What Are Artificial Sweeteners
An artificial sweetener is a substance added to foods or drinks in place of sugar. Oftentimes, these artificial sweeteners are much sweeter than table sugar , so a smaller amount of these compounds can be added to achieve the same taste.
Although artificial sweeteners were originally developed in the mid-1900s to alleviate sugar shortages, their primary use in today’s culture is for weight loss. Sugar substitutes like Splenda, Sweet’N Low, Equal, and more can help achieve the same sweet taste while dramatically reducing calories.1
The U.S. Food and Drug Administration , the same organization that regulates food, medications, tobacco products, and more, also regulates and approves artificial sweeteners before they are sold on the market.1,2
Controversial New Study Links Artificial Sweeteners To Cancer Yet Again
Consuming artificial sweetener could increase the risk of developing cancer, a large-scale study suggested Thursday, but experts not involved in the research said it was not enough proof to consider changing current health advice.
Sweeteners are consumed by millions every day in products like diet soda, partly as a way to avoid weight gain from sugar but how healthy these substitutes are themselves has long been a matter of controversy.
To assess the cancer risk of sweeteners, researchers analyzed the data of more than 100,000 people in France who self-reported their diet, lifestyle and medical history in intervals between 2009-2021 as part of the NutriNet-Sante study.
They then compared consumption to the rate of cancer, while adjusting for other variables such as smoking, poor diet, age and physical activity.
The participants who consumed the largest amount of sweeteners, “beyond the median amount, had an increased cancer risk of 13 percent compared to non-consumers,” Mathilde Touvier, research director at France’s INSERM institute and the study’s supervisor, told AFP.
The study, published in the journal PLOS Medicine, said that a higher cancer risk was particularly seen with sweeteners aspartame and acesulfame potassium both used in many soft drinks including Coke Zero.
Out of the 103,000 participants, 79 percent were women and 37 percent consumed artificial sweeteners.
Inclusion Criteria And Exclusion Criteria
The included articles need to meet the following six inclusion conditions: Patients were clinically diagnosed article was published in peer reviewed journals in the English language the article contains initial data on artificial sweetener consumption and cancer risk the article needs to report the number of people using artificial sweeteners the outcomes were quantitative data that could be extracted or calculated and only include casecontrol studies. The following three exclusion criteria were applied: We excluded studies that did not provide initial data, animal studies, in vitro studies, reviews, letters, personal opinions, book chapters, and conference abstracts only show the consumption of drinks containing artificial sweeteners and studies that full paper copy were not available. Two investigators independently reviewed the literature, extracted all potentially eligible studies, and resolved uncertainty and disagreement by discussion .
FIGURE 1
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Early Studies About Sugar Substitutes And Bladder Cancer
In the late 1960s and early 1970s, studies were performed on rats to determine the effect of artificial sweeteners, specifically, early artificial sweeteners like cyclamate and saccharin.1
In these studies, results pointed toward an association between artificial sweetener consumption and the development of bladder cancer, specifically in male rats. This evidence led to the banning of cyclamate in 1969 and the addition of saccharin to the U.S. National Toxicology Program’s Report on Carcinogens in 1981, indicating that it had the potential to be a carcinogen. Results from these studies and the FDA’s past actions against these early sweeteners have allowed this myth to continue circulating today.1,2
Do Artificial Sweeteners Cause Cancer In People
In the years following these studies, it was determined that the results were not applicable to humans. The development of cancer in humans and rats relies on different mechanisms and are different processes. Studies involving human consumption of these artificial sweeteners did not demonstrate the same effects as those on the rats.1
Saccharin, now Sweet’N Low, was delisted from the Report on Carcinogens in 2000, after extensive research. Although cyclamate was not found to be a carcinogen, nor a co-carcinogen , it is still currently banned by the FDA for reasons unrelated to cancer development.1
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Artificial Sweeteners And The Risk Of Gastric Pancreatic And Endometrial Cancers In Italy
Requests for reprints:
Grant support: This work was conducted with the contribution of the Italian Association for Cancer Research, and the Italian League Against Cancer.
Requests for reprints:
Cristina Bosetti, Silvano Gallus, Renato Talamini, Maurizio Montella, Silvia Franceschi, Eva Negri, Carlo La Vecchia Artificial Sweeteners and the Risk of Gastric, Pancreatic, and Endometrial Cancers in Italy. Cancer Epidemiol Biomarkers Prev 1 August 2009 18 : 22352238.
