Understanding its Role in the Fight Against Obesity and Diabetes

Dr. Keith Ayoob, Associate Clinical Professor Emeritus at the Albert Einstein College of Medicine in New York, spoke to delegates at the International Union of Nutritional Sciences (IUNS) International Congress of Nutrition (ICN), held in Buenos Aires, Argentina October 15-20, 2017.   In his presentation, he discussed two of today’s most common health epidemics – obesity and Type 2 diabetes – and reviewed the science confirming the role low and no calorie sweeteners (LNCS) such as stevia can play in reducing added sugar intake. Dr. Ayoob’s presentation “Health and Wellness of Stevia as a Sweetener” drew from in-vitro, animal and human studies, and discussed stevia’s potential role in helping manage diabetes, blood pressure, weight, and appetite.

BY: Dr. Keith Ayoob

Key Objectives:

  • Explore the extent of the global health epidemics of obesity and type 2 diabetes.
  • Discuss specifics of global health recommendations to reduce intake of added sugars and the role played by zero-calorie sweeteners in achieving these recommendations
  • Explore the unique role plant-based stevia may have in helping persons with diabetes manage blood glucose levels.
  • Learn and apply information related to the benefits of natural-origin stevia and the opportunities and challenges in developing reduced-calorie-reduced-sugar foods with sweeteners/stevia

Global Obesity Epidemic

The issue of global obesity is worsening. The International Diabetes Foundation predicts that 641 million people will have diabetes by 2040, up from 415 million in 2015.  In North America, the prediction numbers 60.5 million by 2040, compared with 44.3 million in 2015. Obesity is a gateway disease for diabetes, which in turn is a gateway disease for chronic conditions such as metabolic syndrome, hypertension, cardiovascular risk, retinopathy, and more.

Worldwide authorities have made a call for healthier lifestyles including reductions in the consumption of total calories and especially added sugar. The World Health Organization (WHO) recommends a decrease in added sugars to less than 10% of total calories, with the organization ultimately aiming for less than 5% of total calories sourced from added sugars.  Without changes, such as replacing sugar with LNCS, this level of reduction will be extremely difficult for most people to achieve in the present environment.

In reducing calories from sugar, and in looking at low calorie sweetener options, let’s look at the scientific evidence and efficacy of stevia as an option in sugar reduction.

Scientific Evidence of Stevia

from Evidence Based Systematic Reviews and Meta Analyses

The European Food Safety Authority (EFSA)[1] reviewed studies  on steviol glycosides (a sweet component from stevia leaf extract):

  • In-vitro studies showed a stimulation in insulin secretion from islet cells, up-regulation of key genes controlling insulin secretion and a positive impact on insulin signaling and release.
  • Animal studies indicated an improved insulin sensitivity and plasma glucose levels in normal, type 2 diabetic or obese rats as well as a decrease in blood glucose levels, possibly by enhancing insulin secretion and regulating gluconeogenesis.
  • Human studies in persons with and without type 2 diabetes, up to 1000 mg preparation, showed no negative effect on glucose homeostasis, with some studies showing reduced postprandial glucose in persons with diabetes. In addition, there was no effect on blood pressure in either those with or without type 2 diabetes.

In the Onakpoya and Heneghan, et el[2] meta-analysis of nine human randomized controlled trials (RCT) studies of various pharmacologic doses, stevioside showed no dose-response relationship between stevia and cardiovascular factors, and in particular showed a small reduction in blood pressure.

In the Maki KC, et el[3] 16-week study , 122 diabetic adults were given 1000mg of Reb A stevia per day. The study found there to be no negative effects on glycemic load, HbA1C, fasting glucose, or serum insulin, noting that the results held even at a pharmacologic dose.

The Mohd-Radzman, et el[4] review  on the potential role of stevia in managing insulin resistance and diabetes in animal studies indicated a decrease in lipid peroxidation when pre-fed with stevia and an increase in insulin secretion, suggesting slower or reduced progression of diabetic co-morbid complications. In human studies, there was a decrease in postprandial glucose levels when fed meals supplemented with stevioside, compared with both sucrose and aspartame. Researchers further noted that stevia seems to have a target-specific effect, by reducing hyperglycemia in human subjects (1gm dose), while having no effect in normoglycemic conditions, suggesting no danger of hypoglycemia. (Evidence Based Com Alt Med)

Efficacy of Stevia

in Real Life

A human study conducted by Anton SD, et al[5]  showed less postprandial glucose spiking with stevia in a reduced-calorie meal, compared with a sucrose-laden meal, and with no differences in hunger or satiety from the sucrose group.

