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Artificial sweeteners increase cardiovascular risk

Consumption of artificial sweeteners is associated with an increased risk of cardiovascular and cerebrovascular disease. The correlation, which has already emerged in the scientific literature, is confirmed by a French study. (1)

Artificial sweeteners and cardiovascular risks

I ricercators selected 103.388 participants from the NutriNet-Santé cohort, the epidemiological project launched in France in 2009 to study the association between nutrition and health.

As per protocol, the participants (average age 42,2 years, 79,8% women) reported their health conditions (with presentation of reports, in the case of cardiovascular diseases) and documented their daily food consumption, using the recording tool dietetics online interactive available 24 hours a day.

At the end of the observation (October 5, 2021), the researchers divided the participants into three categories of consumption of artificial sweeteners (zero, within the average, higher) and noted the respective incidence of cardiovascular disease.

80 mg per day of sweeteners

Net of the participants who died (0,94%) or voluntarily left the study (9,4%), 37,1% of the sample consumed artificial sweeteners, about half of which came from soft drinks and the rest from food and table sweeteners .

The molecules more consumed they turned out

  • aspartame, E 951 (58% of cases),
  • acesulfame potassium, E 950 (29%)
  • sucralose, E 955 (10%).

The remaining 3% consisted of cyclamates (E 952), saccharin (E 954), thaumatin (E957), neohesperidin dihydrochalcone (E959), steviol glycosides (E960) and aspartame-acesulfame potassium salt (E962).

Average consumption per capita was 42,46 mg/day, modulated in

  • 7,46 mg/day among occasional users,
  • 77,62 mg/day among heavy consumers.

Achievement of a dose daily approaching 80 grams of synthetic sweetening molecules may seem exceptional. Yet, it is easy to fill it, by consuming packaged foods often 'with no added sugar', but with synthetic sweeteners. These food additives are widely found in ultra-processed foods, such as soft drinks, snack, ready meals, dairy products (such as we have seen for high-protein yoghurts).

Sugar vs aspartame and Co.

The fears of consuming too much sugar are well founded. The consequence of developing caries and metabolic diseases is certain. For this reason, EFSA invites you to consume as little as possible. (2) And the World Health Organization recommends limiting its consumption to 5% of the daily energy intake. (3) That's 100 kcal in a standard healthy adult diet of 2.000 kcal, equal to about 6 teaspoons of sugar. A threshold easily exceeded even by those who add it to coffee.

Substitute sugar with synthetic sweeteners, however, it is not the ideal solution.

'Our results suggest no benefit from replacing artificial sweeteners with sugar on CVD outcomes', say the study authors.

The result of the study

In a follow-up nine-year-olds, artificial sweetener intake was associated with a 9 percent increased risk of cardiovascular and cerebrovascular disease.

In particular,

  • aspartame (E 951) was associated with an increased risk of cerebrovascular events,
  • Acesulfame potassium (E 950) and sucralose (E 955) were associated with an increased risk of coronary heart disease.

Overall there were 1.502 cardiovascular events (mean age 62,7 years) including

  • 730 coronary artery disease events (143 myocardial infarction, 75 acute coronary syndrome, 477 angioplasty events and 277 angina pectoris events),
  • 777 cerebrovascular disease events (203 strokes and 598 transient ischemic events).

The incidence of these events was higher among heavy users of sweeteners: 346 cases per 100.000 person-years, compared with 314 for those who did not use them.

Identikit of the heavy consumer of synthetic sweeteners

A systematic review it also reveals the typical profile of the heavy (French) consumer of synthetic sweeteners:

– tend to be young,

– with higher body mass index

– smoker,

– less physically active

– on a slimming diet, with a lower total energy intake and a lower intake of alcohol, lipids (saturated and polyunsaturated), fibers, carbohydrates, fruit and vegetables and a higher intake of sodium, red and processed meat, dairy products and drinks with no added sugar .

The thesis that this profile is more prone to cardiovascular risk, regardless of sweeteners, was addressed in the study. And thus resolved: 'We excluded CVD events that occurred during the first two years of follow-up, and we also tested models adjusted for baseline body mass index, weight loss diet, and weight change during follow-up, which did not substantially changed the results'.

Marta Strinati

Footnotes to the story

(1) Debras C, Chazelas E, Sellem L, Porcher R, Druesne-Pecollo N, Esseddik Y et al. Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort BMJ 2022; 378 :e071204 doi:10.1136/bmj-2022-071204

(2) Martha Strinati. The harmful role of sugars in the diet, EFSA opinion. GIFT (Great Italian Food Trade). 1.3.22

(3) Guidelines: sugar intake for adults and children. WHO (World Health Organization). 4.3.15 https://www.who.int/publications/i/item/9789241549028

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Professional journalist since January 1995, he has worked for newspapers (Il Messaggero, Paese Sera, La Stampa) and periodicals (NumeroUno, Il Salvagente). She is the author of journalistic surveys on food, she has published the book "Reading labels to know what we eat".

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