Many people consider utilizing artificial sweeteners since high sugar consumption promotes obesity, metabolic syndrome, heart disease, and diabetes. Sugary-drink consumption is linked to early onset colon cancer, inflammatory bowel diseases, and fatty liver.
Many dietitians have long expressed health concerns regarding artificial sweeteners without strong evidence. Now, studies cast a critical eye on artificial sweeteners showing little benefit and even suggesting harm. These artificial sweeteners include sucralose (Splenda), aspartame (Equal), saccharin (Sweet’N Low), and stevia (Truvia).
The Federal Food and Drug Administration considers these sweeteners safe after review of countless studies. These recent studies contradict previous evidence. The only sweetener ever banned by the FDA was sodium cyclamate in 1969 over potential cancer concerns.
The World Health Organization recently made recommendations to avoid artificial sweeteners found in foods and beverages to control body weight, concluding they are ineffective in long-term use and may increase the risks for cardiovascular disease, Type 2 diabetes, and mortality. Importantly, the recommendations do not include diabetics; sugar intake in diabetics is highly associated with increased cardiovascular disease and mortality.
The WHO’s recommendations are considered conditional since the results may be confounded by study-participant characteristics and by its own admission that the opinions are based on “very low- or low-certainty evidence.” Puzzling.
The WHO most recently reported on the association of “possible” increased cancer risks with aspartame. The conclusions appear to be based on sparse and inconsistent evidence and relevant only to unreasonably high consumption. Further, the FDA disagrees with the conclusions.
The WHO recommends eating foods with naturally occurring sugars and reduce the sweetness of your diet. Unrealistic.
A study in the journal Cell suggested modest use of saccharin and sucralose change gut micobiomes leading to small increases in blood glucose levels and modest weight gain. Experts expressed uncertainty regarding the overall health significance of these changes. And a study in The British Medical Journal found a positive association between artificial sweeteners and Type 2 diabetes.
A Journal of the American College of Cardiology investigation demonstrated that high consumers of artificial sweeteners had a higher rate of cardiovascular disease compared to high consumers of sugar. A NutriNet-Sante cohort study showed a 9 percent increased risk of cardiovascular events for subjects consuming modest amounts of artificial sweeteners.
A report in PLOS Medicine found those with the 20 percent highest intake of sweeteners, especially aspartame, were 13 percent more likely than non-consumers to be diagnosed with obesity-related cancers of the colon, breast, and ovaries. The authors expressed concern that much of the increase may be result of other factors.
Most concerning is a Cleveland Clinic study showing an association between stevia and increased cardiovascular events, probably from enhanced blood-clot formation.
Artificial sweeteners may not offer a much healthier option than sugar. Reductions in body fat are minimal. Current studies are somewhat concerning but are far from conclusive as many are underpowered, of sub-optimal study design, or based on non-clinical data. Many are observational rather than randomized-controlled prospective trials; there are undoubtedly confounding factors affecting the results including “reverse causation” wherein high-risk individuals may naturally consume more artificial sweeteners. Studies have conflicting results depending on study-design type. And remember that the WHO reports are based on low-certainty evidence.
My best counsel is to limit sugar consumption, especially sugary drinks. If you are pleased with artificial sweeteners and find them beneficial, continue their use, but consider moderation in amount.
We are on a learning curve. Let’s wait and see.
Richard D. Feldman, M.D. is an Indianapolis family physician and former Indiana State Health Commissioner who served in the administration of Governor Frank O’Bannon.