In a human study conducted by Li, et al[6] with individuals 8-13 years of age, children actually preferred the stevia-sweetened chocolate milk, and that “label-conscious” parents preferred seeing stevia on the label rather than sugar, whereas the “traditional” parents preferred the label indicating the sugar-sweetened milk.

An Expert Consensus Statement from Gibson, et al[7] showed agreement that low- and no- calorie sweeteners can be useful tools for replacing high-calorie ingredients, enhancing weight loss efforts, managing postprandial glucose and insulin levels in both persons with and without diabetes  without changes in appetite or satiety, and providing dental health benefits.

The Miller, et al[8] meta-analysis  of 15 RCTs and 9 prospective cohort studies showed significant body weight reductions from the use of LNCS, versus sugar sweetened beverages and even water, with the analysis concluding that the LNCS were useful tools for improving compliance with weight loss and weight maintenance efforts.

The Rogers PJ et al[9] meta-analysis also noted that low calorie sweeteners do not increase energy intake or body weight, whether compared with caloric or non-caloric conditions.

Take-Aways

Weight Management

Foods containing stevia may help with a long-term modest effect on body weight, body mass index (BMI) and waist circumference.

Appetite

Foods containing stevia help lower total calorie intake, without over-consumption later in the day.

Diabetes

Stevia has been confirmed as safe and appropriate for persons with diabetes. As a sugar replacer, stevia may benefit blood glucose & insulin levels, with no negative effect on glucose homeostasis.

Blood Pressure

Long-term, the use of stevioside may have a small lowering effect on blood pressure, though most studies used consumption levels higher than the acceptable daily intake (ADI).

In Conclusion

When substituted for sugar, stevia can help with weight management by reducing added sugar and calories.  Stevia can be used by anyone, including normal-weight persons, who simply want to reduce overall sugar intake and improve dietary quality.  All major regulatory bodies found stevia to be safe and suitable for the entire family.

One Caveat: Stevia, like all LNCS, is a tool for managing weight and dietary quality, but should not be the only tool. Placing the burden of solving the obesity crisis on a single factor would be inappropriate.  This requires a gradual change in eating style, lifestyle, with stevia and LNCS as part of that plan.

For a copy of the complete presentation, click here.

For more information about stevia, contact the International Stevia Council or the Calorie Control Council.

About Dr. Keith Ayoob

Keith Ayoob, EdD, RDN, FADN is an Associate Clinical Professor Emeritus at the Albert Einstein College of Medicine. As a pediatric nutritionist and registered dietitian, Dr. Ayoob is also a past national spokesperson for the Academy of Nutrition and Dietetics.

Dr. Ayoob is a consultant with the Calorie Control Council Advisory Board and the Global Stevia Institute (GSI), GSI is supported by PureCircle Ltd, a global leader in purified stevia leaf extract production.

1 EFSA. 2010a. Scientific opinion on the safety of steviol glycosides for the proposed uses as food additive. EFSA J 8(4):1537 [85 pp.]; doi: 10.2903/j.efsa.2010.1537. Available from: http://www.efsa.europa.eu/en/ efsajournal/doc/1537.pdf.

2 Onakpoya IJ, Heneghan CJ. Effect of the natural sweetener, steviol glycoside, on cardiovascular risk factors: a systematic review and metaanalysis of randomised clinical trials. Eur J Prev Card. 2015;22:1575–87

3 Maki, K., Curry, L., Reeves, M., Toth, P., Mckenney, J., Farmer, M., et al. (2008). Chronic consumption of rebaudioside A, a steviol glycoside, in men and women with type 2 diabetes mellitus. Food and Chemical Toxicology, 46, 47–53.

4 N. H. Mohd-Radzman, W. I. W. Ismail, Z. Adam, S. S. Jaapar, and A. Adam, “Potential roles of Stevia rebaudiana Bertoni in abrogating insulin resistance and diabetes: A Review,” Evidence based Complementary and Alternative Medicine, vol. 2013, Article ID 718049, 10 pages, 2013.

5 Anton, S., Martin, C., Han, H., Coulon, S., Cefalu, W., Geiselman, P., et al. (2010). Effects of Stevia, aspartame, and sucrose on food intake, satiety and postprandial glucose and insulin levels. Appetite, 55, 37–43.

6  Li XE, Lopetcharat K, Drake MA. Parents’ and children’s acceptance of skim chocolate milks sweetened by monk fruit and stevia leaf extracts. J Food Sci. 2015;80:S1083-92.

