Researchers Find Link Between Artificial Sweeteners and Heart Disease

Artificial Sweetener Packets

A new study has uncovered a potential direct association between higher artificial sweetener consumption and increased cardiovascular disease risk.

These food additives “should not be considered a healthy and safe alternative to sugar,” argue researchers.

A potential direct association between higher artificial sweetener consumption and increased cardiovascular disease risk, including heart attack and stroke has been uncovered by a large study of French adults published on September 7 by The BMJ.

These food additives are consumed daily by millions of people and are present in thousands of foods and drinks. The findings indicate that these artificial sweeteners should not be considered a healthy and safe alternative to sugar, in line with the current position of several health agencies.

Artificial sweeteners are widely used as no or low-calorie alternatives to sugar. They represent a $7.2 billion (£5.9 billion; €7.0 billion) global market and are found in thousands of products worldwide. They are particularly common in ultra-processed foods such as artificially sweetened drinks, some snacks, and low-calorie ready meals.

Several studies have already linked the consumption of artificial sweeteners or artificially sweetened beverages (ASB) to weight gain, high blood pressure, and inflammation. However, findings remain mixed about the role of artificial sweeteners in the cause of various diseases, including cardiovascular disease (CVD). Moreover, several observational studies have used ASB consumption as a proxy to explore CVD risk, but none have measured artificial sweetener intake from the overall diet.

To investigate this further, a team of researchers at the French National Institute for Health and Medical Research (Inserm) and colleagues, drew on data from 103,388 participants (average age 42 years; 80% female) of the web-based NutriNet-Santé study. Launched in France in 2009, this ongoing study investigates relations between nutrition and health.

Dietary intakes and consumption of artificial sweeteners were assessed by repeated 24-hour dietary records. A wide range of potentially influential health, lifestyle, and sociodemographic factors were taken into account.

Artificial sweeteners from all dietary sources (beverages, dairy products, tabletop sweeteners, etc.) and by type (aspartame, sucralose, and acesulfame potassium) were included in the analysis. 

A total of 37% of participants consumed artificial sweeteners, with an average intake of 42.46 mg/day. This corresponds to approximately one individual packet of tabletop sweetener or 100 mL (3.4 ounces) of diet soda.

Among participants who consumed artificial sweeteners, mean intakes for lower and higher consumer categories were 7.46 and 77.62 mg/ day, respectively.

Compared with non-consumers, higher consumers tended to be younger, be less physically active, have a higher body mass index (BMI), were more likely to smoke, and to follow a weight loss diet. They also had lower total energy intake, and lower alcohol, carbohydrate, saturated and polyunsaturated fats, fiber, fruit, and vegetable intakes, and higher intakes of sodium, red and processed meat, dairy products, and beverages with no added sugar. However, the investigators took these differences into account in their analyses.

During an average follow-up period of nine years, 1,502 cardiovascular events occurred. They included heart attack, angioplasty (a procedure to widen blocked or narrowed arteries to the heart), angina, transient ischemic attack, and stroke.

The scientists found that total artificial sweetener intake was associated with an increased risk of cardiovascular disease (absolute rate 346 per 100,000 person-years in higher consumers and 314 per 100,000 person-years in non-consumers).

Artificial sweeteners were more particularly associated with cerebrovascular disease risk (absolute rates 195 and 150 per 100,000 person-years in higher and non-consumers, respectively).

Aspartame intake was associated with an increased risk of cerebrovascular events (186 and 151 per 100,000 person-years in higher and non-consumers, respectively), while acesulfame potassium and sucralose were associated with increased coronary heart disease risk (acesulfame potassium: 167 and 164 per 100,000 person-years; sucralose: 271 and 161 per 100,000 person-years in higher and non-consumers, respectively).

Because this is an observational study, it can’t establish cause. Additionally, the researchers cannot rule out the possibility that other unknown (confounding) factors might have affected their results.

Nevertheless, this was a large study that evaluated individuals’ artificial sweetener intake using precise, high-quality dietary data. Furthermore, the findings are in line with other studies linking exposure to artificial sweeteners with several markers of poor health.

Therefore, the researchers say their results suggest that there is no benefit from substituting artificial sweeteners for added sugar on CVD outcomes.

Further prospective cohort studies need to confirm these results and experimental studies are required to clarify biological pathways, they add. 

