Diabetes, General | December 22, 2014 | Author: The Super Pharmacist
Artificial sweeteners are widely used as an alternative to sugar in thousands of food and drink products. Since the discovery of the world’s first artificial sweetener, saccharin, in 1879, there have been concerns regarding their safety and potentially toxic effects. A number of health conditions have been linked to an increased uptake of sweeteners such as aspartame including cancers, low birth weight, high blood pressure, seizures, vomiting and dizziness.
Regarding the potential harm associated with artificial sweeteners. Given the length of time that saccharin has been available since its initial discovery, it is probably, along with aspartame, the most heavily researched artificial sweetener that is widely used around the world.
Safety concerns regarding saccharin were first expressed in the US in 1977, following a study that showed an increased incidence of bladder tumours in mice when they ingested the sweetener (1). The studies showed saccharin to be carcinogenic in rats when administered over two generations, although subsequent further observational (2) and epidemiological studies (3) found no increased incidence, or associated risk with cancers in humans who ingested saccharin, despite earlier reports that suggested heightened risk of both cancer and diabetes.
A further large scale retrospective cohort study of 6000 patients, undertaken by researchers in partnership with the British Diabetic Association in 1975, found no relationship between an increased intake of saccharin and cancer (4).
A retrospective analysis of the study that identified increased bladder cancer in mice also showed that the administered dose was significantly higher than that which would ever normally be ingested by humans.
Despite the body of evidence regarding the safety of saccharin, some concerns do remain regarding its potential health impact in regards to allergic reactions, particularly for individuals who are allergic to sulphonamides which are found in several artificial sweeteners. Allergies to this compound are common, although there remains limited specific research regarding saccharin and associated allergic reaction (5).
Aspartame has received similar levels of scrutiny and media attention regarding its supposed links to a range of conditions including cancer, dementia, behavioural disorders, hair loss and depression, although a full review of available literature in the British Medical Journal stated that there was no evidence linking aspartame to any of these conditions (6).
Most regulatory bodies are extremely clear on their position that artificial sweeteners pose no health risks and are very safe, except for individuals with phenylketonuria (PKU) – a rare genetic condition in which the body is unable to adequately break down phenylanine, a common ingredient in sweeteners (7).
The opinion of the regulatory bodies that artificial sweeteners pose no significantly adverse health risk is also shared by large, independent charities and organisations.
The Cancer Council and the Diabetes Association have conducted their own research and found no evidence of harm. In response to a number of concerns raised in the media regarding the safety of Aspartame, the United States National Cancer Institute undertook a study in 2006 that covered more than half a million people, finding no increased risk of leukaemia, lymphoma or brain cancer (8).
A periodic review of the available evidence by the European Food Safety Authority in 2013 also found aspartame to be safe for consumption, including among pregnant women and children (9). In the large majority of Western countries, the consumption of sugar accounts for approximately 10% of total calorific intake. It is argued by many that artificial sweeteners that are non-nutritive and non-calorific are an appropriate substitute for sugar, and have a positive role to play in maintaining a healthy weight (providing that the equivalent calories in sugar are not replaced or even exceeded). However, the evidence about its role in preventing weight gain or obesity is largely inconclusive (10,11), although there is some evidence that substituting full sugar drinks for juices that are artificially sweetened is inversely related to weight gain (12).
There remains no clear evidence for a causative link between artificial sweetener consumption and weight gain. Given the number of confounding variables that contribute towards weight gain over a significant period of time, testing such an association is also methodologically very difficult and would require a robust study design and the observation of a very large population over time. Even so, human diets are complex and consist of many different foods, drinks and associated artificial sweeteners, all of which vary in amount and can change considerably over time.
There is some concern that the prolonged or long-term use of artificial sweeteners can alter taste perceptions and increase the intake of simple carbohydrates. However, there is no evidence to support this theory.
It is common knowledge that saccharin has a very bitter aftertaste, but there is no evidence, and very few studies, to suggest that this it has a permanently negative impact on taste buds.
Similar suggestions regarding the negative long-term effects of other artificial sweeteners – including stevia glycosides, acesulfame K, sucralose, sorbitol and xylitol – have all had questions raised regarding their long term safety, potential role in the development of certain diseases, and longstanding negative impact on taste perception, but to date there is no convincing evidence to suggest that this is the case.
Although much of the literature around artificial sweeteners focuses on its potential harms, there is some evidence that they may have a potentially positive impact in some areas of healthcare. Xylitol, a low calorie sugar substitute, is evidenced in a wide range of studies to reduce the number of dental caries in the general population, and particularly so in young children (13). As well as reducing the sugar intake of popular foods, it also works by inducing remineralisation of enamel on teeth, and reducing the build up of plaque (14).
The evidence on xylitol is wide ranging, with its benefits first made clear in a series of famous Finnish studies in the 1970s that are now widely known as the ‘Turku sugar studies’ (15). In this regard, sweetener substitutes in food, toothpastes, and popular drinks, and clearer recommendations regarding the optimum dose in respect of their efficacy, has the capacity to substantially change both individual and public health for the better (16).
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9. EFSA. (2013). Scientific Opinion on the re-evaluation of aspartame (E951) as a food additive. EFSA Panel on Food Additives and Nutrient Sources added to food (ANS). EFSA Journal 11(12):3496. Available online at http://www.efsa.europa.eu/en/efsajournal/doc/3496.pdf (last accessed 15th December 2014).
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