In a study from French National Institute for Health and Medical Research, scientists suggest a possible link between higher intake of artificial sweeteners and increased heart disease risk, including heart attack and stroke.
The findings indicate that these food additives, consumed daily by millions of people and present in thousands of foods and drinks, should not be considered a healthy and safe alternative to sugar.
Artificial sweeteners are widely used as no- or low-calorie alternatives to sugar.
They represent a $7.2 billion (£5900m; €7000m) global market and are found in thousands of products worldwide, particularly ultra-processed foods such as artificially sweetened drinks, some snacks, and low-calorie ready meals.
In the study, the team used data for 103,388 participants of the web-based NutriNet-Santé study, launched in France in 2009 to investigate relations between nutrition and health.
Artificial sweeteners from all dietary sources (beverages, tabletop sweeteners, dairy products, etc.) and by type (aspartame, acesulfame potassium, and sucralose) were included in the analysis.
A total of 37% of participants consumed artificial sweeteners, with an average intake of 42.46 mg/day, which corresponds to approximately one individual packet of tabletop sweetener or 100 mL of diet soda.
The team found that compared with non-consumers, higher consumers tended to be younger, have a higher body mass index, were more likely to smoke, be less physically active, and to follow a weight loss diet.
They also had lower total energy intake, lower alcohol, saturated and polyunsaturated fats, fiber, carbohydrate, fruit, and vegetable intakes, and higher intakes of sodium, red and processed meat, dairy products, and beverages with no added sugar.
During an average follow-up period of nine years, total artificial sweetener intake was linked to an increased risk of heart disease.
Artificial sweeteners were more particularly linked to cerebrovascular disease risks, such as stroke, blood vessel narrowing, and blood clots.
Aspartame intake was linked to increased risk of cerebrovascular events, while acesulfame potassium and sucralose were linked to increased coronary heart disease risk.
The findings are in line with other studies linking exposure to artificial sweeteners with several markers of poor health.
As such, the researchers say their results suggest no benefit from substituting artificial sweeteners for added sugar on CVD outcomes.
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The study was conducted by Charlotte Debras et al and published in The BMJ.
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