Cardiovascular disease: “Sweeteners may not be a safe alternative to sugar”

Sweeteners have come under increasing scrutiny, and their health effects are being scrutinized by scientists. In March 2022, a major study by researchers from Inserm, INRAE, Sorbonne-Paris-Nord University and Cnam within the Research Group on the Epidemiology of Nutrition (EREN) found that people who consumed the most sweeteners, especially aspartame and acesulfame-K, had higher blood sugar levels. the risk of developing cancer.

According to a published study, the highest consumers of these sweeteners, which reduce added sugar and its associated calories while maintaining the sweet taste of foods, had a 13% increased risk of developing cancer compared to those who did not consume them. in the journal PLOS Medicine.

The same group of researchers analyzed health data from 103,388 adults in the French NutriNet-Santé cohort study for their total consumption of this type of dietary supplement. The results of these statistical analyses, published this Thursday, September 8th in the British Medical Journal, suggest a link between overall sweetener consumption and, this time, an increased risk of cardiovascular disease, the world’s number one cause of death. Study coordinator Mathilde Touvier, director of research at Inserm and head of the nutritional epidemiology research group, details this first study that quantifies the overall impact of sweeteners.

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L’Express: Your study results point to an association between total sweetener consumption and an increased risk of cardiovascular disease. How do you explain it?

Mathilde Touvier: There is a well-documented link between excess sugar, in particular the excessive consumption of sugary drinks, and many pathologies such as tooth decay, diabetes and cardiovascular disease. This has prompted manufacturers to develop alternatives to sugar, which is now widely used as a sweetener. They are mainly found in sweetened drinks such as light carbonated and non-carbonated drinks, in powders that can be added to coffee and tea, for example, or even in dairy products such as light yoghurts.

The epidemiological literature contains studies investigating the association between sweetened beverages and cardiovascular disease. Studies show disturbances in some of the early parameters of cardiometabolic health, such as weight gain, abnormalities in cholesterol levels or blood sugar regulation. These effects could potentially explain what might happen to the cardiovascular system in the long term.

Other research focuses on disruption of the gut microbiota caused by sweeteners. This disorder can also subsequently lead to the development of cardiovascular diseases. These hypotheses are yet to be tested, but we now have a number of arguments that are starting to grow on the subject.

You found that total sweetener intake was associated with an increased risk of cardiovascular disease, especially cerebrovascular disease such as stroke and transient ischemic attack. How high is the increased risk of these diseases?

We don’t talk too much about this issue because it can vary from one cohort of participants to another. However, at follow-up, equivalent to 100,000 people per year, there will be 346 cases of cardiovascular disease among “heavy users” of sweeteners and 314 cases among those who do not use them. Thus, the difference is not gigantic, but remains statistically significant and reliable.

It will not be easy to make these sweeteners disappear overnight. However, what alternatives do you recommend?

Given the information that we have and that is accumulating, sweeteners may not be the safe alternative to sugar, as one might initially think.

We already know that one should not consume too much sugar and especially sugary drinks. (Editor’s note: Given the detrimental effects of excessive sugar consumption, WHO recommends limiting sugar intake to less than 10% of daily energy intake.) The idea is to try to gradually reduce the sweet taste in our diet, to change our long-term eating habits by reducing the amount of sugar and sweeteners.

We should also reach out to young people because many kids still drink a bottle of soda or diet soda with meals, even though this is not a habit. So, it’s not just about banning or reducing sugar and sweeteners, it’s about changing the way we eat.

Further studies in other large-scale cohorts will be required to replicate and confirm your findings…

The results of our work are taken into account in expert assessments, including at the level of the World Health Organization (WHO), which should publish its final recommendations by the end of the year. The positions of the health authorities on this issue will be presented shortly.

For our part, we have studied the increased risk of cancer and are now working on the issue of diabetes risks and weight fluctuations, the next two topics on which we will publish research in 2023.

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NB: In the French NutriNet-Santé cohort study, researchers are always looking for volunteers to continue participating in the study: anyone over the age of 15 with Internet access can register and take part in food service research.


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