Maria Burke
Artificial sweeteners could be linked to heart and circulatory diseases and ‘should not be a considered a healthy and safe alternative to sugar’, a major study suggests.
Artificial sweeteners appear in thousands of foods and beverages, representing a £5900m market globally. While acceptable daily intakes for each artificial sweetener have been set by regulators around the world, they remain controversial and are currently undergoing re-evaluation by several health authorities, including the European Food Safety Authority and the WHO.
The study (BMJ 2022; doi: 10.1136/bmj-2022-071204) followed over 103,000 French, mainly female (around 80%) adults for an average of nine years. The researchers assessed dietary intakes and consumption of artificial sweeteners through repeated 24-hour dietary records and accounted for a range of potentially influencing factors. Artificial sweeteners from all dietary sources such as drinks, table-top sweeteners, dairy products and by type – aspartame, acesulfame potassium, and sucralose – were included in the analysis. Around 37% of participants consumed artificial sweeteners, with an average intake of 42.46 mg/day, corresponding to approximately one packet of table-top sweetener or 100mL of diet drink.
Artificial sweeteners were associated with increased risk of cardiovascular, cerebrovascular conditions that affect blood flow to the brain and coronary heart diseases. When researchers looked more closely at specific illnesses, they found consuming artificial sweeteners was linked to a 9% higher risk of heart disease, and an 18% higher risk of cerebrovascular disease. Aspartame, one of the most common sweeteners in the UK, was associated with a 17% increased risk of strokes, according to the study. Acesulfame potassium and sucralose were particularly associated with an increased risk of coronary heart disease.
‘This study is an observational study, and although well designed with a good-sized population group, there are some limitations which the authors highlight,’ says Helena Gibson-Moore of the British Nutrition Foundation. ‘Cardiovascular diseases are complex multifactorial diseases that typically develop over a long period of time with dietary risk factors such as low fibre and fruit and vegetable intakes, higher sodium intakes, and other factors such as high BMI and lower physical activity levels, which are also observed in the higher consumers of low-calorie sweeteners, so it may be higher consumers had an overall poorer diet and lifestyle. The results of the study are interesting; however they are unlikely to indicate a need to change average consumption habits of low calorie sweeteners with regards to cardiovascular risk.’
Kevin McConway, Emeritus Professor of Applied Statistics, The Open University, agrees. ‘The snag in any observational study is that one can never be sure that all the possible factors have been taken account of. That’s why the research paper points out the study can’t entirely establish that the differences in cardiovascular disease rates are caused by differences in consumption of sweeteners. It’s correlation, not necessarily causation.’
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