Sugar, Spice, and a Troubling Vice: Cardiovascular and Cancer Risk with Artificial Sweeteners

Blog post by Jasmin Skinner

While sugar is a necessary part of a well-rounded diet, the amount of added sugar in most foods across the United States has raised concerns in recent years [1]. The average American consumes roughly 50% more than the recommended daily amount of sugar [1], which can result in insulin resistance, type II diabetes, fatty liver disease, and cardiovascular disease [2]. However, a simple solution for excessive sugar consumption already exists in many “diet-friendly” products. Artificial sweeteners like aspartame, sucralose, and saccharin provide more than a hundred-fold increase in sweetness per gram while also having a near-zero caloric effect, which can be highly desirable for individuals with diabetes or those looking to lose weight [3,4]. However, are artificial sweeteners a healthy and safe alternative to sugar?

While these artificial sweeteners sound like an ideal solution on paper, many researchers have highlighted some concerning side effects of these sugar substitutes, including bladder cancer, brain tumors, and weight gain [3,4]. However, the validity of these studies has been questioned, as few researchers have been able to replicate these results [3]. Despite these conflicting reports, artificial sweeteners have developed a reputation as a healthier alternative to traditional sugars, but two recently published studies by Debras et al. may shift the public’s perspective.

In two similarly designed studies, Debras et al. sought to understand the links between artificial sweetener consumption and two common causes of mortality: cardiovascular disease and cancer. Participants were asked to provide some basic demographic and health information, and recorded their total dietary intake for 24 hours, 3 times per week. The authors evaluated intake for common artificial sweeteners such as aspartame, acesulfame potassium (Sunett® or Sweet One®), sucralose (Splenda®), and saccharin (Sweet’N Low® or Necta Sweet®), as well as other lesser known sweeteners. Cancer and cardiovascular disease risk were determined via declaration by the participants, as well as through comparisons with national health and insurance databases to limit potential bias from individuals not reporting an event.

A positive correlation between high artificial sweetener consumption and overall cancer risk was observed [5]. Aspartame, which comprised approximately 58% of the total artificial sweetener intake in this study (Figure 1), was associated with an increased risk of breast and obesity-related cancers. Acesulfame potassium and sucralose, the second and third most consumed artificial sweeteners, respectively, were also linked to increased cancer risk. Sucralose has also been reported to cause malignant tumors in mice [6]. Previous studies have demonstrated that non-caloric artificial sweeteners are linked to gut microbiota modification [7], with dysbiosis and glucose intolerance being induced in mice and healthy humans. As similar changes in gut microbiota have been observed in cancer patients [8], the authors suggest that these changes might be involved in the development of some cancers.