The not so sweet artificial sweeteners
A new class of addictive white powders
It’s been a few days since we entered 2024, which that means people are still fully committed to their New Year’s resolutions where a huge chunk of them will be relating to health and losing weight. Naturally when people say they’ll go on a diet one of the first things they do is to switch to Diet and No Sugar products, which those typically present with artificial sweeteners and sugar - giving the feel, taste, and sweetness of the original food / drink without the calories associated with sugar. That sound pretty dreamy, but with the good also comes bad.
Aspartame, one of the most popular sweeteners, got quite a bit of attention earlier in 2023 as the International Agency for Research on Cancer (IARC) and the Joint Expert Committee on Food Additives (JECFA) of the WHO and FAO classified aspartame as possibly carcinogenic to humans (Group 2B), especially for hepatocellular carcinoma which is the most common liver cancer. The evidence was limited and the possible mechanism that links it to cancer has not been 100% defined. The FDA did come out and respond that just because it was found to be potentially carcinogenic that does not mean it actually is, and as they undergo rigorous testing for providing the safe levels of consumption it should not be of concern to people. However, in their statement they also said that:
“For example, sweeteners contribute only a few or no calories to the diet and generally will not raise blood sugar levels.”
This technically holds as those sweeteners have a glycemic index (GI) of 0, while sugar’s is 63, meaning a lower blood sugar spike. However, both literature and the WHO have linked artificial sweetener consumption with obesity and type 2 diabetes, as well as increased adipose tissue (which means body fat) [source].
Quite surprisingly sugar consumption has declined in the states which seems a bit contradictory considering what the SAD (standard american diet) is, but artificial sweeteners have increased. Of course, correlation is not causation, and the obesity epidemic is definitely not only due to the consumption of such items, but also the UPF, lack of exercise, hormonal disruptors, and so much more. But evidently, considering that the number of products containing such sweeteners is increasing year on year, then so is the consumption naturally. A long-term study from 1979 to 1988 of over 3,600 participants concluded that artificial sweeteners are actually contributing to the obesity issue, with the increased BMI of those using them being 47% than those who do not.
Another bad consequence with regards to the gut health is their impact on the gut microbiome (source), which is super important for one’s overall physical and mental health. What they actually do is alter the gut microbial communities, leading to glucose intolerance - this was shown for both mice and humans.
A study of the UK Biobank published in BMC Medicine comparing sugar-sweetened, artificially sweetened and naturally sweet juices against mortality in 198,285 participants showed that all-cause mortality was associated with intake of sugar and artificially sweetened beverages. Those consuming more than 2 per day had the highest all-cause mortality risk.
A recent JAMA study looked at the consumption of sugar-sweetened beverages, artificially sweetened beverages, and incidence of liver cancer and chronic liver disease mortality among 98k postmenopausal women followed for a median of 20.9 years. Although both sweetened beverages were associated with an increased risk, the one of artificial sweeteners was not statistically significant.
Another aspect that has been studied is the relationship between the consumption and risk of cardiovascular disease (CVD). A 2023 study showed that overall, higher consumption of sugar-sweetened and artificially sweetened beverages was associated with greater cardiovascular outcomes (HR = 1.27, 95% CI: 1.16-1.40 and RR = 1.16, 95% CI: 1.02-1.33). Similarly, a higher consumption of artificially sweetened beverages was associated with greater cardiovascular outcomes (HR = 1.32, 95% CI: 1.12-1.57). Here high versus low consumption was compared, meaning that both the consumption as well as the volume play a factor in risk and health outcomes. These results were also exhibited in a BMJ study, where they examined each artificial sweetener (aspartame, acesulfame potassium, and sucralose) against overall cardiovascular, coronary heart, and cerebrovascular disease. Consumption of artificial sweeteners was associated with higher CVD (HR=1.09) and cerebrovascular diseases (HR=1.18) which was also statistically significant. For coronary heart disease acesulfame potassium was associated with a 40% (HR=1.40) increase in outcome, which was also statistically significant (p=0.02).
So, evidently artificial sweeteners are not the best when it comes to potential disease risk. Yes, there’s some evidence that’s not conclusive and of course it is difficult to fully account for the food and drink consumption to be accurate in such studies especially when the data is collected retrospectively. That being said, there is also the perspective that these artificial sweeteners are highly addictive, and have even surpassed cocaine rewards in rat models (source). This may also be another reason why companies add artificial sweeteners to their foods, in order to make people ‘addicted to them’. A bit like how UPF messes with the reward system in your brain and makes you crave it more. My 2 cents are, maybe instead of grabbing that diet coke get some water instead, maybe even sparkling.
I hope you enjoyed, see you next week!