Artificial sweeteners should not be considered a safe alternative to sugar, say researchers who found a link between higher levels of consumption and an increased cardiovascular disease risk.
The careful analysis of 103,000 adults taking part in a large study set up in 2009 to investigate nutrition and health found that 37% consumed artificial sweeteners, with an average intake of 42.46 mg/day, the equivalent of 100 mL of diet soda.
Those categorised as higher consumers had an average intake of 77.62mg and 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, the researchers reported in the BMJ.
Over a nine year follow up period, total artificial sweetener intake was associated with an increased risk of cardiovascular disease with an absolute rate 346 per 100,000 person years in higher consumers and 314 per 100,000 person years in non-consumers.
Artificial sweeteners from all dietary sources including drinks, table top sweeteners, and dairy products, among others and types such as aspartame, acesulfame potassium, and sucralose were included in the analysis.
The researchers calculating the risk said they took account of a range of other dietary differences such as total energy intake and consumption of red and processed meat.
They found that aspartame intake was associated with increased risk of cerebrovascular events while acesulfame potassium and sucralose were associated with increased coronary heart disease risk.
It is the first study to look at the link by measuring artificial sweetener consumption from individual diets.
While as an observational study, the results cannot establish cause, the results are in line with other studies linking exposure to artificial sweeteners with several markers of poor health, they concluded.
‘The findings 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,’ they concluded.
UK experts said the study added to the growing body of evidence on the link between artificial sweeteners and cardiovascular health but was not definitive and more work was needed.
Helena Gibson-Moore, nutrition scientist at the British Nutrition Foundation, said conflicting messages around the safety of artificial sweeteners could be confusing for consumers.
‘It’s important that the research on the long-term effects of low calorie sweeteners on disease risk such as cardiovascular diseases continues to be reviewed.
‘The World Health Organization is currently drafting guidelines on the use of low calorie sweeteners, and a public consultation has recently been conducted, but there is no indication yet of when the guidelines may be published.
UK researchers recently identified a six-fold increased risk in cardiovascular diagnoses associated with Covid-19, which included an 11-fold increase in pulmonary embolism.
That risk began to decline five weeks after infection and returned to normal between 12 weeks and one year, the records from GP practices in England between 2020 and 2021 showed.