7 Gibson S, Drewnowski A, Hill J et al. Consensus statement on benefits of low-calorie sweeteners. Nutrition Bulletin 2014; 39(4): 386–9.

8 Miller PE, Perez V. Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies. Am J Clin Nutr 2014; 100: 765-777.

9 Rogers PJ, Hogenkamp PS, de Graaf C, Higgs S, Lluch A, Ness AR et al. Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. Int J Obes 2016;  40: 381-394

©Copyright 2017 – 2018

Dr. John Fry, internationally-acknowledged expert on high-potency sweeteners, presented “Application and Innovation in Stevia and Taste Development: Improved leaf extracts from advanced sensory study” at the International Union of Nutritional Sciences (IUNS) International Congress of Nutrition (ICN), held in Buenos Aires, Argentina October 15-20, 2017. Discoveries he described are now helping to create today’s stevia sweeteners with greatly improved taste. Read on as Dr. Fry explains important research findings, in addition to more on advances made in the taste profile of one of the fastest growing sweeteners today.

BY: Dr. John Fry

Key Takeaways:
• Multiple ways to characterize and develop unique steviol glycoside blends for superior taste
• Using sensory analysis and mathematical modelling as tools to guide blend choice
• Optimized blends deliver superior taste with deep sugar reduction in both model systems and key applications

Charting earlier uses of stevia in consumer products

In 2008, the first commercial steviol glycoside sweetener in Western markets was high purity rebaudioside A (reb A). This was widely thought at the time to be the best-tasting of the main leaf glycosides. It was soon apparent that reb A – and other steviol glycosides also had non-sweet side tastes. Typically described as bitter or liquorice, these were particularly noticeable at higher usage levels. Such challenging taste qualities, coupled with the relative expense of reb A, threatened to limit the use of this new ingredient.

In pursuit of lower cost leaf extracts, products of lower reb A content quickly appeared. Despite expectations that these would have inferior potency and taste, this was not always the case. For example, the concentration-response curves of pure reb A and a leaf extract with only 80% reb A (RA80) were not significantly different. Moreover, there were anecdotal suggestions that the RA80 actually tasted somewhat better than pure reb A.

It seemed that the presence of other steviol glycosides in the RA80, far from being detrimental, might have a positive effect. Studies were initiated to investigate this.

Source: Connect Consulting

Approach I

The first study used highly purified individual steviol glycosides. Eleven compounds were assessed for attributes such as taste recognition threshold and sweet and bitter concentration-response curves.

Ultimately, three concentration-response curves were measured for each glycoside: sweetness referred to sucrose, bitterness referred to caffeine, and liquorice referenced to a standardised liquorice extract – the first time the latter two calibrations had been attempted for steviol glycosides.

The enormous program of tasting demanded high-throughput sensory methods. These involved a body of about 100 trained panellists who, working over two years, carried out difference, descriptive, threshold and quantitative work.

Identifying a superior taste profile

The resulting concentration-response data were the first input to a predictive mathematical model. Once individual glycosides had been assessed, binary mixtures were created and tested again, this time particularly looking for synergistic interactions that might enhance sweetness and/or reduce the undesirable side tastes. Ternary and higher order mixtures were similarly investigated.

The resultant refined model helps identify glycoside mixtures of superior taste. For example, one output is color-coded “maps” showing all possible combinations of various glycosides, and highlighting those areas where sweetness is enhanced or undesirable side tastes reduced.

Source: Carlson et al Cargill Inc, US Patent application 20150237898

These model visualisations have further uses. Similar to geographical mapping, taste contour lines can be drawn. The “finding the sweet spot” chart shows three such plots, one each for sweetness, bitterness and liquorice, overlaid on each other. The easily-seen highlighted area predicts the glycoside compositions with maximum sweetness intensity and minimum side tastes.

Source: Carlson et al Cargill Inc, US Patent application 20150237898

The approach is not limited to three-way blends, but the picture becomes more complicated as more components are added. Ultimately, two-dimensional visualisation of more than four-component blends becomes impossible, and the output of the model is then still as valuable but purely mathematical.

By combining contour plots in this way, the very large and complex array of potential mixtures could be reduced to a small number of blends likely to exhibit the very best taste properties. The model was first validated by comparing its predictions with the properties of some known blends. For example, the model correctly predicted the identical sweetness concentration response curves of reb A and RA80. Other glycoside blends also performed as predicted.

