Artificial Sweeteners: a Bitter Truth?

[Adapted from http://www.cityslim.com]

Q. Dear CitySlim,

I heard artificial sweeteners are worse for you than cigarettes. I also read somewhere that you actually consume more when using an artificial sweetener because your body does not recognize it as sugar and cannot send the proper signals to your brain that you are full. Also, what are the cancer issues associated with artificial sweeteners? ~DZ, New York, NY

A. Dear DZ,

Thank you for submitting such a well-researched, insightful question. I will address each of your concerns in the order they were asked.

First of all, artificial sweeteners are by no means worse for you than cigarettes. (Cigarettes, when lit, emit over 4000 chemical compounds, many of which are toxic and/or carcinogenic. Forty-three known carcinogens are in cigarette smoke, mainstream and second-hand, such as carbon monoxide, nitrogen oxides, and hydrogen cyanides, just to name a few.[i]) In comparison, artificial sweeteners have not been proven to be carcinogenic to humans. In fact, the use of artificial sweeteners has helped prevent cavities by replacing sugar in foods like gum. They have also helped many diabetics to enjoy foods that would normally have required the addition of sugar, which for them, is a forbidden item.

Before I go on, let me just pause here to define what, exactly, artificial sweeteners are. Artificial sweeteners, also called sugar substitutes, are “substances that used instead of sucrose (table sugar) to sweeten foods and beverages.”[ii] Artificial sweeteners are many times sweeter than sugar (Splenda®, or sucralose, is 600 times sweeter!) and so smaller amounts are needed to create the same level of sweetness. The U.S. Food and Drug Administration (FDA) regulates artificial sweeteners.

In response to your second concern, there has been speculation that people may be consuming more of foods that use artificial sweeteners as opposed to sugar. A study published in February 2008 from Purdue University fed laboratory rats two different kinds of yogurts: one group with regularly sweetened yogurt, the other sweetened with the zero-calorie sweetener, saccharin. Interestingly, the rats that ate the saccharin gained more weight and consumed more total calories than rats fed regular feed.[iii] However, no evidence exists to indicate that this is the case in humans, whose digestive systems are much more complicated. On the contrary, “many human studies suggest low-calorie sweeteners in diet sodas and other foods are beneficial for weight loss,” according to registered dietician Beth Hubrich of the Calorie Control Council, a spokeswoman for the low-calorie sweetener industry.[iv] "One of the most recent studies suggested that use of sucralose -- the sugar substitute sold as Splenda® -- along with increased physical activity, helped children lose weight, she says." Either way, be sure to monitor your portions and make sure you do not over-eat, especially when using artificial sweeteners.

Finally, I will address the alleged connection between artificial sweeteners and cancer. Concerns regarding artificial sweeteners and cancer began when studies during the 1970’s linked saccharin, the key ingredient in “Sweet ‘N Low” with the development of bladder cancer in laboratory rats. Twenty years prior, in 1958, Congressman Delaney’s wife died of cancer, inspiring him to pass the “zero tolerance, zero risk principle” of the Delaney Clause.[v] This new law mandated that “no additive shall be deemed to be safe if it is found to induce cancer when ingested by man or animal, or if it is found, after tests which are appropriate for the evaluation of the safety of food additives, to induce cancer in man or animal. In response to the study results of lab rats and bladder cancer, the FDA declared “all food containing saccharin bear the following warning label: ‘Use of this product may be hazardous to your health. This product contains saccharin, which has been determined to cause cancer in laboratory animals.’" However, “mechanistic studies (studies that examine how a substance works in the body) have shown that these results apply only to rats” and human epidemiology studies (studies of patterns, causes, and control of diseases in groups of people) have shown no consistent evidence that saccharin is associated with bladder cancer incidence.”[vi] After fourteen years, in 1991, the FDA formally withdrew its 1977 proposal to ban the use of saccharin, and in 2000, the U.S. Congress repealed the law requiring saccharin products to carry health warning labels.[vii]More information about the delisting of saccharin is available at http://ntp.niehs.nih.gov/ntp/roc/eleventh/append/appb.pdf on the Internet.

