide CCK has been postulated to be associated with satiety (9). However, phenylalanine was not found to affect hunger, food

these

equicaloric

16) and to another

day

compared

to food,

was not tested in different sweeteners

significantly

ofthe

yogurt

eners have

of the

methyl

than

Blundell

paralleled

tions

when

hunger”

containing

intake

and

intake

investigations

(13,

sweetener

was

rest

The

and

because

ratings

yogurt

effects one

intake

the

could could

(1, 3) have

appetite

over

intake.

on appetite

his colleagues

increase

Food

and

charm propose

in capsules

Although intense

1 h later.

vs sour

their

either with saccharin starch and saccharin,

solution of saccharin and Friedman (18-2

is bypassed.

Aspartame

sweetened or with

sweeteners effects that

food

foods

by Rogers

dation.

data

intake

in the study

from

and

consider

food

jects

physiological

be made

to

interest,

The problem

sweeteners

and

found

implications

hunger

to review

sweeteners

sweeteners. to imply

different

hancement

eating

is oftheoretical

drinks with intense sweeteners could increase calories and nutrients in foods with intense have a variety of postingestive physiological obscure

does (4) did

has been

cannot

saccharin-containing

not be interpreted

acesulfame-K)

any

Alleva

can affect subsequent

Although

and drinks

these

taste

and

ofhunger.

the use offoods

data

the taste

aspartame,

increase

ofaspartame 7). Tordoff

so these

that the sweet

(ie, saccharin,

is that

(6,

(15) extended

on food

or 30- or 60-

intervals,

the caloric

drinks, sucrose and maltodextrin plus aspartame, reduced snack intake relative to water. For the 30-mm delay, aspartame reduced snack consumption relative to water. Birch et al (24) replicated this result no effect

hanced

in a subsequent experiment; or decreased subsequent food

intake

either

but

had

never

en-

it.

In a study

ofolder

children

(9-10

sweetened with aspartame, sodium given 90 mm before a buffet lunch

ened

aspartame

drinks

were

given

both

with

y old),

fruit-flavored

cyclamate, (22). The

and without

drinks

or sucrose aspartame-sweet-

added

were

carbohy-


as an indication behavior. Thus,

ingestion

insulin

have

Motivational

saccharin

as the sweetener; aspartame is important to note because

may

lunchtime

with

Blundell

tions

lunch by

the finding that chewing flavored, sugar-sweetened gum stimulates gastric acid secretion (5). The cephalic release of insulin may

sweetened

and

of yogurt, sweetener,

increase

is supported

offoods

Rogers

unflavored

of aspartame was monotonically

873

INTAKE

using saccharin this study. This

are to be extrap-

chewing

FOOD Effects

the importance of using in studies of appetite

these

various concentrations but not in a way that

to concentration.

the

experiences.

emphasize and drinks

olated to real-life situations. Tordoff and Alleva (4) reported gum base with ratings ofhunger,

about

AND

874

ROLLS

TABLE

1

Short-term

effects

of aspartame

ratings

and food intake

Subjects5

Study Anderson (22)

on hunger

Ct al 1989

Dose

Exp 1: 9-l0-y-olds (n = 20)

in a test meal Vehicle

1 1 19 mg (1)

Hunger ratings

300 mL flavored drink with

Type oftest

Food intake

meal

No effect compared with cyclamate

Lunch, 90-mm delay

No effect compared with sucrose No effect or decreased

Lunch,

90-mm

Lunch,

60-mm delay

No effect compared with cyclamate

polycose Exp 2: 9-10-y-olds

295 mg (1)

300 mL flavored

(n = 20) Black

al 1990 (23)

Ct

Males

Birch et al 1989 (24)

only (n

=

drink 280 or 560 mL diet

160 or 320 mg 140 mg

20)

Exp 1: 4-5-y-olds (n = 24)

soda

205 mL flavored

NCt

Snacks,

drink

Exp 2: 2-4-y-olds (n = 20)

102 mg

Body weight NC

162 mg

delay

0-, 30-, 60-mm

NC

150 mL flavored

delay

Snacks, 0-, 30-, 60-mm delay

drink

No effect compared with sucrose No effect compared with water No effect or decreased 30 mm compared with water

at

No effect or decreased 30 mm compared

at

with water

Blundell and Hill 1986(1)

