Non-Nutritive Sweeteners: What the WHO Guidance Actually Says

Non-nutritive sweeteners, which the World Health Organization calls non-sugar sweeteners, are substances that give food and drink a sweet taste while adding little or no energy. Common examples named by the WHO include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, and stevia and stevia derivatives. They turn up in diet sodas, sugar-free gum, low-calorie yoghurts, tabletop sachets, and countless packaged foods marketed as light, diet, or no added sugar.

In May 2023 the WHO released a guideline that drew a great deal of attention, and it is widely misreported. The headline finding is narrow and carefully worded: the WHO suggests that non-sugar sweeteners not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases. Crucially, the WHO labels this a conditional recommendation based on evidence of low certainty overall, and it does not apply to people who already have diabetes. The guideline is also about whether these sweeteners help with weight and long-term health, not a ruling that approved sweeteners are unsafe. This guide is general and educational. It explains what the WHO actually concluded, why the cautious wording matters, why the observational links to disease are not proof of cause, and where the more useful target really lies.

The essentials at a glance

• The World Health Organization suggests that non-sugar sweeteners not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases (WHO, 2023).
• The WHO calls this a conditional recommendation, based on evidence of low certainty overall; it is not a strong or settled instruction (WHO, 2023).
• The underlying systematic review found no evidence of long-term benefit on body fatness in adults or children, which is why the WHO does not recommend them for weight control (WHO, 2023).
• The WHO also flagged possible undesirable effects from long-term use, such as a higher risk of type 2 diabetes, cardiovascular disease, and death, but described these as low-certainty signals that may be confounded, not proof of cause (WHO, 2023).
• The recommendation applies to almost everyone, but it does not apply to people who already have diabetes, who are outside its scope (WHO, 2023).
• Safety and usefulness are different questions: food-safety regulators such as the United States Food and Drug Administration consider approved sweeteners safe at typical intakes, having set an acceptable daily intake for each, while the WHO guideline is about whether they help with weight and disease (FDA; WHO, 2023).
• The more useful target the WHO points to is reducing the overall sweetness of the diet, including free and added sugars, rather than swapping sugar for a sweetener (WHO, 2023).

What the WHO guideline actually said

The exact wording matters here, because the 2023 guideline is easy to overstate. The recommendation, in the WHO's own words, is that non-sugar sweeteners not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases. The WHO immediately qualifies this in two ways that are part of the recommendation, not footnotes to it.

First, it is a conditional recommendation, and the WHO defines that term precisely: conditional recommendations are those for which the guideline development group is less certain that the desirable consequences of implementing the recommendation outweigh the undesirable ones, so substantive discussion among policy-makers may be required before it is adopted as policy. Second, the recommendation is based on evidence of low certainty overall, drawn from a systematic review of the health effects of higher compared with lower intake of these sweeteners. Low certainty means future research could change the picture. A conditional recommendation built on low-certainty evidence is a cautious nudge, not a firm rule, and treating it as a ban or a settled fact misreads what the WHO published.

The practical reason behind the recommendation is straightforward. The systematic review found no evidence of long-term benefit on measures of body fatness in adults or children. Short-term trials, most lasting three months or less, did show reductions in sugar and energy intake and small drops in weight, but the longer trials did not point to a lasting effect on body weight. In other words, the WHO did not conclude that sweeteners are dangerous so much as that they do not appear to be a useful long-term strategy for losing weight or preventing disease, which is a different and narrower claim.

Safety is a different question from usefulness

Much of the confusion around the WHO guideline comes from blurring two separate questions. The first is whether a sweetener is safe to consume. The second is whether it actually helps with weight or long-term health. These are answered by different bodies looking at different evidence, and they can give different-sounding answers without contradicting each other.

