A study published in “The BMJ” warns of a possible direct association between the consumption of artificial sweeteners and an increased risk of cardiovascular diseases, such as heart attack or stroke.
The findings suggest that these additives, consumed daily by millions of people and present in thousands of foods and beverages, should not be considered a healthy and safe alternative to sugar, in line with the current position of various health agencies such as the World Health Organization. Health (WHO).
Sweeteners are an alternative, increasingly common, with few or no calories to sugar. They are found in thousands of products, especially ultra-processed foods such as sugary drinks or low-calorie ready meals.
Multiple studies have linked consumption of these sweeteners or artificially sweetened beverages to weight gain, high blood pressure, and inflammation; however, the role of artificial sweeteners in causing other diseases, including cardiovascular disease, remains undefined.
What’s more, some observational studies have used sweeteners as an indicator of heart disease risk, but none have evaluated artificial sweetener intake from the overall diet.
Now, a team of researchers from the French National Institute for Health and Medical Research (Inserm) has analyzed data from 103,388 participants in the NutriNet-Santé study, launched in France in 2009, to investigate the relationships between nutrition and health.
The study looked at diet and artificial sweetener consumption using repeated 24-hour records; Likewise, a series of potentially influential sociodemographic and lifestyle factors were assessed.
Researchers found that total sweetener intake was associated with an increased risk of cardiovascular disease
Artificial sweeteners from all dietary sources (beverages, tabletop sweeteners, dairy products, etc.) and by sweetener type (aspartame, acesulfame potassium and sucralose).
Artificial sweeteners were consumed by 37% of the participants, with an average intake of 42.46 mg/day, which roughly corresponds to an individual packet of tabletop sweetener or 100 ml of soft drinks.
Compared with non-consumers, those who consumed the most sweeteners were younger, had a higher body mass index, were more likely to smoke, be less physically active, and were more likely to diet to lose weight.
Likewise, this group had a lower total energy intake, but also a lower consumption of alcohol, saturated and polyunsaturated fats, fiber, carbohydrates, fruits and vegetables, and higher sodium, red and processed meat, dairy products and drinks without added sugar.
LoThe researchers took these differences into account in their analyses..
During an average follow-up of nine years, there were 1,502 cardiovascular events: heart attack, angina, angioplasty (a procedure to widen blocked or narrowed arteries in the heart), transient ischemic attack, and cerebrovascular accident or stroke.
The researchers found that total sweetener intake was associated with an increased risk of cardiovascular disease. Specifically, the study notes that artificial sweeteners were especially associated with the risk of cerebrovascular disease.
When the different types of sweeteners were analyzed, the research found that aspartame intake was associated with an increased risk of cerebrovascular events, while acesulfame potassium and sucralose were associated with an increased risk of coronary heart disease.
Although this is an observational study, so it cannot establish cause, and the researchers cannot rule out the possibility that other unknown (confounding) factors may have affected their results, it is a large study that evaluated dietary intake. of people’s artificial sweeteners using accurate, high-quality dietary data, and the findings are in line with other studies linking exposure to artificial sweeteners with various markers of poor health.
Aspartame was associated with an increased risk of cerebrovascular events, while acesulfame potassium and sucralose with coronary heart disease
However, a recent study by researchers at the Weizmann Institute of Science and published in the journal Cell showed that artificial sweeteners and sugar substitutes have an impact on the human body. In fact, some may influence the trillions of microorganisms that reside in our intestines and regulate our blood sugar levels by altering the microbiomes of human consumers. Also, different people respond to sweeteners in very different ways..
The data is in line with a study presented in 2018 that showed that artificial sweeteners change the way in which the body processes fats and obtains its energy. And also, that acesulfame-k, a very common sweetener in ‘diet’ soft drinks, accumulates in the blood and, beyond a certain threshold, causes damage to the cells that form the walls of blood vessels.
There is no evidence of a plausible mechanism to support the potential effects of low or no calorie sweeteners on cardiometabolic health.
International Sweeteners Association
The French researchers acknowledge that more prospective cohort studies are needed to confirm these results and experimental studies are needed to clarify biological pathways, they add.
In the meantime, they suggest their study provides key insights into the context of the re-evaluation of artificial sweeteners currently being carried out by the European Food Safety Authority, the WHO and other health agencies.
For the Professor of Nutrition and Dietetics at the Faculty of Medicine of the Complutense University, Jesús Román, it is a very powerful epidemiological study, but it cannot determine which compound is the most harmful. Now, he points out, “it’s becoming increasingly clear that substance abuse is unhealthy.”
For this reason, he points out, its consumption must be «restricted» and be reduced for special situations during certain periods of time.
It is becoming increasingly clear that substance abuse is unhealthy
Román warns that, contrary to what happens in France, where most of the consumption is made in table sweeteners, “in Spain the majority come from sugary drinks.”
The problem, he says, is the mixture, but it is very difficult to know which is the most harmful. In addition, in animal tests all components have been shown to be safe.
In ABC Salud statements, the International Sweeteners Association (ISA) highlights that, contrary to what is stated in the study, “there is no causal evidence that low/no-calorie sweeteners can increase the risk of cardiovascular diseases.”
From ISA it is emphasized that there is no evidence of “a plausible mechanism to support the potential effects of low- or no-calorie sweeteners on cardiometabolic health”, and recalls that the safety of all approved low-calorie or no-calorie sweeteners has been confirmed by food safety agencies around the world.
Furthermore, they state that there are “randomized controlled trials confirming that low-calorie or no-calorie sweeteners have no adverse effects on cardiometabolic risk factors, such as blood pressure, lipid levels, blood glucose, and body weight, and indeed some benefits when used to replace sugars in the diet.”
And they add that observational studies cannot establish a “rrelationship of cause and effect due to its observational nature and the inability to exclude residual confounding or, more importantly, attenuate the effects of reverse causality.”