1990 (25)

1 12 mg

70 g corn

water

NC

compared

Increased

withwater No effect or decreased

flakes

Next

meal

NC No effect compared with unsweetened

and total

daily

cereal cereal Rodin

1990 (6)

Rogers Rogers (12)

250 mg

ci al 1988 (3)

Overweight and normal (n 24) (n = 12)

162 mg

500 mL lemonflavored water 200 mL plain water

et al 1990

Exp 1 (n

234 mg

Capsules

12)

Exp2(n=15)

Rolls et al 1988 (17)

Females

Rolls et al 1989 (26)

(n

Rollsctal 1990 (27, 28)

Exp 1:malesonly (n = 14)

Ryan-Harshman

et al

Lunch, 38-mm delay

No effect compared

Increased compared

Lunch, 60-mm delay

No effect compared

Lunch,

Decreased

with water

1990(4)

with water

NC

Capsules

60-mm

delay

Decreased

IlOand 220 mg

Gelatin and pudding (ad libitum) 237and473mL lemonade

reased

With

Exp 2: males only (n = 14)

1 10 and 220 mg

237 and 473 mL lemonade

Decreased

Lunch, 30-mm delay

Exp 3: males only (n = 14)

1 10 and 220 mg

237 and 473 mL lemonade

Decreased

Lunch, 60-mm delay

5.04 and lO.O8g

Capsules

No effect

0.05%, 0.30%,

Chewing

Lunch, 60-105-mm delay NC

=

Males

=

12)

32)

21 1-391

only (n

=

13)

Dieters and nond.ieters (n= 120)

Gelatin mg

(ad libitum)

gum

Increased

compared

withwater Decreasedcompared with water No effect compared with sucrose No effect compared with sucrose Noeffectcompared with water or no drink No effect compared with water or no drink No effect compared with water or no drink No effect

Lunch, 60-mm delay

Decreased compared with water Decreased

Cheese on crackers, 60-rain delay Lunch, 120-mm delay

only (n

1987(10)

Tordoff and Alleva

235and 470 mg 77 mg (1)

or sucrose

NC

with water =


Mattes

(n=95) (n = 24)

200 mL plain

lunch

NC

0.50%, 1.0% 5

Normal-weight,

nondieting

male

and female

adults

unless

otherwise

specified.

Exp, experiment.

t Not collected.

drate (polycose), and the cyclamate-sweetened cose added. None ofthe treatments differentially fullness, desire to eat, or lunch-time food intake. consumed with or without polycose did not food

intake

in children

when

compared

with

drinks

had poly-

affected Thus,

affect sodium

hunger,

aspartame hunger or cyclamate

or sucrose. Effects ofaspartame in adults. We (26) examined the effects ofconsumption ofcommercially available foods sweetened with either sucrose or aspartame on appetite ratings and food intake in adults.

Normal-weight,

nondieting

males

and

females

were

given large portions of either a high- or low-calorie pudding or gelatin dessert and were instructed to eat as much as they liked. Subjects were either informed or not informed of the caloric content ofthe pudding or gelatin. All subjects ate similar weights

ofthe different caloric versions ofeach food. Despite the resulting difference in caloric intake ( 861 Id, or 206 kcal) after consumption of the’ high- or low-calorie version of the same food, subjects

did

not eat significantly

more

after

the low-calorie

food

when presented with a buffet lunch later. Over the 2 h after consumption

with a variety of foods 2 h ofthe puddings or gelatins,

ratings

amount

of hunger,

desire

to eat,

the

subjects

wanted

to

eat, and the pleasantness of the taste of the eaten food were similarly decreased and fullness was similarly increased by consumption ofthe different caloric versions ofthe foods. Knowing the caloric content ofthe pudding and gelatin did not influence intake sponded

both

or appetite: similarly

sucrose-

and

both

informed

and

in the tests. Thus, aspartame-sweetened

uninformed under foods

subjects

re-

these conditions, had similar effects

SWEETENERS

AND

FOOD

on hunger ratings over the 2 h after they were consumed, and food intake 2 h later was not differentially influenced by the sweeteners. We recently completed a study comparing the effects of as-

study

partame-

(1) that

or sucrose-sweetened

food intake nondieting

(27,

28).