There Is Still No Conclusive Evidence That Artificial Sweeteners Cause Cancer
Even systematic reviews of studies involving artificial sweeteners, meaning reviews of the results found from a variety of studies across many years, have yet to find conclusive evidence that artificial sweeteners are directly responsible for or contribute to cancer development.2
Some individual studies have pointed toward associations between artificial sweeteners and certain types of cancer. However, these are generally unsupported by additional research and do not take into account other potential variables. As an example, many individuals using artificial sweeteners are doing so to lose weight.2
Obesity is a known risk factor for cancer development, and it may be the individual’s weight, rather than their use of an artificial sweetener that could be contributing to this association.2
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What Have Studies Shown About A Possible Association Between Specific Artificial Sweeteners And Cancer
Saccharin
Studies in laboratory rats during the early 1970s linked saccharin with the development of bladder cancer, especially in male rats. However, mechanistic studies have shown that these results apply only to rats. Human epidemiology studies have shown no consistent evidence that saccharin is associated with bladder cancer incidence.
Because the bladder tumors seen in rats are due to a mechanism not relevant to humans and because there is no clear evidence that saccharin causes cancer in humans, saccharin was delisted in 2000 from the U.S. National Toxicology Programs Report on Carcinogens, where it had been listed since 1981 as a substance reasonably anticipated to be a human carcinogen . More information about the delisting of saccharin is available in the Report on Carcinogens, Fourteenth Edition.
Aspartame
Aspartame, distributed under several trade names , was approved in 1981 by the FDA after numerous tests showed that it did not cause cancer or other adverse effects in laboratory animals.
A 2005 study raised the possibility that very high doses of aspartame might cause lymphoma and leukemia in rats . But after reviewing the study, FDA identified many shortcomings in it and did not alter its previous conclusion that aspartame is safe. In 2005, the National Toxicology Program reported that aspartame exposure did not cause tumors in or affect the survival of two types of genetically modified mice .
Sucralose
Acesulfame potassium, Neotame, and Advantame
Cyclamate
Newer Sugar Substitutes With No Link To Bladder Cancer
In addition to the investigation of these artificial sweeteners, studies have been performed on newer artificial sweeteners as they are being developed as well.
The FDA has not approved any newly developed artificial sweetener for the market unless numerous safety studies were completed, including studies that investigated the potential association of a sweetener and cancer development. Sweeteners that made it to the market and showed no signs of being a carcinogen include, but are not limited to:1
- Aspartame – Equal, Nutrasweet
- Acesulfame – ACK, Sunett, Sweet One
- Neotame – a product similar to aspartame and made by Nutrasweet
- Advantame – a product similar to aspartame and made by Ajinomoto
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Sugar packets via Shutterstock
Artificial sweeteners present a conundrum for many people. They cut calories and sugar intake, but attention-grabbing articles come out with some frequency linking them to cancer and other heath problems. Its enough to turn your morning coffee order from a simple task to an indecision-riddled dilemmabut experts say it doesnt have to.
Caroline Apovian, director of the Nutrition and Weight Management Center at Boston Medical Center and a professor at Boston University Medical School, says that, despite what you may have heard, no concrete research has shown a link between artificial sweeteners and human cancer. The National Cancer Institute has weighed in on this, Apovian says. There is no scientific evidence that any of the artificial sweeteners approved in the United States cause cancer in humans.
Apovian says many people associate artificial sweeteners with cancer because of studies that took place in the 1970s linking sweeteners with bladder cancer in male rats, studies that Apovian says shed little light on their effect on humans and were conducted using extremely high doses of the substances. Sometimes you can use animal studies to extrapolate what happens in humans, but you have to know the model youre using, she explains. Male rats had a higher risk of developing bladder cancer than humans anyway, but people still have in mind, all these years later, that artificial sweeteners cause cancer.
Can Artificial Sweeteners Cause Cancer
A direct association between artificial sweeteners and cancer has been disproven recently by the US Food and Drug Administration, but is it still a factor because these products can lead to weight gain?”
Artificial sweeteners are used as a replacement for sugar in food and drinks, as they are very sweet and contain fewer kilojoules . There are several types of artificial sweeteners, including aspartame, sucralose, cyclamate and saccharin. The evidence suggests that artificial sweeteners found in diet drinks and some foods are unlikely to cause cancer.
Saccharin is used in tablets that substitute for sugar and is sometimes contained in diet soft drinks from fountain dispensers to help extend shelf life. In rats, high doses of saccharin have been shown to cause the formation of bladder stones that can lead to bladder cancer. However, saccharin consumption does not appear to cause the formation of bladder stones in humans. If saccharin does increase cancer risk in humans, it would be at doses many times greater than amounts typically consumed.