Helping Reduce Sugar by 75% While Keeping Taste Quality

Subsequently, using the indications of the model, glycoside blends of potentially superior taste quality were identified and their taste properties verified. Several high-performance quaternary blends were found.

Some of these synergistic extracts have been commercialised. To produce them, there is no need to isolate the individual glycosides as was done for the research. Instead, different leaf extracts are carefully analysed and combined to give the key glycosides in the correct ratios.

Source: Connect Consulting based on data from Carlson et al Cargill Inc, US Patent application 20150237898

Such extracts have much reduced side tastes – so they can be used in higher concentrations, permitting greater levels of sugar reduction. For example, in a lemon lime carbonated soft drink, the maximum acceptable sugar reduction was about 50% with reb A. In contrast, a synergistic leaf extract could be used to achieve 75% sugar reduction with little change in quality.

Source: Carlson et al Cargill Inc, US Patent application 20150237898

Approach II

In an alternative approach, a design of experiment platform was used to first screen leaf extracts of single and combination steviol glycosides in specific applications. The data from this screening was applied to determine the optimal combination of glycosides to achieve the sweetness and sensory attributes closest to target taste profile. A descriptive analysis panel provided a description of key sensory attributes of the experimental design prototypes in finished food and beverage application and statistical significance of attribute difference was determined. Principle component analysis (PCA) was used to visually compare the control prototype to the optimal and design samples.

The optimized blend of glycosides identified by the design of experiment platform outperformed Reb A as predicted in the model. In the examples below, the deep sugar reduced chocolate milk and no sugar added yogurt performed best with the optimized blends. These solutions both showed a significant improvement in bitterness and overall liking compared to the single glycoside, Reb A.

Caption: PureCircle Proprietary Research

In Conclusion

These studies show substantial investment in sensory and mathematical analysis has driven the development of today’s synergistic mixtures of steviol glycosides with superior taste that allows greater sugar reduction than ever.

For more information about stevia, contact the International Stevia Council or the Calorie Control Council.

About Dr. John Fry

John Fry is an internationally-acknowledged expert on high-potency sweeteners. Since 1997 he has directed Connect Consulting, one of the world’s foremost technical resources for sweetener manufacturers and users. He speaks and trains widely on sweeteners, sweetness and calorie-control.

Previously, John was Director of Scientific & Technical Services at Holland Sweetener Company, before which he managed the Science Group at Leatherhead Food Research.

John has a BSc and PhD in Food Science from Leeds University. He is also a Chartered Chemist and holds Fellowships of the Royal Society of Chemistry, the Institute of Food Science & Technology and the British Society of Flavourists.

The International Stevia Council and the Calorie Control Council sponsored Dr. Fry’s presentation.
@Copyright 2017 – 2018

The Calorie Control Council welcomes this week’s decision by the European Commission to authorize the use of steviol glycosides, more commonly known as stevia, as a sweetener in foods and beverages.

After months of examining the safety of natural sweeteners derived from the stevia plant, approval was publicly announced by the Commission on Monday, November 14. Stevia has now been cleared for use in the EU’s 27 member states.

Stevia is still relatively new to the mainstream food and beverage market but has been used in South America for hundreds of years. It is derived from the Stevia rebaudiana plant, which has long been used to sweeten beverages and make tea. While the word “stevia” refers to the entire plant, only some of the components of the stevia leaf are sweet. These sweet components are called steviol glycosides.

In 2010, the European Food Safety Authority (EFSA) assessed the safety of steviol glycosides from stevia and established an Acceptable Daily Intake (ADI) for their safe use. This opinion has been confirmed this week with final EU regulatory approval of sweeteners made from stevia.

“Stevia’s approval for use in the EU is an exciting development,” said Haley Stevens, Ph.D., President of the Calorie Control Council, a non-profit international trade association of manufacturers of low-calorie and reduced-fat foods and beverages.  “Stevia provides the food and beverage industry with a wider repertoire for delivering zero-calorie sweetness and offering additional variety and choice for consumers that enjoy products they perceive as natural.”

Stevia sweeteners are ingredients in many products throughout Asia and South America, such as in ice cream, bread and soft drinks,. In the US, stevia sweeteners are primarily found in tabletop products and reduced calorie beverages as sugar substitutes. Heightened consumer interest in reducing caloriesand increased demand for a greater variety of low calorie products has provided an impetus to incorporate stevia sweeteners into foods and beverages.

Stevia is already permitted in many countries including the US, Canada, France, Mexico, Japan, Korea, Taiwan, China, Russia, Australia, Argentina, New Zealand, Columbia, Peru, Paraguay, Uruguay, Brazil, Switzerland and Malaysia.