males,

crose-sweetened a self-selection

lemonade

The

subjects,

consumed

237

on hunger

who or 473

were mL

ratings

and

normal-weight, aspartame-

receiving

the lemonade,

had been

used,

manipulated.

subjects

were

nor did they suspect When

the

drinks

not

told

which

or su-

taken

with

normal-weight,

There

is little because

studies

contribute

tam

to the warnings taste

sweet

outcome

may

restricting

energy

including

patterns

ratings

findings

are

ofeating

not

found

laboratories

after

ingestion

always

among

Several

laboratories,

not

a problem.

increases

Ofcourse,

They

lead

cer-

increases

found

ofaspartame.

in

aids “may

aspartame

have

Hill

found

prevalent that

also

and

been

such dietary

individuals.”

have

Other

has

ofhunger,

weight

Blundell’s,

intake.

of Blundell

of aspartame

ratings

of normal

hunger

sig-

The

are actively

the

to disordered

groups

was being meal,

people.

who

substance

to increase

food

the

nondieting

in individuals

intake.

sweetener

that the sweetener

were

were

well be different

their

lemonade, plain water, or no drink, either with lunch or 30 or 60 mm before the lunch. When

875

INTAKE

in

negative

to questions

about

nificantly more overall calories (lunch plus the drink) were consumed when subjects drank the sucrose-sweetened lemonade. This trend remained when the drinks were consumed 30 and 60 mm before the meal, but it was statistically significant only for the 473-mL sucrose-sweetened lemonade consumed 30 mm before lunch. There were never any differences in food intake between the aspartame and water conditions. Thus, aspartamesweetened drinks were not associated with increased food intake nor were there differences in hunger ratings among any of the conditions. Another recent study showed no effect ofaspartame in drinks on subsequent food intake (6). Male and female normal-weight and overweight subjects received 500 mL plain water or lemonflavored water mixed with fructose, glucose, or aspartame 38 mm before being offered a buffet lunch. The results showed that the fructose had the largest suppressant effect on food intake and that the aspartame-sweetened drinks and plain water did not differ. Black et al (23) also showed that aspartame-sweetened soft drinks and water had similar effects. Twenty normal-weight

whether particular features of the study’s design could account for the negative findings. However, in relation to the effects of

males

ment

tested

in four

conditions:

280

mL

mineral

water

consumed in 2 mm, 280 mL aspartame-sweetened diet soda (their choice of flavor) consumed in 2 mm, 280 mL diet soda consumed in 10 mm, and 560 mL diet soda consumed in 10 mm. All drinks were consumed 60 mm before lunch. The 560mL drink decreased hunger ratings over the 60 mm after consumption, but the other conditions had no significant effects on ratings of hunger or satiety. Intake in the lunch did not differ among conditions. Thus, aspartame consumption again did not increase ratings of hunger or affect food intake. Mattes (25) suggests that the effects ofdifferent sweeteners on hunger and food intake should be evaluated independently of their energy value and taste. Thus, he held the energy content and the rated pleasantness of a test meal constant. The effects of equicaloric breakfasts of unsweetened cereal or cereal sweetened with either sugar or aspartame on subsequent hunger and food intake over 5-d test periods were assessed using diet records. There were no significant differences in hunger ratings. Also, there were no significant differences in intake of the next meal, total daily intake, or the types of foods selected. Informing the subjects nificantly

about affect

the

caloric

intakes.

content There

of the was

breakfast

a nonsignificant

did

not

sig-

trend

for

the subjects who knew that they had consumed aspartame to eat more during the rest of the day, perhaps because they mistakenly believed that the aspartame-sweetened cereal had fewer calories. Mattes suggested that the value of intense sweeteners as aids in weight management will depend on responses to the expected energy savings they provide. Although this may turn out to be the case, it should be stressed that the subjects in this

there

ferent

laboratories

ofthe

studies

showed

have

of the

foods

drinks

(Table

on

as whether

it could

rather,

they

of as-

1). Nevertheless,

ratings

with

be ofinterest

food

dif-

in some

consumption

appetite

control

hunger

if

intense

in the study

intake.

on appetite

and

the sweet

taste taste

in ordinary

intake; and drinks

foods

the studies

about

the types

and

subsequent

interval the

the

age, body

have

intake;

have

effects

of sweetener food intake.

