As a low- or no-calorie substitute for sugar, artificial sweeteners have become increasingly popular. They are found in hundreds of items around the world, especially ultra-processed foods such as artificially sweetened drinks, some snacks, and low-calorie ready meals, and have a global market value of $7,200,000,000.
Researchers are still uncertain as to whether or not artificial sweeteners, or artificially sweetened beverages (ASB), play a causal role in the development of diseases like cardiovascular disease, despite numerous studies linking their consumption to weight gain, high blood pressure, and inflammation (CVD).
Several observational studies have examined the relationship between ASB use and CVD risk, but none of these research has actually quantified the amount of artificial sweetener consumed in the context of a normal diet.
Researchers from the French National Institute of Health and Medical Research (Inserm) and their colleagues analysed data from 103,388 people (mean age 42; 80% female) to learn more about the connections between diet and health.
— Harvard Health (@HarvardHealth) September 9, 2017
The researchers considered a variety of dietary and lifestyle factors, including artificial sweetener use. Since total artificial sweetener intake may be directly associated with an elevated risk of cardiovascular illness, including heart attack and stroke, these data, published in The BMJ, show that artificial sweeteners should not be considered a healthy and safe substitute for sugar.
Repeated 24-hour food diaries were used to evaluate dietary intakes and artificial sweetener consumption, together with a variety of other potentially significant health, lifestyle, and sociodemographic characteristics. Aspartame, acesulfame potassium, and sucralose were analysed alongside other artificial sweeteners found in a variety of foods and drinks.
An average of 42.46 mg/day was ingested by those who used artificial sweeteners; this is roughly equivalent to one packet of tabletop sweetener or 100 mL of diet Coke.
Higher users were more likely to smoke, engage in less physical activity, and adhere to a weight-loss plan compared to those who did not consume as much. They consumed more sodium, red and processed meat, dairy products, and sugar-free beverages while eating fewer calories overall and eating less saturated and polyunsaturated fats, fibre, carbohydrates, fruit, and vegetables. But the researchers accounted for those distinctions in their examinations.
A total of 1502 cardiovascular events occurred over the course of an average follow-up duration of nine years. Among these were cardiac arrest, angina, angioplasty (a treatment used to open up restricted or obstructed coronary arteries), mini-strokes, and strokes.
Total use of artificial sweeteners was connected with elevated cardiovascular disease risk, the study authors concluded (absolute rate 346 per 100,000 person-years in higher consumers and 314 per 100,000 person-years in non-consumers).
The risk of cerebrovascular disease was found to be increased in those who regularly consumed artificial sweeteners (absolute rates 195 and 150 per 100,000 person-years in higher and non-consumers, respectively).
Consumption of aspartame was linked to an increased risk of cerebrovascular events (186 and 151 per 100,000 person-years in higher and non-consumers, respectively), whereas acesulfame potassium and sucralose were linked to an increased risk of coronary heart disease (acesulfame potassium: 167 and 164 per 100,000 person-years; sucralose: 271 and 161 per 100,000 person-years in higher and non-consumers, respectively).
The researchers cannot determine whether or whether additional unmeasured (confounding) factors contributed to the observed associations because this is an observational study.
However, this was a big study that evaluated people’s artificial sweetener intake using accurate, high-quality dietary data, and the results are consistent with previous research that has linked exposure to artificial sweeteners to a variety of health indicators.
They conclude that using artificial sweeteners instead of added sugar has no effect on cardiovascular disease outcomes. They also noted the need for additional prospective cohort studies to confirm these findings and for experimental investigations to explain biological mechanisms.
Meanwhile, they’ve been saying that this study is crucially important for the ongoing re-evaluation of artificial sweeteners by the European Food Safety Authority, the WHO, and other health agencies.
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