Artificial sweeteners are linked to an increased risk of heart disease and “should not be considered a healthy and safe alternative to sugar”, according to researchers.
The harmful effects of added sugars have been long established for multiple chronic diseases, leading food companies to use artificial sweeteners instead in a wide range of food and drinks consumed daily by millions of people worldwide.
However, their use has come under increased scrutiny in recent years, although study findings have been divided about their part in various diseases.
Their role in cardiovascular disease has previously been suggested in experimental studies, but data from human studies was limited and previous observational studies focused solely on artificially sweetened drinks used as a proxy.
Now the findings from a large-scale prospective cohort study suggest a potential direct association between higher consumption of artificial sweetener and an increased risk of cardiovascular disease.
“Our results indicate that these food additives, consumed daily by millions of people and present in thousands of foods and beverages, should not be considered a healthy and safe alternative to sugar, in line with the current position of several health agencies,” the researchers wrote in the BMJ.
In the study, of 103,000 French adults, artificial sweeteners were associated with increased risk of cardiovascular, cerebrovascular, and coronary heart diseases. “The results suggest that artificial sweeteners might represent a modifiable risk factor for cardiovascular disease prevention,” they wrote.
The research, led by experts from the Sorbonne Paris Nord University, examined intake of sweeteners from all dietary sources, including drinks, tabletop sweeteners and dairy products, and compared it with their risk of heart or circulatory diseases.
Participants had an average age of 42, and four in five were women. Sweetener intake was tracked using diet records.
The participants noted everything they ate, including which brand, for 24 hours, with their diet diary repeated three times at six-month intervals – twice on weekdays and once on a weekend day. Some 37% of them consumed artificial sweeteners.
During an average follow-up period of about a decade, 1,502 cardiovascular events were recorded, including heart attacks, stokes, mini strokes and angina.
Artificial sweetener consumption was linked to a 9% higher risk of cardiovascular disease, the BMJ reported. When researchers looked at specific types of illness, they found artificial sweetener consumption was linked to an 18% higher risk of cerebrovascular disease – conditions that affect the blood flow to the brain.
A specific type of sweetener – aspartame – was associated with a 17% increased risk of cerebrovascular events, while acesulfame potassium and sucralose were linked to increased risk of coronary heart disease.
The study was observational, so cannot establish cause, nor rule out the possibility that other unknown factors may have affected the results. Nevertheless, the researchers said, it was a large study that assessed artificial sweetener intake using precise, high-quality dietary data, and the findings were in line with other studies linking artificial sweeteners with markers of poor health. Further studies were needed, they said.