not been they

best

in agreesuggested

have

that may affect the outcome.

consumption,

gender,

and food

of sweetener

the

is no

asked. The sweeteners

sweeteners

to date

dose

administration,

appetite

sweeteners,

variables

the type

is administered,

sweetener

There being about

and whether the type affects appetite and

of intense

ofexperimental

sweetener

affects

conducted

the effects

include

intake.

is bypassed,

and food

Although

food

must fit the question a variety of questions

the sweet

when

sated),

and

that

The experiment reviewed asked

whether,

and

negative;

after

to increase

sweeteners

These

simply

from

Also,

has been much discussion (1 1, 17, 29) about the apexperimental design for the study of the effects of in-

design. studies

such

not

was characterized,

There propriate tense

were

findings

protocols.

ratings

paradigm

mechanisms

negative

different

in hunger

partame-sweetened sweeteners

several

used

the findings

a decrease

a robust

been

that

of the

offoods

with

learn

to adjust

should

attempt

termine

how

appetite

and food

Effects

of long-term

offered

subjects

the after

(hungry

or

are

or weeks

tense

sweeteners

ulatory

in the

energy

are required can

seen

have

throughout

subjects

these effects

can

experiments variables

to de-

of sweeteners

on

or sugar

content

controls manipulations

to determine

whether

affect

body

since

could

obscure

several the

density

on the short-term studies ofcaloric

in short-term

been

sweeteners

of sweeteners

shed light long-term

mechanisms intake

There sugar

manipulate

use of intense

ofthe

days

food

and involved

manipulation

or meals However,

content,

(30, 3 1). Future

intake.

Manipulations foods intake.

restraint,

energy

intake

to isolate

Experimental

reduced

subsequent they

dietary

way

sweetener

and whether or not the subject knows about the sweetener ( 17). Also, the familiarity ofthe subjects with the sweetener and the food could be important since some studies have shown that with repeated consumption

weight,

the the

of meal

type

state

used,

between

day

weight

of single of food over

the use of inweight regof sweeteners on

body

the effects

studies.

studies over

in which

several

days.

aspartame

replaced

Porikos

et al (32-


were

aspartame,

876

ROLLS

35) studied

both

normal-weight

and

obese

individuals

confined

to a hospital room. Subjects were not told that the caloric content of the foods and drinks was being manipulated. Foods were served from platters with large portions available and subjects were encouraged to consume sweet drinks (they were required to drink at least two sodas a day). In the study of normal-weight individuals,

which

lasted

for

24 d, the

foods

and

drinks

were

kcal), or no soda the soda sweetened with the

higher

than

7, when

for the large

Subjects

consumed

the

enough

sugar,

of the

the

menu

weight

gain

items

stopped.

to produce

an

average decrease in energy intake of 24% when aspartame replaced sucrose. Initially, the subjects continued to eat the same weight of food they had been consuming during the sucrose baseline

lation.

and,

therefore,

their

customary

diet.

showed

imprecise

caloric

regu-

dilution, subjects compensated for and they did this by eating more of

However,

total

caloric

intake

significantly below N 15%) baseline levels over the rest of the 12-d dilution period. When, at the end ofthe study, sucrose was again consumed, energy intake rose back to the level eaten in the baseline period. Although Porikos et al (33, 35) suggest that aspartame may have some efficacy in weight control, more work is needed to substantiate

this

conclusion.

These

studies,

although

pioneering

other

No condition

volume

(ie,

of soda

study

of diet

sugar-sweetened

or drinks

products

are

run

to control

of both

in weight their

control, findings

surreptitious

substitution

sweetened

with high-fructose

studies

in which

are knowingly

normal

A recent

clinical

partame-sweetened

diet affected and women

study

explored whether the addition of asand beverages to a low-fat, hypocaloric weight loss (39). Fifty-nine obese, free-living men were assigned randomly to a hypocaloric, balanced foods

their

exchanges

supplementation with in the experimental

as aspartame-sweetened

aspartamegroup were

pudding

also included support groups, ercise instruction. There were

behavior modification, no significant differences

switched

weight

and

and

then

were

switched

back

to sucrose.

of aspartame

ment, drinks

In another

accurately reduced manipulation The

was

associated

residential

study

in which

caloric

intake

monitored, the carbohydrate content by 1.67 MJ (400 kcal) for 3 d (37). Most

subjects,

was due who

to the substitution

were

six

could

normal-weight,

be

for sugar.

nondieting

males,

were naive about the manipulation. Apart from the required lunch and for a 1-h period after lunch when no food was available, subjects could eat freely from a wide variety offoods. They made up for the difference in calories in the lunches every day of the experiment and this compensation was seen by dinner time. Total daily energy intake was the same regardless of the energy

content

of the

and unaware

ofthe

in the energy

content

energy intake. In a recent study, ofconsumption or aspartame cessive

daily soda

3-wk

Thus,

manipulation,

in subjects

not

trying

a 1.67 MJ (400-kcal)

oflunch

had

no significant

effect

Alleva

sweetened intake and subjects

with

body

(9 females

1.2 L aspartame-sweetened sweetened with high-fructose

soda

corn

(38) compared high-fructose

to diet

reduction on daily

weight. and (1 3 Id,

syrup

the effects corn

Over 2 1 males)

three

to use other group was told

or saccharin-sweetened

loss

of the

groups

The

In a follow-up period

after

products.

with

males

syrup

suc-

received

or 3 kcal), 1.2 L (2.22 Mi, or 530

study

the

The

without

lost slightly the

(40) of the

the

more

the

12-wk

or

with all asprogram

and cxin the

aspartame

weight

females

12-mo

12 wk of treatment,

products to avoid

sup-

without

showed

as-

the

op-

weight-maintenance patients

decided

them-

selves whether or not to use aspartame. By the end of the 12 mo, both groups were using similar amounts ofaspartame. Fac-

tors associated

with

maintenance

sumption, correlation was found

and decreased desire for sweets. A strong negative between aspartame consumption and weight regain for the males but not the females. For males larger

aspartame

intake weight

aspartame

at the end

maintenance.

does not increase some improvement

levels,

loss at I 2 mo were

physical

better

activity

of weight

increased

increased

aspartame

ofmaintenance This

study

was associated indicated

weight gain and suggested in weight loss and weight

is substituted

that there maintenance

takes

were

study

obtained

from

suggests (41).

that

aspartame

Seven-day

I 6 women

who

may baseline

had

who had successfully lost weight and maintained average of 13 y. The subjects were then instructed aspartame aspartame

their consumers

from

diets and

stress

may be when that

maintenance

authors

with

aspartame

their

clinical

The

that

that

efit for weight

for sugar.

con-

sample size was too small for definitive conclusions and more long-term investigations of the effects of aspartame body weight in obese men and women are needed. Another

Tordoffand

ofsodas on food periods,

lunch.

were encouraged The control

partame (10.4 vs 12.2 kg) whereas posite trend (7.4 vs 5.8 kg).

of lunch was ofthis dietary

of aspartame

partame-

plementation.

with a reduction, not an enhanceconsumed in a variety of foods and

of food intake when over several days.

for

required.

milk shake and intense sweeteners.

to aspartame,

of

substituted

6 d when the baseline was being established, the sucrose intake was well above normal levels so that the manipulations took place under abnormal conditions. Furthermore, the experiment was not counterbalanced for order of sweetener presentation. Subjects always started with sucrose for the first 6 d, were The experiments should also be conducted so that the rotation goes from aspartame to sucrose and then back to aspartame. Despite these criticisms, the studies indicated that consumption

the too

investigations

milk

first

was

in intake data imply

naturalistic

foods

given

the

the

ofsoda

36) argues

during

in both

with a reduction Although these

involved

Their

aspartame for large volumes corn syrup. Clearly, more

diets

that

of the

intake

Consumption

broadly.

with or without products. Patients

(29,

1.2 L water)

be of some benefit about extrapolating

diet either containing

Booth

caloric

consumed.

that aspartame may authors are cautious

A criticism is that the baseline did not represent the normal

subjects.

were higher

Consumption

daily

was associated other sources.

and precise, had some problems. diet encouraged overeating and of the

the soda

significantly

conditions.

decreased

types of sweet drinks of refined sugar from

Clinical

from

and

body

females.

