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Does artificial sweetener aspartame really cause cancer? What the WHO listing means for your diet soft drink habit

<p><em><a href="https://theconversation.com/profiles/evangeline-mantzioris-153250">Evangeline Mantzioris</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p>The International Agency for Research on Cancer (IARC), which is the specialised cancer agency of the World Health Organization, has declared aspartame may be a <a href="https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released">possible carcinogenic hazard to humans</a>.</p> <p>Another branch of the WHO, the Joint WHO and Food and Agriculture Organization’s Expert Committee on Food Additives has assessed the risk and developed recommendations on how much aspartame is safe to consume. They have recommended the acceptable daily intake be 0 to 40mg per kilo of body weight, as we currently have <a href="https://www.foodstandards.gov.au/consumer/additives/aspartame/Pages/default.aspx">in Australia</a>.</p> <p>A hazard is different to a risk. The hazard rating means it’s an agent that is capable of causing cancer; a risk measures the likelihood it could cause cancer.</p> <p>So what does this hazard assessment mean for you?</p> <h2>Firstly, what is aspartame?</h2> <p><a href="https://www.foodstandards.gov.au/consumer/additives/aspartame/Pages/default.aspx">Aspartame is an artificial sweetener</a> that is 200 times sweeter than sugar, but without any kilojoules.</p> <p>It’s used in a <a href="https://www.foodstandards.gov.au/consumer/additives/aspartame/Pages/default.aspx">variety of products</a> including carbonated drinks such as Coke Zero, Diet Coke, Pepsi Max and some home brand offerings. You can identify aspartame in drinks and foods by looking for additive number 951.</p> <p>Food products such as yogurt and confectionery may also contain aspartame, but it’s not stable at warm temperatures and thus not used in baked goods.</p> <p>Commercial names of aspartame include Equal, Nutrasweet, Canderel and Sugar Twin. In Australia the acceptable daily intake is 40mg per kilo of body weight per day, which is about 60 sachets.</p> <p><a href="https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food#:%7E:text=How%20many%20packets%20can%20a,based%20on%20its%20sweetness%20intensity%3F&amp;text=Notes%20About%20the%20Chart%3A,50%20mg%2Fkg%20bw%2Fd">In America</a> the acceptable daily intake has been set at 75 sachets.</p> <h2>What evidence have they used to come to this conclusion?</h2> <p><a href="https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released">IARC looked closely</a> at the <a href="https://cdn.who.int/media/docs/default-source/nutrition-and-food-safety/july-13-final-summary-of-findings-aspartame.pdf?sfvrsn=a531e2c1_5&amp;download=true">evidence base</a> from around the world – using data from observational studies, experimental studies and animal studies.</p> <p>They found there was some limited evidence in human studies linking aspartame and cancer (specifically liver cancer) and limited evidence from animal studies as well.</p> <p>They also considered the biological mechanism studies which showed how cancer may develop from the consumption of aspartame. Usually these are lab-based studies which show exactly how exposure to the agent may lead to a cancer. In this case they found there was limited evidence for how aspartame might cause cancer.</p> <p>There were only three human studies that looked at cancer and aspartame intake. These large observational studies used the intake of soft drinks as an indicator of aspartame intake.</p> <p>All three found a positive association between artificially sweetened beverages and liver cancer in either all of the population they were studying or sub-groups within them. But these studies could not rule out other factors that may have been responsible for the findings.</p> <p>A study <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284800/">conducted in Europe</a> followed 475,000 people for 11 years and found that each additional serve of diet soft drink consumed per week was linked to a 6% increased risk of liver cancer. However the scientists did conclude that due to the rarity of liver cancer they still had small numbers of people in the study.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/35728406/">In a study from the US</a>, increased risk of liver cancer was seen in people with diabetes who drank more than two or more cans of a diet soda a week.</p> <p>The <a href="https://aacrjournals.org/cebp/article/31/10/1907/709398/Sugar-and-Artificially-Sweetened-Beverages-and">third study</a>, also from the US, found an increase in liver cancer risk in men who never smoked and drank two or more artificially sweetened drinks a day.</p> <p>From this they have decided to declare aspartame as a Group 2b “possible carcinogen”. But they have also said more and better research is needed to further understand the relationship between aspartame and cancer.</p> <p>IARC has four categories (groupings) available for potential substances (or as they are referred to by IARC, “agents”) that may cause cancer.</p> <h2>What does each grouping mean?</h2> <p><strong>Group 1 Carcinogenic to humans:</strong> an agent in this group is carcinogenic, which means there is convincing evidence from human studies and we know precisely <em>how</em> it causes cancer. There are 126 agents in this group, including tobacco smoking, alcohol, processed meat, radiation and ionising radiation.</p> <p><strong>Group 2a Probably carcinogenic to humans:</strong> there are positive associations between the agent and cancer in humans, but there may still be other explanations for the association which were not fully examined in the studies. There are 95 agents in this group, including red meat, DDT insecticide and night shift work.</p> <p><strong>Group 2b Possibly carcinogenic in humans:</strong> this means limited evidence of causing cancer in humans, but sufficient evidence from animal studies, or the mechanism of how the agent may be carcinogenic is well understood. This basically means the current evidence indicates an agent may possibly be carcinogenic, but more scientific evidence from better conducted studies is needed. There are now <a href="https://monographs.iarc.who.int/agents-classified-by-the-iarc/">323</a> agents in this group, including aloe vera (whole leaf extract), ginkgo biloba and lead.</p> <p><strong>Group 3 Not classifiable as a carcinogen:</strong> there’s not enough evidence from humans or animals, and there is limited mechanistic evidence of how it may be a carcinogen. There are 500 agents in this group.</p> <h2>So do I have to give up my diet soft drink habit?</h2> <p>For a 70kg person you would need to consume about 14 cans (over 5 litres) of soft drink sweetened with aspartame a day to reach the acceptable daily intake.</p> <p>But we need to remember there may also be aspartame added in other foods consumed. So this is an unrealistic amount to consume, but not impossible.</p> <p>We also need to consider all the evidence on aspartame together. The foods we typically see aspartame in are processed or ultra-processed, which have recently also been <a href="https://theconversation.com/ultra-processed-foods-are-trashing-our-health-and-the-planet-180115">shown to be detrimental to health</a>.</p> <p>And artificial sweeteners (including aspartame) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892765/#!po=59.3750">can make people crave more sugar</a>, making them want to eat more food, potentially causing them to gain more weight.</p> <p>All together, this indicates we should be more careful about the amount of artificial sweeteners we consume, since they <a href="https://theconversation.com/the-who-says-we-shouldnt-bother-with-artificial-sweeteners-for-weight-loss-or-health-is-sugar-better-205827">do not provide any health benefits</a>, and have possible adverse effects.</p> <p>But overall, from this evidence, drinking the occasional or even daily can of a diet drink is safe and probably not a cancer risk.</p> <hr /> <p><em>Correction: this article originally stated each serve of soft drink in a study was linked to a 6% increased risk of liver cancer, however it was each additional serve per week. This has been amended.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/208844/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></em></p> <p><em><a href="https://theconversation.com/profiles/evangeline-mantzioris-153250">Evangeline Mantzioris</a>, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/does-artificial-sweetener-aspartame-really-cause-cancer-what-the-who-listing-means-for-your-diet-soft-drink-habit-208844">original article</a>.</em></p>