Safety is the domain of food-safety regulators. In the United States, the Food and Drug Administration has approved a set of high-intensity sweeteners as food additives, including saccharin, aspartame, acesulfame potassium, sucralose, neotame, and advantame, and has accepted others, such as certain stevia and monk-fruit extracts, as generally recognized as safe. For each approved additive sweetener the FDA established an acceptable daily intake, which it describes as the amount of a substance considered safe to consume each day over the course of a person's lifetime, and it concluded that even a high consumer's typical intake stays below that level. The European Food Safety Authority runs a comparable approval and acceptable-daily-intake system in the European Union. People with the rare genetic condition phenylketonuria are the standard exception, because they must limit phenylalanine, a component of aspartame.

The WHO's 2023 guideline does not overturn any of that. It does not declare approved sweeteners unsafe, and it is not a product recall or a ban. It addresses the second question, usefulness, and answers that non-sugar sweeteners do not appear to help with long-term weight control or disease prevention. A sweetener can be both safe to consume within established limits and unhelpful as a weight-loss tool. Keeping the two ideas apart is the single most important step in reading the headlines accurately.

Why the disease links are not proof of cause

The part of the guideline that generated the most alarming headlines is the WHO's note about possible undesirable effects from long-term use. The systematic review pointed to a higher risk of type 2 diabetes, cardiovascular disease, and death associated with higher long-term intake of non-sugar sweeteners. It is essential to read what kind of finding that is, because the WHO was careful and the coverage often was not.

Those disease signals come largely from observational studies, which track what happens to groups of people over time but cannot, on their own, establish cause and effect. The WHO described them as potential undesirable effects, used the word may, and noted explicitly that the link observed between sweeteners and disease outcomes might be confounded by the baseline characteristics of the people studied. Confounding is the central problem here. People who consume a lot of low-calorie sweeteners are often already trying to manage their weight or a health condition, so an existing higher risk of diabetes or heart disease can be the reason they reached for sweeteners, rather than a result of using them. Reverse causation of that kind can make a harmless or even helpful behaviour look harmful in the data.

This is why the whole recommendation was rated low certainty and made conditional. A low-certainty observational association is a reason for caution and further research, not a verdict that sweeteners cause disease. Anyone reading that the WHO linked sweeteners to diabetes or heart disease should hold that finding at the strength the WHO actually gave it: a possible signal, drawn from imperfect evidence, that may partly reflect who chooses to use these products.

The more useful target: less sweetness overall

If swapping sugar for a sweetener is not the long-term answer the WHO had hoped to confirm, what is the practical takeaway? The WHO's own framing points away from the sweetener question and toward the broader one: reducing the overall sweetness of the diet, ideally starting early in life. Non-sugar sweeteners are not essential dietary factors and have no nutritional value, so the WHO frames them as one tool among many rather than a solution in themselves.

That puts the real focus back on free and added sugars, which is where the stronger evidence and the clearer guidance sit. Cutting down on sugary drinks, sweetened snacks, and ultra-processed foods reduces both sugar and the constant expectation of intense sweetness, whether that sweetness comes from sugar or a substitute. The companion guide on how much added sugar per day covers what current dietary guidance says about added sugars, and the guide on ultra-processed foods covers why heavily processed products, which are often the main source of both sugar and sweeteners, deserve attention as a category.

None of this is a directive to start or to stop using sweeteners. For some people, a diet drink is a reasonable step down from a full-sugar one while they work on the bigger picture, and the WHO's point is simply that leaning on sweeteners is unlikely to do the long-term work on its own. The durable goal is a dietary pattern that is not built around intense sweetness in the first place, with sugar and sweetener both kept modest, rather than treating a sweetener as a free pass.

Frequently asked questions

Are artificial sweeteners bad for you?

The evidence does not support a simple yes or no. Food-safety regulators such as the United States Food and Drug Administration consider approved sweeteners safe to consume at typical intakes, having set an acceptable daily intake for each. Separately, the World Health Organization's 2023 guideline suggests not using non-sugar sweeteners for weight control or to reduce disease risk, because a systematic review found no long-term benefit on body fat and flagged possible links to type 2 diabetes, heart disease, and death. The WHO stressed that this is a conditional recommendation based on low-certainty evidence, and that the disease links come from observational data that may be confounded, so they are not proof that sweeteners cause harm. The recommendation also does not apply to people with diabetes.

