Researchers Find Link Between Artificial Sweeteners and Heart Disease

A sizable research of French individuals, which was published on September 7 in The BMJ, found a probable direct link between higher artificial sweetener usage and increased cardiovascular disease risk, including heart attack and stroke.

Millions of people everyday eat these food additives, which can be found in countless foods and beverages. According to the findings, these artificial sweeteners should not be viewed as a secure and healthy substitute for sugar, which is in accordance with the existing stance of many health organizations.

Artificial sweeteners are frequently employed as calorie-free or low-calorie substitutes for sugar. They are present in millions of items around the world and have a global market value of $7.2 billion (£5.9 billion; €7.0 billion). They are particularly prevalent in highly processed foods including artificially sweetened beverages, some snacks, and ready meals with less calories.

Artificial sweeteners and artificially sweetened drinks (ASB) have already been linked in several studies to weight gain, high blood pressure, and inflammation. However, evidence about how artificial sweeteners contribute to the development of many diseases, such as cardiovascular disease, is still fragmented (CVD). Furthermore, a number of observational studies have utilized ASB use as a proxy to examine CVD risk, but none have quantified the total intake of artificial sweeteners in the diet.

A group of researchers from the French National Institute for Health and Medical Research (Inserm) and colleagues used data from 103,388 participants of the online NutriNet-Santé study (average age 42 years; 80% female) to further explore this. This ongoing investigation, which was started in France in 2009, looks at the connections between nutrition and health.

Dietary intakes and artificial sweetener usage were evaluated using several 24-hour dietary records. Numerous potentially important sociodemographic, lifestyle, and health aspects were considered.

The analysis includes aspartame, sucralose, and acesulfame potassium as artificial sweeteners from all dietary sources (beverages, dairy products, tabletop sweeteners, etc.).

37% of individuals used artificial sweeteners in total, with a daily intake average of 42.46 mg. This is equivalent to around 100 mL (3.4 ounces) of diet Coke or one packet of tabletop sweetener.

The average daily intakes for lower and higher consumer groups among participants who drank artificial sweeteners were 7.46 and 77.62 mg, respectively.

Higher consumers were more likely to be younger, less physically active, have higher body mass indices (BMI), smoke, and adhere to weight loss diets when compared to non-consumers. Additionally, they consumed less total energy and less alcohol, carbohydrates, saturated and polyunsaturated fats, fiber, fruit, and vegetables while consuming more sodium, red and processed meat, dairy products, and non-sugary beverages. However, the researchers considered these variations in their analysis.

An average of nine years of follow-up resulted in 1,502 cardiovascular events. They included transient ischemic attack, stroke, angina, and angioplasty (a technique to widen blocked or restricted arteries to the heart).

The researchers discovered that consuming artificial sweeteners in their entirety was linked to a higher risk of cardiovascular disease (absolute rate 346 per 100,000 person-years in higher consumers and 314 per 100,000 person-years in non-consumers).

Artificial sweeteners had a stronger link to the risk of cerebrovascular illness (absolute rates 195 and 150 per 100,000 person-years in higher and non-consumers, respectively).

Acesulfame potassium and sucralose were linked to an increased risk of coronary heart disease, but aspartame consumption was linked to an increased risk of cerebrovascular events (186 and 151 per 100,000 person-years in higher and non-consumers, respectively) (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).

This study is an observational one, thus cause cannot be established. Furthermore, the researchers cannot completely rule out the potential that additional unidentified (confounding) factors may have impacted their findings.

However, this was a sizable study that assessed people's consumption of artificial sweeteners using accurate, high-quality dietary data. The results are consistent with past research that have linked exposure to artificial sweeteners with a number of signs of ill health.

Accordingly, the researchers claim that their findings imply that there is no benefit to using artificial sweeteners instead of additional sugar on the outcomes of CVD.

They note that additional prospective cohort studies are necessary to corroborate these findings and that experimental research are necessary to understand biological processes.

In the interim, they contend that this research offers crucial insights into the context of the re-evaluation of artificial sweeteners being conducted by the European Food Safety Authority, the World Health Organization (WHO), and other health organizations.

By BMJ