A newly published scientific review seems to indicate that consuming artificial sweeteners increases cardiovascular disease risks. However, this research has some weaknesses, that I will discuss in this article, and contradicts other research that has shown no effect between artificial or non-nutritive sweeteners and health.
However, I think it’s important to discuss conflicting evidence regarding health. I am always concerned that people will overstate an effect that may just be a correlation without any evidence of causation.
Nevertheless, as usual, I’ll guide you through the study and then critique it, if necessary.
Artificial sweeteners and cardiovascular disease article
In a paper published on 12 April 2023 in Current Opinion in Cardiology, Francisco Gómez-Delgado, MD, Ph.D., Vascular Risk Unit, Internal Medicine Unit, Jaen University Hospital, Jaen, Spain, and colleagues coordinated an updated review of the leading scientific evidence surrounding artificial sweeteners and cardiovascular disease.
The researchers reviewed studies on the consumption of these artificial sweeteners and their negative influence on the development of obesity and several of the most important cardiovascular risk factors, such as hypertension (high blood pressure), hyperlipidemia (high cholesterol), and type 2 diabetes.
Here are some of their findings:
- The consumption of artificial sweeteners favors weight gain because of neuroendocrine mechanisms related to satiety that are abnormally activated when artificial sweeteners are consumed. However, there is powerful research that actually disputes this link, that is, artificial sweeteners do not cause hunger.
- Artificial sweeteners seem to increase weight gain. Again, the data is weak, with lots of confounding factors that make the evidence almost useless. Furthermore, there is no evidence that sugar has less of an effect on weight gain than artificial sweeteners — in other words, artificial sweeteners may be an effective method of weight loss compared to consuming sugary foods.
- Consuming artificial sweeteners raises the risk of type 2 diabetes by between 18% and 24%, and they increase the risk of metabolic syndrome by up to 44%.
Critique
I am very troubled by this review. First, the authors appeared to have cherry-picked research that supports their claims without much analysis. Second, the study is neither a systematic review nor a meta-analysis, either of which is the best type of study in medical science.
The article reads like an opinion piece, that is, presenting data that is the opinion of the researchers rather than based on the best evidence.
But here are my very specific criticisms:
- Too many people do nutritional studies without examining confounding factors. For example, individuals who consume artificial sweeteners may have pre-existing conditions like obesity, which is a risk factor for cardiovascular disease.
- The authors seem to ignore data that contradicts their claims.
- The authors seem to set aside the differences between correlation and causation. As I mentioned in number 1 above, consuming artificial sweeteners may be correlated with cardiovascular risk factors, but do they cause them? That takes a lot more research to uncover, and it’s not there.
- It’s almost impossible to do a nutritional clinical trial that controls for all factors that might be linked to cardiovascular disease. You just can’t do a trial where one group gets artificial sweeteners, another group gets sugar, and a third group gets neither. You just can’t lock these people in a room and force them to consume the correct amounts of different foods.
This research is scary, but I remain very skeptical of its conclusions. There are types of research, such as case-control or cohort studies, that could provide us with better evidence, but the results are all over the place.
A large systematic review examined the evidence of links between artificially sweetened beverages and cardiovascular disease, and they concluded that “According to the network meta-analysis, there was a large amount of heterogeneity across studies, showing no consistent pattern implicating added sugar, artificially-sweetened beverages, or sugar-sweetened beverages in cardiovascular disease outcomes.”
Despite this new research, there is too much conflicting evidence to conclude that artificial sweeteners cause weight gain, cause type 2 diabetes, or increase the risk of cardiovascular disease.
For those of you who think that this shows that medical science doesn’t know what are facts, what this does show is that science evolves with more data. And I think we need a lot more data to support the claims that artificial sweeteners are linked to cardiovascular disease.
Citations
- Gomez-Delgado F, Torres-Peña JD, Gutierrez-Lara G, Romero-Cabrera JL, Perez-Martinez P. Artificial sweeteners and cardiovascular risk. Curr Opin Cardiol. 2023 Jul 1;38(4):344-351. doi: 10.1097/HCO.0000000000001048. Epub 2023 Apr 12. PMID: 37115819.
- Yang B, Glenn AJ, Liu Q, Madsen T, Allison MA, Shikany JM, Manson JE, Chan KHK, Wu WC, Li J, Liu S, Lo K. Added Sugar, Sugar-Sweetened Beverages, and Artificially Sweetened Beverages and Risk of Cardiovascular Disease: Findings from the Women’s Health Initiative and a Network Meta-Analysis of Prospective Studies. Nutrients. 2022 Oct 11;14(20):4226. doi: 10.3390/nu14204226. PMID: 36296910; PMCID: PMC9609206.
- Zhang R, Noronha JC, Khan TA, McGlynn N, Back S, Grant SM, Kendall CWC, Sievenpiper JL. The Effect of Non-Nutritive Sweetened Beverages on Postprandial Glycemic and Endocrine Responses: A Systematic Review and Network Meta-Analysis. Nutrients. 2023 Feb 20;15(4):1050. doi: 10.3390/nu15041050. PMID: 36839408; PMCID: PMC9965414.