In the meantime, they suggest this study provides key insights into the context of artificial sweetener re-evaluation currently being carried out by the European Food Safety Authority, the World Health Organization (WHO), and other health agencies.

Reference: “Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort” by Charlotte Debras, Eloi Chazelas, Laury Sellem, Raphaël Porcher, Nathalie Druesne-Pecollo, Younes Esseddik, Fabien Szabo de Edelenyi, Cédric Agaësse, Alexandre De Sa, Rebecca Lutchia, Léopold K Fezeu, Chantal Julia, Emmanuelle Kesse-Guyot, Benjamin Allès, Pilar Galan, Serge Hercberg, Mélanie Deschasaux-Tanguy, Inge Huybrechts, Bernard Srour and Mathilde Touvier, 7 September 2022, The BMJ.
DOI: 10.1136/bmj-2022-071204


View Comments

  • I believe tht the majority of people, like myself, use artificial sweeteners are diabetics. We are at a higher risk for cardiovascular disease without using artificial sweeteners. Because of this, I think the study is flawed.

  • I agree, it seems from reading the review artificial sweeteners are of no or little health benefit in people that are high BMI with a poor diet. I think it would be nice to see a study looking at the influence of sweeteners in 'normal' BMI groups who eat better diets with a proper control, ie a double blinded randomised control comparing sugar with sweeteners. Dietary studies are always difficult with so many variables including the variety of sweeteners that also need comparing.

    • I think it would be similar to studies done with eggs, which show they alone have little impact on health. Ultimately factors like BMI, exercise, age and overall diet are infinitely more important than a sing

  • The study explicitly states "Those with prevalent CVD or pre-existing diabetes were excluded". You can read the study in the link provided at the bottom of the article.

  • So they're just gonna ignore the fact that the participants were relatively overweight, smoked, and didn't exercise on regular basis. But it was the artificial sweetness that was the cause of their heart disease. Ok? Lol. You make a case study but you don't give a consistent baseline of people for the study. It's like saying drinking pop causes cancer,when the subjects smoked, worked in a place where friable asbestos was present, and family had a long history of cancer diagnosis. But it was the pop.

  • I am a diabetic from a line of diabetic family members. I played sports growing up and ate pretty healthy. I was told at 18 I was borderline diabetic. I ate what I wanted and never had any problems. When I turned 46 I could not do sports anymore. At 50 I became a full blown diabetic. I am allergic to artificial sweeteners. I truly believe that we should not be using artificial sweeteners. The issue is moderation. People over do eating. What kills me when I go into an all you can eat buffet people load down their plates and have a diet drink. Really!? When I go to all you can eat buffet I get one plate with a medium amount on the plate with a coke. I drink only half my coke. And some water. People need to stop drinking those sweeteners and moderate themselves so they can enjoy a LITTLE soda. And water.

    • Do you think those people at the buffet should get a 440-calorie quart of Mountain Dew instead of the zero-calorie diet? I've never understood people who rant about people eating a lot of food with a diet drink. Sure, they probably shouldn't be eating that much food, but it's better that they're not consuming all the extra calories from the drink too. You really should be ranting about the people that choose the sugary drinks instead.

  • It was mentioned that the artificial sweeteners were found to be used more regularly in higher bmi population. Furthermore against the control the only substance that had close to a 100% increase was sucralose, the 12 more occurrences out of cca 150 in consumers vs non consumers is hardly convincing. Have not read the study yet but I also speculate that the bmi had more impact here than anything else. Lastly, questionnaire based studies are the least reliable studies in nutrition, yet most used. Some questions are awkward to answer, like how many eggs do you consume per week? Sometimes i'll eat 6 eggs in a week and then not eat them for 2-3 months, sometimes even longer, and any estimation at this input is wrong.

  • The key word is "associated"... They did not use the word "caused"... They have not provided any scientific explanation as to how their "associated" effects occur. Don't be concerned with this study ... Looks like another hype and scare study and article, designed to frighten innocent public.

  • "...artificial sweetener intake was associated with an increased risk of cardiovascular disease (absolute rate 346 per 100,000 person-years in higher consumers and 314 per 100,000 person-years in non-consumers)."

    346-314 = 32. That's the increased risk of CVD attributed to artificial sweetener intake per 100000 people.

    Percentage wise, that works out to a 0.032% increase. How will I sleep tonight?

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