The study, published Sept. 7 in The BMJ journal, included over 103,000 French adults who participated in a web-based nutrition study. The average age of participants at the start was 42 years and almost 80% were female.
At the start of the study, people filled out questionnaires about their diet, health, physical activity, and personal information such as education, smoking status, and occupation.
They also completed multiple dietary assessments at the beginning of the study and every 6 months afterwards. During these dietary recalls, they were asked to report every food and beverage they consumed over a 24-hour period.
This provided researchers with a detailed estimate of people’s consumption of artificial sweeteners from all sources, as well as their intake of fruits, vegetables, dairy products, red meat, and other types of foods or nutrients.
People also reported on new health events, medical treatments, and examinations — including ones related to cardiovascular diseases, such as heart disease, heart attack, and stroke.
Overall, 37% of participants consumed artificial sweeteners in some form. On average, these people consumed about 42 milligrams per day, equivalent to one individual packet of tabletop sweetener or 100 millilitres of diet soda.
The average intake of artificial sweeteners for “high consumers” was around 78 milligrams per day; for “low consumers” it was around 8 milligrams per day. There was also a group of people who didn’t consume any artificial sweeteners.
People who consumed higher amounts of artificial sweeteners tended to be younger, have a higher body mass index (BMI), and were more likely to smoke, be less physically active and follow a weight-loss diet.
They also consumed fewer calories overall, and less alcohol, saturated and polyunsaturated fats, fibre, carbohydrates and fruits and vegetables; and consumed higher amounts of sodium, red and processed meats and dairy products.
Researchers took into account these differences, as well as other factors such as age, sex, physical activity, education, smoking status, and family history of cardiovascular disease.
“After the adjustment [for these], there is still a signal that there appears to be increased cardiovascular events in those reporting increased use of artificial sweeteners,” said Dr. Elizabeth H. Dineen, a cardiologist at the Susan Samueli Integrative Institute at UCI Health in Orange County, Calif. Dineen was not part of the research.
People who ate the most artificial sugar also had an 18% higher risk of stroke or another type of cerebrovascular disease compared to non-consumers.
In addition, higher consumers of aspartame had an increased risk of cerebrovascular disease; and higher consumers of acesulfame potassium and sucralose had a higher risk of coronary heart disease.
The dietary assessments recorded people’s intake of other types of artificial sweeteners — including plant-based stevia — but participants consumed too little of these for researchers to include them in their analysis.
Given the results of the study, artificial sweeteners “should not be considered a healthy and safe alternative to sugar,” they wrote, especially with the “extensive use of these substances in products on the global market.”
Dineen said the study was well-done, but there are certain limitations. One is that it’s an observational study, so the researchers can’t prove a causal link between artificial sweeteners and cardiovascular disease.
Reference:
Debras C, Chazelas E, Srour B, Druesne-Pecollo N, Esseddik Y, Szabo de Edelenyi F, et al. (2022) Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study. PLoS Med 19(3): e1003950. https://doi.org/10.1371/journal.pmed.1003950