A new study suggests a possible link between some sugar substitutes and heart disease. Photo courtesy of National Institutes of Health
Sept. 7 (UPI) -- The potential health woes from artificial sweeteners -- already blamed by some researchers for diabetes, obesity and more -- have expanded to include a possible link between some sugar substitutes and heart disease, a large-scale study published Wednesday suggests.
According to the study's findings which appeared in the British Medical Journal and are being disputed by the International Sweeteners Association, no- or low-calorie food additives are not a healthy, safe alternative to sugar.
In the study, researchers led by the French National Institute for Health and Medical Research found total artificial sweetener intake was associated with a greater risk of overall cardiovascular diseases.
The scientists analyzed artificial sweeteners from all dietary sources, including beverages, table top sweeteners and dairy products, and looked at three types: aspartame, acesulfame potassium and sucralose.
Aspartame was linked to an increased risk of cerebrovascular events, the study indicates, while acesulfame potassium and sucralose were associated with a greater risk of coronary heart disease.
All are among several "high-intensity sweeteners" approved by the Food and Drug Administration, with more expected soon. They are part of a global market estimated at $7.2 billion in 2021 -- and expected to reach $9.7 billion by the end of 2027.
Yet, despite the sugar substitutes' widespread use, they remain controversial, the French researchers said.
They explained that, while several studies have linked consumption of artificial sweeteners or artificially sweetened beverages to weight gain, high blood pressure and inflammation, the findings are inconclusive about the sugar alternatives' role in the development of various diseases, including cardiovascular disease.
Earlier studies have looked into artificially sweetened drinks and the risk of cardiovascular disease, they said, but none measured artificial sweetener intake from a person's overall diet.
So, the investigators analyzed dietary records from 103,000 participants, most of them female, averaging 42 years old. They were drawn from the NutriNet-Santé study, a project launched in France in 2009 to explore the relationship between nutrition and health.
Overall, more than a third -- 37% -- of the study's participants consumed artificial sweeteners, a news release said.
Their average intake was about 42 milligrams daily, equivalent to roughly one individual packet of table top sweetener or 100 milliliters, just shy of 3.5 ounces, of diet soda. So-called "higher consumers" averaged closer to 78 mg. per day.
The International Sweeteners Association, a nonprofit group based in Brussels, Belgium, representing "suppliers and users" of artificial sweeteners, issued a statement Thursday on the French study, saying "there is no causal evidence that low/no calorie sweeteners could increase the risk of cardiovascular diseases."
The group said "the safety of all approved low/no calorie sweeteners has been confirmed by food safety bodies worldwide," including the World Health Organization and the FDA.
Moreover, the association characterized the consumption of low/no calorie sweeteners in the NutriNet-Santé study's population as "extremely low," noting that "experts have questioned the ability to detect an association between artificial sweeteners at such low levels of intake and any health outcome."
The French researchers conceded that when compared to people who didn't take artificial sweeteners, larger users "tended to be younger, have a higher body mass index, were more likely to smoke, be less physically active, and follow a weight loss diet," the release said.
They also ate fewer fruits and vegetables and more "sodium, red and processed meat, dairy products, and beverages with no added sugar."
But the scientists said they took these differences into account in the analysis.
Over a nine-year follow-up period, the study's participants had 1,502 cardiovascular events, including heart attack, angina, transient ischemic attack and stroke.
Some observers pointed to the French study as important, but limited in some respects.
The research is based on large and small consumers of artificial sweeteners within their study's population, not globally -- and the comparative increased risk overall of heart disease between the two groups was in the 10% range -- "not insignificant, but not huge either," said Thomas Galligan, principal scientist for food additives and supplements at the Washington, D.C.-based Center for Science in the Public Interest.
However, Galligan, formerly a toxicologist with the Environmental Working Group, told UPI the center suggests avoiding all three artificial sweeteners analyzed, as well as saccharin, "due to evidence from animal studies suggesting they cause cancer."
The National Cancer Institute finds insufficient evidence of these additives' link to cancer, and Galligan concedes there is "some debate about this within the scientific community."
But he said WHO's International Agency for Research on Cancer has agreed to explore aspartame's possible link to the disease in a review scheduled next June.
Overall, Galligan said the center already concluded there's insufficient evidence that low- and no-calorie sweeteners cause type 2 diabetes or weight gain. He added that the center believes diet beverages are preferable to sugar-sweetened beverages.
"But that's not to say the diet beverage or the treat sweetened with aspartame is the best choice," he said. "We'd rather you swap your diet soda for a glass or water or seltzer or something like that."
For people who choose to consume the no-sugar sweeteners, the center recommends selecting those rated as "safe" in its "Chemical Cuisine" ratings, he added.
The French scientists noted that this is an observational study and cannot establish cause, and the possibility that other unknown factors might have affected their results cannot be ruled out.
So, they said, further studies are needed to confirm their results, but they suggested the new research might provide insights to health agencies confronting the issue of how to make recommendations on artificial sweeteners.
In July, the WHO issued a draft guideline on the health effects of using artificial sweeteners, citing sugar's link to obesity and the need to find ways to reduce its intake -- but suggesting these products should not be used to control weight.
The sweeteners' association responded to WHO's draft guideline, saying the recommendation "may be confusing for people with diabetes for whom low/no calorie sweeteners are a useful dietary aid to manage their carbohydrate and sugar intake."