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“Diet” drinks linked to increased risk of dementia and stroke

<p>We all know that too much sugar in our diet is bad for our health, and that includes sugary soft drinks. But many reach for the artificially sweetened ‘diet’ drinks, thinking that it has to be a better choice than sugary soft drinks.</p> <p>It has now been proven that these ‘diet’ drinks are equally bad for our health, if not worse. This is the latest data from the Framingham Heart study in Massachusetts.</p> <p>“We advise that people don’t drink sugary beverages because we know they are associated with a whole range of adverse health outcomes such as obesity, diabetes,” said Matthew Pase, a visiting postdoctoral fellow at Boston University School of Medicine and an investigator at the Framingham Heart Study. Pase, who authored the study, said the outcomes of consuming diet drinks with artificial sweeteners can be just as bad.</p> <p>“We found that those people who were consuming diet soda on a daily basis were three times as likely to develop both stroke and dementia within the next 10 years as compared to those who did not drink diet soda,” said Pase. About 4,000 Framingham residents aged 30 or older were monitored for this study.</p> <p>It was found that those who drank sugary drinks showed faster brain ageing and poorer memory function. <span><a href="http://stroke.ahajournals.org/content/48/5/1139">The conclusion to this study</a></span> was that "artificially sweetened soft drink consumption was associated with a high risk of stroke and dementia." The artificial sweeteners used in the study were saccharin, acesulfame, aspartame, neotame, and sucralose.</p> <p>Aspartame is considered by some to be the most dangerous substance on the market that is added to foods and drinks. It accounts for more than 75 per cent of the adverse reactions reported to the US FDA, yet the additive is still widely permitted and no warning labelling is required.</p> <p>The range of symptoms and ailments attributed to aspartame in a 1994 Department of Health &amp; Human Services Report  include headaches, migraines, memory loss, dizziness, seizures, numbness, rashes, depression, fatigue, irritability, tachycardia, insomnia, vision problems, hearing loss, heart palpitations, breathing difficulties, slurred speech, tinnitus, vertigo and joint pain.</p> <p>Aspartame is an excitotoxin, and excessive exposure can cause damage to your brain cells. It is important to be aware when food shopping that you look at the ingredients list on the packaged foods and drinks. Look out for (950) or (951) - these are the number codes for aspartame, so avoid purchasing anything with those numbers.</p> <p>Start cutting back on the artificially sweetened drinks, with a view of eliminating them completely from your diet to protect your heart and brain health.</p> <p><em><a href="https://www.smartbrainhealthcentre.com.au/">Louise Hallinan</a> is the international award-winning author of </em>Smart Brain, Healthy Brain<em>, a natural medicine practitioner and founder of the Smart Brain Health Centre which specialises in the prevention of memory problems and improving brain health.</em></p>

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Is artificial sweetener really healthier than sugar?

