Artificial sweeteners are added to thousands of foods and beverages—sodas, yogurts, pancake syrups, jams, baked goods, frozen desserts, chewing gum, candy—to help us satisfy our sweet tooth with less (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 mainly shown that, when substituted for sugar-sweetened beverages, artificially sweetened beverages help prevent weight gain.
However, the results of numerous observational studies suggest that, in the long term, a regular intake of these substances can have harmful effects on cardiometabolic health, such as increased waist circumference, elevated sugar in blood, insulin resistance and inflammation.
Now, new research published in The British Medical Journal adds to growing evidence that high intakes of artificial sweeteners can 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 health and nutrition study of adults who they live in France
The participants, who were followed for nearly a decade, provided 24-hour, three-day diet records, which included product brands, at the start of the study and every six months thereafter. The researchers calculated the participants’ intake of total artificial sweeteners (from food, beverages and tabletop sweeteners), as well as the intake of different types of artificial sweeteners.
Diet sodas accounted for half (53%) of artificial sweeteners consumed. Other important contributors were table sweeteners (30%) and flavored dairy products, such as yogurt and cottage cheese (8%). Aspartame, acesulfame potassium, and sucralose accounted for most of the total artificial sweetener intake.
Participants who had a higher intake of total artificial sweeteners had a higher risk of developing cardiovascular disease compared to non-consumers. The average daily intake of artificial sweetener among people classified as “highest consumers” was 77 mg, equivalent to about two packets of table sweetener or 200 ml of diet pop.
Aspartame intake was linked to an increased risk of stroke; Sucralose and acesulfame potassium were associated with an increased risk of coronary heart disease.
The researchers took into account several factors related to cardiovascular risk, including age, family history, smoking, physical activity and dietary components.
Strengths of the study include its large sample size and high-quality dietary data. The researchers collected repeated 24-hour diet records, which are known to be more accurate than food frequency questionnaires commonly used in nutrition studies.
A limitation of this study is that the results only show correlations; they do not establish a cause-effect relationship.
In addition, it is possible that some participants assessed as higher consumers at the start of the study may have increased their artificial sweetener intake in response to having risk factors for cardiovascular disease and already had poorer cardiovascular health. .
How artificial sweeteners can be harmful
These new findings are consistent with those of 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 cardiovascular disease risk factors that can include abdominal obesity, high blood pressure, high blood triglycerides, increased blood sugar and HDL (good) cholesterol. down
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Artificial sweeteners can also activate sweet taste receptors in the gut, which can alter the body’s blood glucose regulation.
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 regular use of sugar-free sweeteners is effective for long-term weight loss, or linked to other long-term health effects, in July the World Health Organization Health proposed draft guidelines recommending that “no Sugar sweeteners are used as a means of achieving weight control or reducing the risk of non-communicable diseases”.
If you are a daily consumer of artificial sweeteners, I advise you to cut back. This does not mean that it is necessary to avoid them completely; there is no evidence that occasional use is harmful.
Replace sodas with sparkling water, sugar-free flavored carbonated water, or plain water with a citrus wedge.
If you add a packet of sweetener to your coffee, tea or hot cereal, reduce it slowly and gradually. Ditto for real sugar.
Replace artificially sweetened yogurt with natural yogurt; sweeten it with fruit.
The good news: Your taste buds will prefer a less sweet taste.
Leslie Beck, a dietitian in private practice based in Toronto, is director of food and nutrition at Medcan. Follow her on Twitter @LeslieBeckRD