Earlier this month, CFA submitted comments on the U.S. Food and Drug Administration’s (FDA’s) proposed rule to change which foods can be labeled or marketed as “healthy” by food companies. The proposed rule mostly does a good job of drawing the line between healthy and unhealthy foods, but it misses an opportunity to educate consumers about artificial sweeteners.

Since 1994, FDA has prohibited companies from calling a food “healthy”—or “healthful,” “good for health,” etc.—if the food lacks certain specified nutrients, or if it has too much added sugar, sodium, or saturated fat. One problem with the current definition: it excludes many foods that most nutritionists would characterize as “healthy.” For example, salmon cannot bear a “healthy” claim because of its high fat content. Another problem is that the current rule allows “healthy” claims on foods that most nutritionists would agree are not good for you, like sugary vitamin fortified cereals. The new rule attempts to fix these problems by replacing criteria based on minimum nutrient values—which gave companies an incentive to fortify foods with vitamins and minerals—with criteria based on the food groups defined in the 2020-2025 Dietary Guidelines for Americans (DGAs), namely: vegetables, fruits, grains, dairy, protein foods, and oils. So, for example, the rules allow cereals to bear a “healthy” claim if they meet a minimum threshold for whole grains, but not for vitamins.

The new rule also continues to exclude foods that are high in sodium and saturated fat—with an exception for saturated fats in nuts and seeds. And the rule continues to exclude foods that are high in added sugars, but it does not exclude foods that are high in added sweeteners, such as aspartame, acesulfame potassium, sucralose, and stevia extract. This omission opens the door to misleading claims insofar as foods made with artificial sweeteners are unhealthy.

“Unhealthy for whom?,” you may be asking yourself. The broadest consensus holds that children under 2 years of age should not consume artificially sweetened foods. According to the DGAs, “high-intensity [i.e., artificial] sweeteners are not recommended for children under 2” because “[t]aste preferences are being formed during this time period, and infants and young children may develop preferences for overly sweet foods if introduced to very sweet foods during this timeframe.” Caregivers often feed “adult” foods to children, and this fact alone arguably supports banning “healthy” claims on artificially sweetened foods.

But the evidence also indicates that artificial sweeteners are bad for adults. Last year, a large scale prospective cohort study of over 100,000 adults in France found “a potential direct association” between higher artificial sweetener consumption (especially aspartame, acesulfame potassium, and sucralose) and increased cardiovascular disease risk.” According to the study, sweetener consumption was linked to a 9 percent increase in risk of cardiovascular disease, and an 18 percent risk of stroke.  Sweeteners may cause these ill health effects in part by interfering with the metabolic process. In a randomized-controlled trial encompassing 120 healthy adults, also conducted last year, subjects who were administered various sweeteners for 2 weeks—in doses lower than FDA’s acceptable daily intake—had “impaired glycemic responses” compared with controls given sugar or nothing at all.

This research raises serious concerns because low-calorie sweeteners have become ubiquitous in the food supply, with over 25 percent of children now estimated to be consuming these ingredients as part of their normal diet. The concerns have led some public health authorities to reexamine policies on sweeteners. New York City, for example, has banned low-calorie sweeteners from all food and beverages at “sites serving a majority of children age 18 or younger.”

Ultimately, “healthy” claims are marketing claims, designed not so much to inform consumers as to sell food products. After all, many of the healthiest foods, such as fresh fruit and vegetables, have no labels at all, or minimal labeling. “Healthy” claims may lead to excessive consumption of “healthy”-labeled products, at the expense of unlabeled, healthier alternatives. They are also simplistic, as dietary needs are specific to each individual, and “healthy claims” may deter consumers from looking further into a product’s nutritional content.  Because of these inherent deficiencies, CFA has urged FDA to abandon development of a “healthy” icon in favor of a comprehensive front-of-package labeling system that identifies which foods are unhealthy.

In the meantime, FDA should take a conservative stance in defining misleading and deceptive “healthy” marketing claims. “Healthy” claims should not apply where the evidence suggests a food product may cause significant health problems, and the evidence against artificially sweetened foods is substantial, and growing.