Artificial sweeteners and cancer
Artificial sweeteners are nonnutritive substances that serve as low-calorie substitutes for sugar in various food products. Commonly used to help manage weight and insulin levels, they are approved by regulatory bodies like the U.S. Food and Drug Administration (FDA). In the U.S., several artificial sweeteners, including aspartame, saccharin, and sucralose, have been deemed safe for consumption, although ongoing research continues to explore their long-term effects on health.
The relationship between artificial sweeteners and cancer has been a topic of debate, particularly after early studies linked saccharin to bladder cancer in animals. However, subsequent human studies have largely failed to find a definitive correlation. Conversely, concerns have resurfaced with recent reports labeling aspartame as "possibly carcinogenic." The FDA has countered these claims, emphasizing that extensive research has not confirmed a strong link between artificial sweetener consumption and cancer risk. While these sweeteners can be beneficial, particularly for individuals with diabetes or those on weight-loss plans, their long-term effects remain a subject of discussion, highlighting the importance of moderation in their use.
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Subject Terms
Artificial sweeteners and cancer
ALSO KNOWN AS: Aspartame, saccharin
DEFINITION: Artificial sweeteners are nonnutritive chemical substances with virtually no or very low caloric value. They are used as substitutes in food products for natural sweeteners such as sugar and honey. Artificial sweeteners are commonly used to control weight and insulin levels.
Government-approved artificial sweeteners: Artificial sweeteners are nonnutritive food additives since they provide no calories or energy to the body. In the 2020s, there were six artificial sweeteners approved for use in the United States by the US Food and Drug Administration (FDA):
- aspartame (NutraSweet, Equal)
- saccharin (Sweet’N Low, Sweet Twin, Necta Sweet)
- acesulfame potassium (Sunnet, Sweet One)
- neotame (Newtame), sucralose (Splenda), advantame
Two artificial sweeteners that the FDA has not approved are alitame and cyclamate.
"Generally regarded as safe" (GRAS) notices for the plant-derived steviol glycosides (Truvia, PureVia) and Siraitia grosvenorii Swingle fruit extract (Nectresse, PureLo) have been submitted to the FDA. Items that are deemed GRAS do not require FDA approval before being sold.
Aspartame is two hundred times sweeter than sugar and was approved as a general-purpose sweetener in all foods and drinks in 1996. Saccharin is two hundred to seven hundred times sweeter than sugar. It is used as a tabletop sweetener, soft drinks, and chewing gum. The FDA first approved acesulfame potassium as a tabletop sweetener, which is about two hundred times sweeter than sugar. Neotame, about seven thousand to fourteen thousand times sweeter than sugar, was approved in 2002 as a general-purpose sweetener in various food products. Sucralose is the only artificial sweetener with three chlorine atoms in its chemical structure and is six hundred times sweeter than sugar. The FDA approved sucralose in 1998 for use in food products, such as beverages, chewing gum, and frozen desserts. In 1999, the FDA approved sucralose as a general-purpose sweetener. Advantame is twenty thousand times sweeter than sugar and was allowed as a general-purpose sweetener for many foods in 2014. Nonetheless, a decade later, in the mid-2020s, research into the substance still needed more depth, and the impacts of advantage consumption by humans still needed to be fully understood.
Metabolism: Sucrose, the chemical entity in natural table sugar, binds to particular receptor proteins in the taste buds. This binding initiates a cascade of events, resulting in a signal sent to the brain that causes a sweet taste sensation. Additionally, sugar is a carbohydrate metabolized by the body to provide calories. Artificial sweeteners have a greater affinity for the receptor proteins and work by binding two hundred to fourteen hundred times more strongly to the receptor proteins than sucrose. As a result of their stronger binding capacity, artificial sweeteners are needed in much lower quantities than sugar to produce the same degree of sweetness.
The artificial sweeteners are either excreted by the body or converted to by-products with little or no caloric output. Saccharin, sucralose, and acesulfame potassium are excreted unchanged by the body and do not provide any calories. The enzymes in the body hydrolyze neotame and produce methanol as a by-product. Aspartame is broken down in the body to produce methanol, amino acids, aspartic acid, and phenylalanine. In comparison to sugar, very few calories result. Methanol is further degraded to formaldehyde in the body. Both methanol and formaldehyde are toxic to human beings at high doses. People with the genetic disease phenylketonuria (PKU) lack the enzyme that breaks down phenylalanine. Because phenylalanine is produced as a by-product of aspartame digestion, people with PKU should not ingest aspartame. Foods containing aspartame must carry a label warning consumers with PKU that the product is a source of phenylalanine.
Cancer risk: Questions regarding the risk of cancer associated with the consumption of artificial sweeteners arose when early studies indicated that saccharin with cyclamate caused bladder cancer in test animals. Subsequent epidemiological studies of groups of people did not find a definitive correlation between saccharin use and bladder cancer. There are two more controversial reports on the correlation between aspartame use and cancer. One 2005 study, which the FDA deemed flawed, found more lymphomas and leukemias in rats fed very high doses of aspartame, while a large 2006 study found no link between aspartame use in humans and cancer.
The FDA regulates artificial sweeteners. Before they can be sold in the US market, the FDA reviews numerous safety studies conducted with them, including studies that assess their potential cancer risk. The reviews have not conclusively demonstrated any solid positive correlation between various cancers and artificial sweetener use. Studies continue to be conducted, and the FDA will continue to review and evaluate the results.
Artificial sweeteners are beneficial for people with diabetes and for people on weight-loss plans. However, the effects of their long-term use on weight maintenance and cancer risk are controversial because they are not clearly understood. In light of insufficient experimental data and all the controversy swirling around artificial sweeteners, moderation should be the watchword for everyone using them.
In 2023, controversy materialized after a pronouncement by the International Agency for Research on Cancer (IARC) that aspartame was “possibly carcinogenic to humans.” Manufacturers of diet soft drinks were immediately impacted as fears were raised in consumers that such beverages could cause cancer. The FDA sought to dampen the IARC report with a response articulating that it disagreed with the IARC’s conclusions. The FDA mentioned that its scientists reviewed the scientific information in the IARC’s report and expressed concerns over what the FDA described as shortcomings in the IARC study. The FDA also asserted that aspartame was one of the most studied food additives and that regulatory agencies in Europe and Canada did not issue safety concerns.
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