<p><em><strong>Sarah McNaughton is an Advanced Accredited Practising Dietitian and an Associate Professor at Deakin University’s Institute for Physical Activity and Nutrition.</strong></em></p> <p>We know Australians are consuming too much sugar. The latest results from the <span style="text-decoration: underline;"><strong><a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4364.0.55.011main+features12011-12" target="_blank">Australian Bureau of Statistics</a></strong></span> show 52 per cent of the population are consuming more than is <span style="text-decoration: underline;"><strong><a href="http://www.who.int/nutrition/publications/guidelines/sugars_intake/en/" target="_blank">recommended</a></strong></span>, and this is affecting weight and dental health.</p> <p>But criticism of sugar is so widespread that sugar in foods such as milk and fruit have also come under fire. We should be mindful it’s really added sugar we need to focus on. Whole foods such as fruit and milk come with many other beneficial components. Fruit also contains vitamins, fibre and various phytochemicals compared to other sources of sugar, such as soft drinks. And the amount of sugar we consume from whole foods is generally lower, since the amount of sugar per serve is lower. In the case of fruit, we are unlikely to eat multiple pieces of fruit in one go when consumed as whole fruit compared to when consumed as fruit juice.</p> <p>There’s now <span style="text-decoration: underline;"><strong><a href="http://www.mdpi.com/2072-6643/9/7/701" target="_blank">evidence</a></strong></span> to show much of the food we eat contains high levels of added sugar. Currently in Australia, there’s no requirement to label foods with the amount of sugar added. This can be tricky for consumers, given “sugar” on the label may appear under many different names. So if added sugar is something to avoid, should we look to alternatives like artificial sweeteners?</p> <p><strong>Artificial sweeteners – friend or foe?</strong></p> <p>Artificial sweeteners are food additives, also known as “intense sweeteners”. They have a sweetness level that is many times that of sugar and so can be used in small amounts in food and beverages. In Australia, the use of these food additives is regulated by <span style="text-decoration: underline;"><strong><a href="http://www.foodstandards.gov.au/consumer/additives/intensesweetener/Pages/default.aspx" target="_blank">Australia New Zealand Food Standards Code</a></strong></span>.</p> <p>There are a range of intense sweeteners approved for use including acesulfame potassium (Ace K), aspartame, saccharin, sucralose and steviol glycosides. Food additives, including intense sweeteners, undergo a safety review before they’re permitted to be used in foods. This involves assessing whether there are any harmful effects from the additive, and modelling of potential consumption levels.</p> <p>While artificial sweeteners have been proposed as a <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/22709780" target="_blank">strategy</a></strong></span> for reducing energy intake and preventing weight gain, there is emerging evidence to suggest artificial sweeteners may not be as beneficial as some think.</p> <p>Evidence for a role in weight gain prevention has been mixed (although conclusions seems to be influenced by the <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015869/" target="_blank">source of funding</a></strong></span>).</p> <p>A recent <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/28716847" target="_blank">review</a></strong></span> of 37 trials and cohort studies has shown that over the long term, use of artificial sweeteners may be associated with higher risk of metabolic syndrome (a collection of conditions that increase your risk of diabetes, stroke and heart disease) and type 2 diabetes.</p> <p>There is also emerging evidence artificial sweeteners may adversely impact the <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/27090230" target="_blank">gut microbiota</a></strong></span> and <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/25231862" target="_blank">glucose tolerance</a></strong></span>. But the existing studies in this area have mainly been conducted in animal models, so further work is required in human trials before recommendations can be made.</p> <p>A final concern with the use of artificial sweeteners relates to the fact that their use does not necessary help people change their taste preferences for sweetness. Therefore, they may not lead to changes in behaviours or desire for sweet foods and may lead to overconsumption <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/25184369" target="_blank">elsewhere</a></strong></span>.</p> <p>So it’s clear we need to reduce the consumption of added sugars in our diet. Artificial sweeteners are considered safe for consumption and may be an alternative. While there is emerging evidence around some health issues, we definitely need more robust evidence, particularly in human studies, before ruling them out.</p> <p>But the best advice is to look at reducing your consumption of foods high in added sugars, which are commonly processed and packaged foods, and focus on <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/26746178" target="_blank">dietary patterns</a></strong></span> rich in core foods such as vegetables, legumes, fruit, wholegrains, lean meat, fish, nuts and dairy foods.</p> <p>If you keep your intake of added sugar low, you should only need to use artificial sweeteners occasionally.</p> <p><em>Written by Sarah McNaughton. Republished with permission of <a href="https://theconversation.com/" target="_blank"><strong><span style="text-decoration: underline;">The Conversation</span></strong></a>. </em><img width="1" height="1" src="https://counter.theconversation.com/content/82576/count.gif?distributor=republish-lightbox-advanced" alt="The Conversation"/></p>

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