Did the WHO ban aspartame?

No. The World Health Organization has not banned aspartame or any other sweetener. Its 2023 guideline on non-sugar sweeteners is a use recommendation, not a ban or a product recall: it suggests not relying on these sweeteners for weight control or disease prevention, and it explicitly does not declare approved sweeteners unsafe. Aspartame remains approved by food-safety regulators within an acceptable daily intake. A recommendation about whether something helps with weight is a different thing from a safety ban, and the two are easy to confuse in headlines.

Are sugar substitutes good for weight loss?

According to the World Health Organization's 2023 review, non-sugar sweeteners do not appear to help with weight over the long term. Short-term trials showed small reductions in sugar intake and body weight, but longer trials did not point to a lasting effect on body weight, so the WHO suggests not using these sweeteners as a means of weight control. The WHO frames this as a conditional recommendation based on low-certainty evidence, and its broader advice is to reduce the overall sweetness of the diet, including free and added sugars, rather than to rely on a substitute. The companion guide on how much added sugar per day covers the sugar side of that picture.

Do sweeteners cause diabetes or heart disease?

The evidence does not show that they cause these conditions. The World Health Organization noted possible undesirable effects from long-term use, including a higher risk of type 2 diabetes, cardiovascular disease, and death, but it described these as low-certainty signals from observational studies that may be confounded by the baseline characteristics of the people studied. Observational data can show that two things occur together without showing that one causes the other, and people who use a lot of low-calorie sweeteners are often already at higher risk for reasons unrelated to the sweetener. That is why the WHO rated the recommendation low certainty and made it conditional, rather than concluding that sweeteners cause disease.

Does the WHO advice apply to people with diabetes?

No. The World Health Organization stated that the recommendation applies to all people except individuals with pre-existing diabetes, who are outside its scope. The trade-offs are different for someone managing blood sugar, and the guideline did not assess that situation, so people with diabetes should follow advice from their own doctor or dietitian rather than apply this general recommendation to themselves. This is one of the most commonly dropped details when the guideline is summarized.

Is stevia healthier than artificial sweeteners?

The World Health Organization treated stevia and stevia derivatives as non-sugar sweeteners alongside synthetic ones such as aspartame and sucralose, and its 2023 recommendation against using non-sugar sweeteners for weight control applied to the group as a whole rather than singling out any one as healthier. A plant origin does not by itself place a sweetener outside the recommendation. As with the others, stevia extracts are accepted as safe by food-safety regulators at typical intakes, and the WHO's point is about long-term usefulness for weight and disease, not a ranking of one sweetener against another.

Should I switch from diet soda back to regular soda?

Nothing in the World Health Organization's guideline suggests that returning to full-sugar drinks is the goal. The recommendation is not to rely on non-sugar sweeteners for long-term weight control, and the broader advice is to reduce the overall sweetness of the diet rather than to swap one sweet drink for another. A diet drink can still be a smaller-sugar step than a full-sugar one in the short term, but the durable target is fewer intensely sweet drinks of either kind. This is general information, and anyone weighing a specific change for a health reason should discuss it with a doctor or a registered dietitian.

References

1. 1WHO advises not to use non-sugar sweeteners for weight control in newly released guideline (news release, 15 May 2023) · World Health Organization. Accessed 2026-06-14.
2. 2Use of non-sugar sweeteners: WHO guideline (2023) - Recommendation and supporting information; Executive summary (NCBI Bookshelf NBK592246 / NBK592245) · World Health Organization / National Library of Medicine. Accessed 2026-06-14.
3. 3High-Intensity Sweeteners · U.S. Food & Drug Administration. Accessed 2026-06-14.