Cancer warning: Artificial sweeteners may be associated with increased risk after all

Trisha Goddard discusses her breast cancer in 2018

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Artificial sweeteners are low-calorie or calorie-free chemicals which are used as a substitute for sugar in the sweetening of food and drinks. They can be found in thousands of different products, from drinks and desserts to cakes, chewing gum and even toothpaste. According to the European Food Safety Authority, the use of artificial sweeteners can be beneficial in helping to improve oral health by reducing the risk of tooth decay, as well as in helping to control blood sugar levels. Both Cancer Research UK and the US National Cancer Institute have asserted that there is “strong evidence” that artificial sweeteners are safe for human consumption — but, despite this, fears continue that there may be a connection between sugar substitutes and cancer.

The latest research was undertaken by nutritional epidemiologist Charlotte Debras of the Sorbonne Paris North University and her colleagues.

They said: “Our findings do not support the use of artificial sweeteners as safe alternatives for sugar in foods or beverages and provide important and novel information to address the controversies about their potential adverse health effects.

“These results need to be replicated in other large-scale cohorts and [the] underlying mechanisms clarified by experimental studies.”

However, they added, the findings do “provide important and novel insights for the ongoing re-evaluation of food additive sweeteners by the European Food Safety Authority and other health agencies globally”.

In their work, the researchers analysed health data on 102,865 French adults who volunteered to participate in the so-called “NutriNet-Santé” study into diet, nutrition and health that was launched back in 2009.

Subjects who enrol in the study do so online and self-report data on their diet, health, lifestyle, medical history and sociodemographic status.

The researchers extracted information on each participant’s intake of artificial sweeteners from 24-hour dietary records and then compared this with records of cancer diagnoses.

They also accounted for a range of other variables that could play a role in cancer risk, including age, body mass index, levels of physical activity, other dietary habits and sex.

The researchers found that participants who reported consuming larger quantities of artificial sweeteners — in particular aspartame and acesulfame-K — appeared to have a 13 percent higher risk of developing cancer overall than those who never consumed sugar substitutes.

In particular, the team said, the sweeteners were associated with a higher risk of both breast cancer and obesity-related cancers.

Ms Debras said: “Results from the NutriNet-Santé cohort suggest that artificial sweeteners found in many food and beverage brands worldwide may be associated with increased cancer risk.”

This conclusion, she explained, is in line with several previous experimental studies on the impact of artificial sweeteners.

Ms Debras added: These findings provide novel information for the re-evaluation of these food additives by health agencies.”

The researchers did caution, however, that their study has several important limitations that will need to be addressed in future studies.

The principal of these potential issues is that the dietary habits of the participants in the study were all self-reported.

In addition, the team noted, the demographics of the NutriNet-Santé cohort is skewed towards women, those with higher education levels and those that exhibit health-conscious behaviours.

Geneticist and epidemiologist Dr Michael Jones of The Institute of Cancer Research, London, said: “This large observational study of over 100,000 adults in France links the use of artificial sweeteners to cancer risk. However, the current consensus, according to the US National Cancer Institute, is that there is no clear evidence that artificial sweeteners cause cancer in humans — although there is frequent re-evaluation of the available evidence by food safety health authorities.

“The link between artificial sweeteners and cancer reported in this study does not imply causation — it is not proof that artificial sweeteners cause cancer.

“The types of people who use artificial sweeteners may be different in many ways to those who do not, and these differences may partly or fully explain the association. The authors used statistical methods to try to make allowance for these differences but they admit there could be other reasons for the association between artificial sweeteners and cancer risk.

“Some limitations of the study are that the authors had to exclude 15 percent of participants from the analysis because of under-reporting, and artificial sweetener use was not measured directly, but came from 24-hour dietary records linking food brands with information from food content databases.

“In addition, the ‘dose-response’ relationship was not strong. For some results, risk of cancer was higher in the lower consumer group than the higher consumer group, despite higher consumers reporting 10 times the total artificial sweetener consumption than lower consumers.

“This also suggests that cancer risk may be raised in the type of person who uses artificial sweetener rather than the sweetener itself.”

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Cancer Research UK’s senior health information manager, Fiona Osgun, said: “This large study suggested there’s an association between some artificial sweeteners and cancer, but that doesn’t mean they cause it or that people need to avoid them.

“While the researchers have tried to find out what people were eating and account for other factors that could affect cancer risk, this is a single study that relies largely on self-reports.

“What we eat and drink overall is much more important than one single element of our diet — so aim to eat more fruit, veg and wholegrains, and cut back on red and processed meats and foods high in fat, sugar and salt.”

Food Standards Agency head of food additives, flavourings and food contact materials, Adam Hardgrave, said: “All food additives are subject to an extensive safety assessment before they are authorised for the market.

“We keep all approved additives under review and will reassess them if new evidence emerges to suggest concerns.”

A European Food Safety Authority (EFSA) spokesperson said: “EFSA is re-evaluating all food additives on the market, including artificial sweeteners, that were permitted for use in the EU as of 20 January 2009. We launched an open call last year for additional data on sweeteners, including acesulfame K (E 950) and sucralose (E 955), for which the deadline for submissions is 31 March and 30 November respectively. EFSA’s experts will subsequently complete their safety evaluations after a thorough assessment of all the available data.

“EFSA’s experts have assessed the validity of numerous specific health claims related to sweeteners and found that the evidence supports the claim that they maintain healthy teeth when consumed instead of sugars.

“Separately, EFSA published a scientific opinion at the end of February on sugars in the diet and their potential links to health problems. EFSA’s experts concluded that consumption of added and free sugars should be as low as possible as part of a nutritionally adequate diet.

“Sugar consumption is a known cause of dental caries. Evidence also links ― to varying degrees of certainty ― consumption of sugar-sweetened beverages, juices and nectars with various chronic metabolic diseases including obesity, non-alcoholic fatty liver disease, and type 2 diabetes.”

The full findings of the study were published in the journal PLOS Medicine.

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