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food for thought

Participants in the study who had a higher intake of total artificial sweeteners had an increased risk of developing cardiovascular disease compared to non-consumers.NYSE/PEPSICO Handout via Reuters

Artificial sweeteners are added to thousands of foods and beverages – soft drinks, yogurts, pancake syrups, jams, baked goods, frozen desserts, chewing gum, candy – to help us satisfy our sweet tooth with fewer (or zero) calories and no added sugar.

But the effect of artificial sweeteners on body weight and health has long been debated.

Short-term randomized controlled trials have mostly shown that, when substituted for sugar-sweetened beverages, artificially-sweetened drinks help prevent weight gain.

Findings from numerous observational studies, however, suggest that over the long-term, a regular intake of these substances can have harmful effects on cardiometabolic health including increased waist circumference, elevated blood sugar, insulin resistance and inflammation.

Now, new research published in The British Medical Journal adds to growing evidence that a high intake of artificial sweeteners may harm cardiovascular health.

The latest findings

For the study, researchers examined the link between artificial sweetener intake and risk of cardiovascular disease in 103,388 participants enrolled in the NutriNet-Santé study, an ongoing nutrition and health study conducted among adults living in France.

Participants, who were followed for close to a decade, provided three days’ worth of 24-hour diet records, which included brand names of products, at the start of the study and every six months thereafter. The researchers calculated participants’ intakes of total artificial sweeteners (from foods, beverages and tabletop sweeteners), as well as intakes of different types of artificial sweeteners.

Diet soft drinks accounted for half (53 per cent) of artificial sweeteners consumed. Other important contributors were tabletop sweeteners (30 per cent) and flavoured dairy products, such as yogurt and cottage cheese (8 per cent). Aspartame, acesulfame potassium and sucralose represented most of the total artificial sweetener intake.

Participants who had a higher intake of total artificial sweeteners had an increased risk of developing cardiovascular disease compared to non-consumers. The average daily artificial sweetener intake among people classified as “higher consumers” was 77 mg, equivalent to roughly two packets of tabletop sweetener or 200 mL of diet pop.

Aspartame intake was linked to a greater risk of stroke; sucralose and acesulfame potassium were associated with an increased risk of coronary heart disease.

The researchers accounted for several factors tied to cardiovascular risk including age, family history, smoking, physical activity and diet components.

Strengths, caveats

The study’s strengths include its large sample size and high quality dietary data. The researchers collected repeated 24-hour diet records, which are known to be more precise than food frequency questionnaires typically used in nutrition studies.

One limitation of this study is that the findings show correlations only; they don’t establish a cause-and-effect relationship.

As well, it’s possible that some participants assessed as higher consumers at the start of the study had increased artificial sweetener intake in response to having risk factors for cardiovascular disease and may have already been in poorer cardiovascular health.

Artificial sweeteners may activate sweet taste receptors in the gut, which can alter the body’s regulation of blood glucose.Justin Sullivan/Getty Images

How artificial sweeteners may harm

These new findings are consistent with those from several other large observational studies that investigated the association between artificially sweetened soft drinks and cardiovascular disease risk.

There are plausible ways in which artificial sweeteners may increase heart risk. Previous studies have linked artificially sweetened beverages to metabolic syndrome, a collection of risk factors for cardiovascular disease that can include abdominal obesity, elevated blood pressure, high blood triglycerides, increased blood sugar and low HDL (good) cholesterol.

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Artificial sweeteners may also activate sweet taste receptors in the gut, which can alter the body’s regulation of blood glucose.

And experimental studies have shown that some artificial sweeteners alter the composition of the gut microbiome in a direction that can lead to inflammation and glucose intolerance.

What to do?

Due to a lack of consensus on whether the habitual use of non-sugar sweeteners is effective for long-term weight loss, or tied to other long-term health effects, in July the World Health Organization proposed a draft guideline recommending that “non-sugar sweeteners not be used as a means of achieving weight control or reducing the risk of non-communicable diseases.”

If you’re a daily consumer of artificial sweeteners, I do advise cutting back. That doesn’t mean it’s necessary to completely avoid them; there is no evidence that occasional use is harmful.

Replace soft drinks with sparkling water, unsweetened flavoured carbonated water or plain water with a wedge of citrus fruit.

If you add a packet of sweetener to coffee, tea or hot cereal, cut back gradually and incrementally. Ditto for real sugar.

Replace artificially sweetened yogurt with plain yogurt; sweeten it with fruit.

The good news: your taste buds will come to prefer a less sweet taste.

Leslie Beck, a Toronto-based private practice dietitian, is director of food and nutrition at Medcan. Follow her on Twitter @LeslieBeckRD