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The Calorie Control Council, established in 1966, is an international non-profit association representing the low-calorie and reduced-fat food and beverage industry. Today it represents 40 manufacturers and suppliers of low-calorie, low-fat and light foods and beverages, including the manufacturers and suppliers of more than a dozen different dietary sweeteners, fat replacers and other low-calorie ingredients.

The Standing Committee of the European Commission (Directorate-General Health and Consumers Protection) voted to approve stevia extracts (steviol glycosides) for use in the European Union (EU) at its meeting held in July.  Steviol glycosides are the sweet components isolated and purified from stevia leaves. Stevia currently is approved as a dietary supplement in the European Union, but not for use as a sweetener.

In 2010, the European Food Safety Authority’s (EFSA) Scientific Panel on additives established an Acceptable Daily Intake (ADI) for the low-calorie sweetener stevia, clearing the way for broader approvals of the popular ingredient as a sweetener in the European Union.  The Panel recommended an ADI of 4 mg/kg body weight/day for stevia as part of the opinion, requested by the European Commission.

Stevia is relatively new to the mainstream food and beverage market but has been used in South America for hundreds of years.  It is derived from the Stevia rebaudiana plant, which has long been used to sweeten beverages and make tea.  While the word “stevia” refers to the entire plant, only some of the components of the stevia leaf are sweet.  These sweet components are called steviol glycosides.

The next step in the regulatory process for stevia extracts is scrutiny of the proposed regulations by the European Parliament.

In the U.S., steviol glycosides are used as general purpose sweeteners in foods and beverages as well as in tabletop sweeteners.  For EFSA’s full report please visit: http://www.efsa.europa.eu/en/scdocs/doc/1537.pdf

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The Calorie Control Council, established in 1966, is an international non-profit association representing the low-calorie and reduced-fat food and beverage industry. Today it represents 40 manufacturers and suppliers of low-calorie, low-fat and light foods and beverages, including the manufacturers and suppliers of more than a dozen different dietary sweeteners, fat replacers and other low-calorie ingredients.

 

A new study published in the August 2010 journal, Appetite, further demonstrates that people who consume low-calorie sweeteners are able to significantly reduce their caloric intake and do not overeat.  In fact, study participants who received the sugar substitutes instead of sugar consumed significantly fewer calories and there was no difference in hunger levels despite having fewer calories overall.

The researchers noted, “In conclusion, participants did not compensate by eating more at either their lunch or dinner meal and reported similar levels of satiety when they consumed lower calorie preloads [pre-meals] containing stevia or aspartame than when they consumed higher calorie preloads containing sucrose.”

This study was conducted in both healthy and overweight adults and participants were given a pre-meal containing either sucrose, aspartame or stevia.  Those who received the stevia or aspartame consumed fewer calories overall, did not overeat and did not report increased feelings of hunger.

“Although the totality of the scientific evidence demonstrates that low-calorie sweeteners and the products that contain them are not related to weight gain, increased hunger or overeating, there have been recent reports questioning the benefits of low-calorie sweeteners,” notes Beth Hubrich, a dietitian with the Calorie Control Council, an international trade association.  “When used as part of an overall healthy diet, low-calorie sweeteners and light products can be beneficial tools in helping people control caloric intake and weight.”

“This human study, in addition to the many others, serves as a counter to the recent allegations about low-calorie sweetener benefits from epidemiological studies (which cannot show cause and effect) and studies performed in a small number of rats,” adds Hubrich.

This study also builds upon a recent 2009 meta-analysis (evaluating 224 studies) published in theAmerican Journal of Clinical Nutrition and conducted by Mattes and Popkin.  These researchers concluded, “A critical review of the literature, addressing the mechanisms by which non-nutritive [low-calorie] sweeteners may promote energy intake, reveals that none are substantiated by the available evidence.”

For further information about low-calorie sweeteners (sugar substitutes) and low-calorie, sugar-free foods and beverages, visit: www.caloriecontrol.org.

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Anton, S et al. Effects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels. Appetite: 55 (2010) 37-43.  [Abstract]

The Calorie Control Council, established in 1966, is an international non-profit association representing the low-calorie and reduced-fat food and beverage industry. Today it represents 40 manufacturers and suppliers of low-calorie, low-fat and light foods and beverages, including the manufacturers and suppliers of more than a dozen different dietary sweeteners, fat replacers and other low-calorie ingredients.