Large population studies have not reported increases in bladder cancers among people using saccharin, and the US National Toxicology Program has removed it from the list of established human carcinogens. In Australia, Food Standards Australia New Zealand sets acceptable levels for all types of additives including artificial sweeteners. These levels are regularly reviewed and adjusted by FSANZ.
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Sources And Methods Of Data Retrieval
We searched the PubMed, Cochrane library, Web of Science, and EMBASE databases from the inception dates to April 2021. The following terms were used to identify published literature evaluating the effect of artificial sweeteners on cancer: artificial sweetener, non-nutritive sweeteners, aspartame, saccharin, cyclamate, stevia, sucralose, acesulfame, cancer, and tumor. The term OR was used as the set operator to combine different sets of results. The literature search was limited to English language and human subjects.
Should I Avoid Artificial Sweeteners
The decision to consume products with artificial sweeteners is a personal one and may be done for a variety of reasons or under the guidance of an expert. Suggesting to an individual, especially one who has been diagnosed with bladder cancer, that the use of artificial sweeteners is what caused their cancer is not true and can be frightening to hear.
Although there is still much to be learned about what causes cancer and how we can potentially treat and prevent it, this is one myth that is better left uncirculated.
Which myth should we tackled next? Let us know in our forums!
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Is There An Association Between Artificial Sweeteners And Cancer
Questions about artificial sweeteners and cancer arose when early studies showed that cyclamate in combination with saccharin caused bladder cancer in laboratory animals. However, results from subsequent carcinogenicity studies of these sweeteners have not provided clear evidence of an association with cancer in humans. Similarly, studies of other FDA-approved sweeteners have not demonstrated clear evidence of an association with cancer in humans.
What Are Artificial Sweeteners And How Are They Regulated In The United States
Artificial sweeteners, also called sugar substitutes, are substances that are used instead of sucrose to sweeten foods and beverages. Because artificial sweeteners are many times sweeter than table sugar, much smaller amounts are needed to create the same level of sweetness.
Artificial sweeteners are regulated by the U.S. Food and Drug Administration . The FDA, like the National Cancer Institute , is an agency of the Department of Health and Human Services. The FDA regulates food, drugs, medical devices, cosmetics, biologics, tobacco products, and radiation-emitting products. The Food Additives Amendment to the Food, Drug, and Cosmetic Act, which was passed by Congress in 1958, requires the FDA to approve food additives, including artificial sweeteners, before they can be made available for sale in the United States. However, this legislation does not apply to products that are generally recognized as safe. Such products do not require FDA approval before being marketed.
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Artificial Sweeteners And Human Bladder Cancer
- Show footnotesHide footnotesAuthor Footnotes1 The following sixteen co-authors took part in this collaborative study: MARGARET CHILD, Atlanta Surveillance Center THOMAS J. MASON, MAX MYERS, and DEBRA SILVERMAN, National Cancer Institute DONALD AUSTIN, California State Department of Health RONALD ALTMAN and ANNETTE STEMHAGEN, New Jersey State Department of Health KENNETH CANTOR, Envirronmental Protection Agency AMBATI NARAYANA, University of Iowa DAVID THOMAS, Fred Hutchinson Cancer Research Center, Seattle, Washington CHARLES KEY, University of New Mexico J. W. SULLIVAN, Louisiana State University Medical Center DEE WEST, University of Utah MARIE W. SWANSON, Michigan Cancer Foundation J. WISTER MEIGS and LARAINE D. MARRETT, Yale University.
Associations Between Intakes Of Artificial Sweeteners And Cancer Risk
During follow-up , 3,358 incident cancer cases were diagnosed . Average age at diagnosis was 59.5 ± 12.2 years.
Artificial sweetener intake was positively associated with the risk of overall cancer . In particular, higher cancer risks were observed for aspartame and acesulfame-K . Increased risks were observed for breast cancer and obesity-related cancers . Overall, the same direction of association was observed in pre- and postmenopausal women . Heterogeneity tests showed no difference between pre- and postmenopausal models for total artificial sweeteners, aspartame, and acesulfame-K . P for heterogeneity was 0.015 for sucralose, but associations with cancer risk were non-significant in both strata for this food additive, with a low number of consumers per strata. No association was found with prostate cancer . Forest plots in Fig B in S1 Appendix present both minimally and fully adjusted associations, showing similar results. Results for competing risk analyses are presented in Result A in S1 Appendix.
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Risk Of Bias Within Individual Studies
The methodological quality for the selected literature was evaluated independently by two investigators according to the NewcastleOttawa scale . The NOS contains eight items, categorized into three dimensions including selection, comparability, and outcome or exposure . Each quality item has one star, and a study can get nine stars at most. The investigators resolved inconsistencies by discussion and consensus.