Using Artificial Sweeteners May Raise the Risk of Heart Disease, Study Shows

Researchers say artificial sugar substitutes aren't necessarily a safe or healthy alternative.

Man pouring sugar into coffee at restaurant
Photo: RobertoDavid/Getty

Artificial sweeteners— also called sugar substitutes—can be found in everything from soft drinks to baked goods, yogurts, cereals and dairy products. These sweeteners have long been viewed as a way to avoid the health-related risks associated with traditional sweeteners, such as high blood sugar, type 2 diabetes and obesity. Many people also use artificial sweetening alternatives rather than real sugars as a way to cut calories and lose weight.

A new study published in The BMJ journal, however, has found that artificial sweeteners may actually be harmful to your health and could potentially lead to heart disease.

"Artificial sweeteners are present in thousands of food products worldwide and consumed by millions of citizens daily," Mathilde Touvier, PhD, the study's author and a research director at the French National Institute for Health and Medical Research, told Health. "These results suggest that artificial sweeteners may not be safe alternatives to added sugars."

Even though health agencies recommend people limit sugar consumption in their diet already, the new study highlights the fact that it's just as important to "not replace sugar with artificial sweeteners" as they may not be the healthy alternative you think they are, Touvier said.

Link Between Artificial Sweeteners and Heart Health Risks

Touvier and her colleagues analyzed more than 103,000 adults in France who were involved in a web-based nutrition study to investigate the association between artificial sweetener intakes and cardiovascular disease risk. Almost 80% of participants were female and the average age was 42 years old.

Participants completed questionnaires detailing their food consumption over the course of 24 hours. They also provided information about health, lifestyle and sociodemographic factors—including their physical activity, smoking status and personal information like education and occupation.

Researchers also tasked participants with completing multiple food diary assessments at the start of the study and every six months afterward. This step, Touvier said, gave researchers an estimate of how much artificial sweeteners people consumed along with their intake of other foods—such as fruits, vegetables, red meats and dairy products.

Overall, researchers found 37% of participants consumed artificial sweeteners in some form. Participants who consumed around 78 milligrams of artificial sweeteners per day were considered "high consumers" and those that had around 8 milligrams per day were identified as "low consumers." There was also a group of participants who didn't consume any artificial sweeteners, Touvier said.

Individuals who consumed higher amounts of artificial sweeteners had a 9% increased risk of cardiovascular disease compared to those who didn't consume any at all, Touvier said. This included younger individuals who had a higher body mass index (BMI), were less physically active and more likely to smoke.

"We observed that total artificial sweetener intake was associated with an increased risk of cardiovascular disease," Touvier said.

They also studied different types of artificial sweeteners and found aspartame intake was associated with a 17% increased risk of cerebrovascular events, while acesulfame potassium and sucralose were linked with increased coronary heart disease risk.

Observational Results Should Be Interpreted With Caution

Although the study found an association between artificial sweetener consumption and cardiovascular disease, health experts say people should consider the results with caution, as it was an observational study with self-reported data points.

"We cannot definitively say that this difference was actually caused by the sweetener," Alexander Postalian, MD, a cardiologist at Texas Heart Institute, who was not involved in the study, told Health.

While the authors of the study did their best to ensure the accuracy of the results, limitations and confounding issues may remain, Dr. Postalian added. For example, people that consume high amounts of artificial sweeteners may be in poorer health status than their counterparts, and perhaps also consume greater amounts of other unhealthy foods.

"Rather than establishing that artificial sweeteners are 'bad' and should be avoided at all costs, the more adequate take-home point is that we should be vigilant about the indiscriminate use of these additives and consume them in moderation while ongoing research continues," said Dr. Postalian.

The study authors and other health experts noted that further research is needed to confirm or refute the current findings. Dr. Postalian, for instance, said that the links observed between artificial sweeteners and cardiovascular disease are not yet clear and more investigation is needed to better understand the connection.

"There are multiple theories about why artificial sweeteners may cause disease. From alteration of insulin and glucose balance to modification of the gut microbiota," Dr. Postalian said. "However, the truth is we don't know for certain."

Another factor could be the interaction of artificial sweeteners with intestinal sweet taste receptors, which plays a part in insulin secretion and glucose absorption.

"Additionally, the alteration of gut microbiota by some artificial sweeteners could increase glucose intolerance and may be involved in the underlying mechanisms," Touvier said. "Vascular dysfunction and inflammation could also be involved. But these are hypotheses that need to be confirmed."

Some Artificial Sweeteners More Harmful Than Others

Even though the researchers found an association between aspartame and a higher risk of cerebrovascular events, along with acesulfame potassium and sucralose being linked with a higher risk of coronary heart disease, Touvier said it is not possible to state why one artificial sweetener molecule might be worse than others.

Those three sweeteners were the most frequently consumed, which allowed the researchers to study them separately and observe associations with cardiovascular disease risk compared to less consumed artificial sweeteners, Touvier said.

"It does not mean that other sweeteners could not be associated as well, but since they were consumed to a lesser extent, they could not be investigated separately in this study and only contributed to the sum "total sweeteners."

A definitive explanation as to why some sweeteners are linked to specific cardiovascular outcomes and not others, remains to be found. But Dr. Page said it's possible that "the different types of artificial sweeteners are metabolized differently, they may have different effects on the body.

Should Artificial Sweeteners Be Avoided Altogether?

If you use artificial sweeteners in foods and beverages, health experts recommend that you use them sparingly or in moderation, rather than relying on them excessively.

"Although artificial sweeteners were developed as a healthier, lower calorie alternative to sugar, they appear to carry the significant risk themselves in the development of the same conditions that are associated with high sugar intake," Nick West, chief medical officer and divisional vice president of global medical affairs at Abbott's vascular business, told Health. These conditions include cardiovascular diseases like coronary heart disease (angina and heart attack) and cerebrovascular disease (stroke).

While some sugar is required for metabolic needs including powering muscle contractions and cellular functions, "artificial sweeteners should not be regarded as a viable healthier sugar alternative" until more research can be conducted to examine the findings of the study, said Dr. West.

Beyond cutting down your consumption of such sweeteners, Dr. Page and Dr. Postalian said there are other steps people can take to minimize risk of cardiovascular disease and other health conditions associated with these products. Some of the actions people can take include:

  • Becoming more aware of how much artificial sweetener you're consuming in your diet
  • Cutting back on diet sodas or other drinks and foods. Instead drink unsweetened teas, sparkling waters and regular water
  • Consuming a healthy well-balanced diet that consists of fruits, vegetables, fish, proteins, legumes, beans and other food items
  • Getting regular physical activity

"I believe that it is reasonably safe to use these additives in moderation, avoiding excessive use," Dr. Postalian said. "More importantly, ensure positive overall habits are being followed – a healthy diet and regular physical activity."

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