quantities

remained

calories

of

was associated

with the no-drink condition and was associated weight in the males and no change in weight

decreased

in the

(the

Consumption

syrup

been

on

be of bendietary

in-

obese

but

the loss for an to exclude all

for 3 wk. Five subjects were 1 1 were regular consumers.

occasional The base-


40%

period

After 4-6 d of the ofthe missing calories,

in the

corn

intake)

soda

sexes compared with

replaced

intakes

additional

aspartame-containing

sweetened with sucrose over the first 6 d of the test. With free access to a variety of foods, the subjects gained weight. On day aspartame

caloric

of this

gains

order.

with high-fructose

daily

source

weight

in a counterbalanced

SWEETENERS line

caloric

stention regular

intakes

of these

from aspartame aspartame users

aspartame,

and

there

two

did found was

groups

did

not

differ,

AND

and

ab-

not affect intake. However, the dietary control difficult without

a tendency

for caloric

intakes

to in-

FOOD

INTAKE

situations,

there

controls been

These

clinical

problem normal

studies

of knowing environment

plied

with

are

difficult

to interpret

whether participants, and were self-reporting

dietary

modifications.

because

of the

who were in their intake, really com-

Also,

in

multicomponent

weight-loss programs it is difficult to attribute single component of the intervention (42).

weight

loss to a

found

showed

to

that

The (43)

study

1982

benefit

in long-term designed

survey

as evidence

weight

to look

by Stellman

that

intense

maintenance.

Garfinkel

That

from

Data based

study,

however,

in daily

the

energy intake sweeteners are

relevant

only

to saccharin

sweetener

was

not

in weight

changes

dieters

women been

lost

ofthe

saccharin

users

at all,

it is

because

survey. and

that

Differences

nonusers

were

kg). The study specifically excluded women their dietary habits (including sweetener use) 10 y, and this would have eliminated many

from

the survey.

more

ignored

not aspartame,

at the time

between

very small(0.23-0.68 who had changed over the previous serious

use and

available

it is relevant

weight

in most

The

fact that

if they

reviews

intense

used

of these

the most

data.

overweight

sweeteners

Stellman

has

and

Gar-

finkel (44) state that the weight changes they observed probably had liule clinical meaning. They also point out that the saccharin users may have gained weight ifthey had not used the sweetener. They conclude that casual long-term use of intense sweeteners in the

absence

itselflead is the help

of other

to weight key

with

here.

major

loss. The

Because

weight

changes

need

intense

loss only

in lifestyle

for other

changes

sweeteners

through

dietary

does

can

not

changes,

to

the

Future methods body

result

changes.

can

show

as establishing

mind

very

epidemiologic for determining

weight

surveys

of the

It should

retrospective

randomized

and

In addition,

(45)

trolled,

size

be stressed,

correlations

causality.

ducting

sample

of this

epidemiologic

that

such

be interpreted should

about

the dangers

studies

instead

bear

in

of con-

of well-con-

trials.

is much

more

on food and

one

to learn

intake

study

and

investigators

associated aspartame

hunger.

have

with aspartame is associated

Even

if aspartame

about

body

in humans

sumption may be followed tiating this finding requires

eral

Laboratory-

sugar

indicate

that

if

The

caveat

here

intake

Ifthe

food is not

will

actively

studies

depend

uses

the consump-

to restrict

may remain unchanged. part ofa weight-control

but

these

with measuring regimens. and

because

be run in they lead

sweeteners

on food

intake

field studies

and

energy. that

sweeteners

pro-

can

to know

be extrapolated lack

naturalistic

difficult

and with ensuring

precision,

the laboratory and to similar conclusions intake

suggesting

long-term

intrinsically

it is difficult

studies

daily

with reduced data

More

are

Because

laboratory-based

food,

intake,

on how the use of intense patterns and body weight

individuals.

needed,

on

However, if intense program, they could aid

of foods and drinks with intense intake and weight gain in dieters.

are

should whether

Ifan individual for one higher

to eat a high-calorie

trying

Little information is available sweeteners affects food-consumption

these

nondieting

probably

individual

as an excuse

in community-dwelling

is that

the

because

compliance whether

rig-

to natural parallel

field about

studies

to determine the effects

of

U

weight.

body

References 1. Blundell

JE,

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