Aside from saccharine, aspartame, the main ingredient of Nutrasweet® and Equal®, was approved in 1981 by the FDA after numerous tests showed that it did not cause cancer or other adverse effects in laboratory animals.[viii] The FDA currently supports the same position regarding the safety of aspartame; however, because of its phenylalanine component, aspartame does carry a risk for people with the rare genetic disorder phenylketonuria.[ix] People who have this disorder should avoid or restrict aspartame use due to their body's difficulty in metabolizing phenylalanine.

Last, but not least, sucralose (also known as Splenda®®) was approved by the FDA as a tabletop sweetener in 1998, followed by approval as a general purpose sweetener in 1999.[x] “The FDA reviewed studies in human beings and animals and determined that sucralose did not pose carcinogenic, reproductive, or neurological risk to human beings. However, sucralose contains chlorine, a suspected carcinogen used in “poisonous gas, disinfectants, pesticides, andplastics. The majority of studies were done on animals for short lengths of time. The alleged symptoms associated with sucralose are gastrointestinal problems (bloating, gas, diarrhea, nausea), skin irritations, wheezing, cough, runny nose, chest pains, palpitations, anxiety, anger, moods swings, depression, and itchy eyes.” The only way to be sure of the safety of sucralose is to conduct more long-term studies on humans.

Be wary of Splenda®, especially those of you with diabetes. Although links to cancer are uncertain, sucralose contains both calories and carbohydrates. One cup of Splenda® has 96 calories and 32 grams of carbs, despite the label claiming that is a “no calorie sweetener.”[xi] The Acceptable Daily Intake (ADI) for sucralose was set at “5 mg/kg of body weight/day. To determine your ADI, divide your weight in pound by 2.2 and then multiply it by 50. For example, if you weighted 200 lbs., your weight in kg would be 91 (200 divided by 2.2) and your ADI for sucralose would be 455 mg (91 x 5).”[xii]

Overall, the link between artificial sweeteners and cancer in humans has yet to be proven. Rats in the Purdue study seemed to lack satiety when fed artificial sweeteners versus regular food, but the digestive mechanisms between rodents and humans vary substantially. Zero-calorie (and reduced calorie) sweeteners may or may not have a similar effect in humans, so it is important to monitor and control your intake of foods with sugar substitutes. While smoking will invariably compromise your health, the consumption of artificial sweeteners has not been proven to cause any chronic adverse effects in humans.

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[i] Martin T. About.com: Smoking Cessation. http://quitsmoking.about.com/cs/nicotineinhaler/a/cigingredients.htm

[ii] National Cancer Institute Website, U.S. National Institutes of Health. www.cancer.gov. “Artificial sweeteners and cancer: questions and answers.” http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners

[iii] Swithers SE, Davidson TL. A role for sweet taste: calorie predictive relations in energy regulation by rats. Behav Neurosci. 2008 Feb;122(1):161-73.

[iv] Boyles S. (Reviewed by Chang L.) Webmd.com, 2008: “Do Sweeteners in Diet Soda Increase Weight?” WebMD Medical News. http://www.webmd.com/diet/news/20080211/artificial-sweeteners-increase-weight

[v] Senauer B. Staff Paper, “Food Safety: A Growing Concern.” Department of Agricultural and Applied Economics, University of Minnesota. October, 1989.

[vi] National Cancer Institute Website, U.S. National Institutes of Health. www.cancer.gov. “Artificial sweeteners and cancer: questions and answers.” http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners

[vii] Wikipedia article: “Saccharin.” http://en.wikipedia.org/wiki/Saccharin

[viii] National Cancer Institute Website, U.S. National Institutes of Health. www.cancer.gov. “Artificial sweeteners and cancer: questions and answers.” http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners

[ix] National Cancer Institute Website, U.S. National Institutes of Health. www.cancer.gov. “Artificial sweeteners and cancer: questions and answers.” http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners

[x] National Cancer Institute Website, U.S. National Institutes of Health. www.cancer.gov. “Artificial sweeteners and cancer: questions and answers.” http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners

[xi] National Cancer Institute Website, U.S. National Institutes of Health. www.cancer.gov. “Artificial sweeteners and cancer: questions and answers.” http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners

[xii] National Cancer Institute Website, U.S. National Institutes of Health. www.cancer.gov. “Artificial sweeteners and cancer: questions and answers.” http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners