[draft] How safe are fake sweeteners?

An inquiry into sugar substitutes

Revised: 09-22-2024

[This is still a draft, but I’ve plugged a few more with oakum, as it were…]

Nearly 40 years ago, in my mid-20s, I was a major consumer of soda pop. The regular stuff, sweeteend with sugar or the high fructose corn syrup that was rolling out in the 1980s. Six or more cans a day. I lived with someone who had a library of health and nutrition books. I browsed these. Most of the advice went unheeded. But I did make one change. I resolved that if I was going to guzzle soda in the quantities I ingested, I’d be better off with the diet ones. I still stand by that decision.

Refined carbohydrates in general and sugar(s) in particular, especially in the historically unprecedented amounts that we consume them, are implicated in all manner of chronic health issues. But that’s a separate topic.

One can of regular soda contains about 140 calories, all of it sugar(s). If I was drinking six a day, that was 840 calories. Probably 1/3 of my total calories. Unhealthy! (For comparison, the average diet gets about 20% of total calories from added sugars whether food or beverage.)

I still drink a lot of soda, but I’m not sure how much. But nearly all of it is diet.

I admit that I’ve never done much inquiry into the safety of the various artificial sweeteners. And there is a dizzying array of them. Given what I’ve already learnt about the flaws of safety testing by corporations and the easy pass that government gives, perhaps it’s time I turned my spotlight to the fake sweeteners.

This essay is, if you like, merely raising questions. I don’t claim any definitive answers. But as with many topics, there is a lot of information available but one has to look for it.

WebMD Says Aspartame is Bad

https://www.webmd.com/diet/obesity/ss/slideshow-worst-habits-for-belly-fat

This article claims that aspartame can lead to belly fat. Odd! I will look into.

2011 Huffing ton Post article on the sketchy approval of Aspartame

ttps://www.huffpost.com/entry/donald-rumsfeld-and-the-s_b_805581

Misconceptions abound — Possibly Including Mine?

In late Feb. 2023 I was meeting with some cronies, most of whom are my age or older (old farts, to not mince words.) As I was putting a packet of “pink stuff” into my coffee, Bruce derisively said, “That stuff’ll kill you!” I didn’t take the bait at the time, but it occurred to me later: here’s a crowd of men stting down to an Italian dinner, many of whom were trusting enough of the medical system to take the mRNA jabs, and some of whom have Type 2 Diabetes, and they propose to lecture me on artificial sweeteners.

The thought did pop into my mind at the time, that I suggested to Bruce to research what excessive sugar consumption does to the body and compare and contrast with saccharin, a sweetener in use since the 19th century, and then see if he really thought he’d made the best decision. Other than its bitter aftertaste, I think that saccharin has been cleared of any dire health risks, like cancer. I may be wrong. But it too, is one of many things on my “to investigate” list.

April 6, 2023 Updates

In early April, I began more or less to try the Atkins diet. I’d already been more or less low-carb since late 2022. With the new diet, I’ve redoubled my efforts to be low carb and thus have jettisoned, at least for the time being, such treats as corn chips at the Mexican restaurant [Edit: I “fell off the wagon” the week of May 14-20; beware the chips and salsa!] Indeed, I’m ignoring the tortillas and the bread if it even makes it to the table. Other high-carb foods are either being given away to friends or tucked away for emergency uses. All to say: I envision a growing potential for fake sweeteners.

I do use them, but not in huge quantity. For years, my preferred coffee sweetener has been saccharin, which is probably the oldest known sugar substitute. I use it in recipes that don’t require a bulk sweetener. For that, my current go-to is Erythritol.

Anyway, the latest installment of this essay has to do with aspartame. I rarely buy this as a standalone but it’s a common sweetener in many goods, including diet colas, which I frequently consume. As such, it remains on my to-research list. Here are a few studies that deal with it.

Paper claims 9-18% jump in CVD in users of selected sugar replacements.

https://pubmed.ncbi.nlm.nih.gov/36638072/

Was a survey of a French population, mostly middle-aged and majority female. At least three different types of artificial sweeteners were trapped. The only metric studied for was CVD. Overall they claim a 9% higher incidence, 18% in the higher users.

Ranged from least harmful to most. Aspartame 17%, sucralose 31% and acesulfame 40%.

My criticisms. This was basically a web-based survey of 100,000 or more consumers. As such I suspect the data is a very self-reported and a very low quality. Also the usual base rate applies. Even in middle age, CVD is rare as is death from any cause, so even a 40% relative increase is pretty small. And the big picture is typically not considered. Here, a relevant question would be: “Even if this sweetener has risks, how do they compare to other alternatives, including sugar, which has well-documented risks all its own?”

Mice study finds potential heart issues with aspartame, but how valid is a comparison to human use?

https://pubmed.ncbi.nlm.nih.gov/36251541/

This study looked at the effects of aspartame in mice. It opened by noting that other studies had found potential ill health effects from this sweetener.

For reference, I found on Google that the FDA says 50 mg per kilogram of body weight per day is an acceptable limit for this sweetener. Google also says that one can of Diet Coke sweetened with that has 200 mg. In this case, just for reference, 180 lb man would have to drink 4,000 mg which would be 20 cans of Diet Coke per day.

The study found that dose is not much higher than that FDA limit in mice over period of several months produced damn potential damage to the heart in the form of oxidative stress and other damages.

Favorable to this paper: On the other hand, the levels of aspartame tested in the mice were not ridiculously high as is sometimes the case in such studies. In fact, they were within the maximum allowable range, or perhaps 1/10 of normal usage. If one allows that physical effects might be similar in mice and humans, therefore it would be reasonable to be concerned that more than the tiniest amount of use of this sweetener in humans might bring on risks of heart or other illness.

Wikipedia on Aspartame sounds reassuring…

And now for an oasis of Tranquility

If the information presented in the Wikipedia entry for Aspartame is accurate then it is one of the most research and studied artificial sweeteners ever. It is been in the United States use since at least 1981. It's breakdown products no it's it is broken down in the intestine into amino acids and other substances including methanol and formaldehyde. The Wikipedia article notes and several times that while these some of these products are potentially toxic a normal diet will supply those in equal or greater amounts than even a fairly High consumption of aspartame would impose.

I recall health conscious friends having told me you shouldn't use that stuff it turns into formaldehyde in your body. Apparently so, but again it's the dose that makes the poison and if the regular foods I eat supply me with even more of that potential poison just how toxic is a few milligrams of aspartame?

Interim conclusion

So here we have it a common sweetener that has been in widespread commercial use for well over four decades. Apparently has a quite good if not perfect safety record. Yes, it does have some side effects in certain susceptible people. Yes, some surveys say that in higher doses it may cause CVD or perhaps other illnesses. But this product is long off patent. Nobody is getting rich selling aspartame. Unlike the MRNA vaccines of a couple years ago there's not a gold rush to profit from, cut corners and mandate they're used.

My gut instinct says that it's probably relatively safe. Will I continue using it? At least till I finish using up the two cases of diet cola I have.

WHO says artificial sugars are harmful, a year after saying they were better than sugar. The WHO’s reputation has taken quite a nosedive in recent years, and apparently they’ve turned their “expertise” to fake sweeteners.

https://dailysceptic.org/2023/05/20/who-says-artificial-sweeteners-dont-help-with-weight-loss-and-may-be-dangerous/

[Aside: A great name for a Substack would be The Sceptic Tank. But I’m stuck with Satan’s Doorknob for the time being.]

You can read the above article, but the one it links to is pay walled. Not having looked at the source document, I can only comment upon what Daily Sceptic says. Actually, I’d give some credit to WHO. Based on a few of the studies I found (above), I would tend to concur that artificial sweeteners do not “help with weight loss.” But, as the other studies imply, might that be due to not reducing, or even increasing, the user’s craving for other foods? With the possible exception of aspartame, which some claim may affect metabolism in some ways, I’d think it nearly impossible that a non-nutritive sugar replacement in and of itself, could possibly cause weight gain.

Are they dangerous? “Dangerous” is a loaded word. Any substance, potentially, has adverse effects. For example, water and salt are critical to human life. You will quickly die with too little or too much of either. Better to inquire “under what circumstances is it safe or not?”

Earlier, I’d seen an article specifically on Erythritol, a sweetener I use. The study claimed potential harms. I’ll link it here if I can find it again. Ah here it is:

Erythritol may be harmful and contribute to circulatory issues, says study that gave large quantities of the sweetener to test subjects who already had serious heart disease, diabetes and were elderly.

https://www.science.org/content/blog-post/trouble-erythritol

Hey a rarity: news that is pertinent to my life! I do low-carb diet and am an occasional user of Erythritol. I read the linked article and ... well, I'm skeptical. I'm far from an expert, but I've read many similar studies and know a few things to look for. If you're a rank amateur, don't feel dejected if you don't understand a word...such studies are written in a certain style and clarity is not a priority. Here are just a couple criticisms; some of the respondents to the Science article voiced related doubts. The actual study requires paid access, so if you lack that, you’ll just have to take my word for the following.

The cohorts (test subjects) were VERY unhealthy. This is just a snapshot, but the average subject was well into his 60s. About 25% are diabetic. About 1/6 were smokers. About 3/4 had "coronary artery disease"; roughly half had prior heart attacks. I'm not even going to bother with the lipids or blood pressure numbers; in fact, if you research those, they are not big factors to predict CVD (cardiovascular disease.) In sum, these were a bunch of sick old folks.

I don't see a control group. Nor was this a double blind test. That doesn't make the study worthless; but it does mean there was no control group (non-Erythritol users) for drawing comparison; this class of study is far down the list in terms of quality (the “gold standard” being the randomized, placebo-controlled test.)

The closest, apparently, was dividing into Quartiles (by amount of Erythritol in blood). The charts do seem to indicate that Q4 (heaviest users) have 3-4 times the "MACE" (CVD risk) as the Q1 (lowest users). But those are relative rates. The study provides no actual data (absolute occurrence) on any endpoints used.

Additional comments:

Fig. 1 of the study if I read them correctly, seem to show little to no risk of MACE (major CVD event) in the three years of study for the three lowest Quartiles. By far the increased risk is in the Q4 quadrile, the heaviest users of Erythritol.

Possible concern: in healthy individuals, consumption of a single 30 g dose remains in the blood stream for at least a few days, at levels where the platelet clumping may occur. It sounds as though that the sensitivity of platelets is raised, i.e. that they are more prone to react to an injury than in the control case.

I sometimes like to examine (more likely: “speculate upon”) the motivations of the emitters of a narrative. In other words, what likely motivations do they have to believe that matters are a certain way? Similarly, what factors likely are shaping their words? Why are they presenting a perspective as they are, presumably to convince their audience to accept it? To use an historical example, if sugar interests paid Harvard researchers to “research” the health effets of sugar [1], a person should reasonably suspect that funding might sway the “professional” opinion. While I’ve not checked the possible conflicts of interest in this current study, here is a simple observation: the substance of interst (erythritol) is a natural chemical, and in any event, unpatented and unpatentable. This fact alone should lend great confidence to any researchers studying it: Although inaccuracy or deception can never be ruled out, it would seem most unlikely that financial motives would bias their findings one way or the other. It bears mentioning that quite the opposite shold be assumed in the more common case where a new, on-patent drug is being researched at enormous cost, and when billions of dollars hang in the balance. The love of money may not really be the root of all evil, but avarice and its nefarious kin should always be suspected to be lurking in the shadows. Having introduced all that reason for suspicion, allow me to issue a disclaimer: Just because a person is funded by a special interest doesn’t necessarily mean his results are biased. They could still be objective. Conversely, just because researchers are studying something that could not be manipulated for profit, does not mean they automatically will arrive at the truth. It’s entirely possible that they might draw erroneous conclusions due to accident or some deliberate deceit. Did one of the lead researchers lose a loved one to disease, and he was a heavy user of erythritol? That may not be likely, but it’d be an excellent reason to suspect it might color his findings.

Mind you, all the above is just one layman's opinion from barely scanning a study he doesn't fully understand. So yes, perhaps there are issues with Erythritol. Or perhaps it's not much worse than any other sweetener. For comparison, look up the adverse health issues caused by common "sugar" (sucrose/corn syrup.) Absent better proof of risk, I plan to continue using these fake sweeteners. That’s especially the case with Erythritol, which I use sparingly: perhaps one tablespoon (15 grams) in a dish, a few times per week.

Here’s a really confusing meta-analysis; seems to argue for +12% added relative risk of all-cause mortality.

https://pubmed.ncbi.nlm.nih.gov/36145117/

(Freely available). I did a quick browse; jump to “Discussion” to follow along. They looked at more than two dozen studies. The results point in several different directions. Despite title saying the topic of interest is cancer, they also looked at all cause mortality. This may be the sole most important endpoint. Counter-intuitively, while the intent of “…artificial sweeteners was originally to replace the sugar so that using these products would reduce caloric intake, result in weight loss and reduce diabetes mellitus’ incidence. However, existing research has shown that instead of reducing the risk of certain chronic diseases such as obesity, insulin resistance, or coronary artery disease, the use of artificial sweeteners even increases the likelihood of these diseases.”

What is the increased risk? If I read Figure 4 properly, very close to +12% (relative risk, I assume).

Aug. 2024: Erythritol studied in healthy people and — well, not much new I see

I took a quick look at this study

https://www.ahajournals.org/doi/epub/10.1161/ATVBAHA.124.321019

This study only looked at platelet activation in healthy subjects. Since they were feed a reasonable dose (30 g), it may be significant that platelet aggregation was noted. This could lead to thrombotic (clotting) events. Unlike the prior study, there is no long-term tracking to see what if any adverse events develop. There are few if any long-term studies of this sweetener. Since erythritol is slowly eliminated, I may try to determine what the optimal daily amount would be (likely, equal to what’s excreted.) That’s probably less than 30 grams.

Sucralose is Safe — Or Is It? Yet another scary study.

This recent article (and reporting on study linked below it):

https://medicalxpress.com/news/2023-05-chemical-common-sweetener-dna.html

https://www.tandfonline.com/doi/full/10.1080/10937404.2023.2213903

reports new findings upon sucralose; it may have undesirable health issues. At present, I take no position on the value of the study itself. I will comment upon a few background issues. As with many other fake sweeteners, sucralose is hardly brand new. The Schiffman et al paper provides a capsule history of the chemical. It’s been around since the 1970s. It has been, presumably, extensively tested before it was approved worldwide as a sweetener. Diet advice, such as Atkins for Life (2004), preferentially recommended sucralose (and some others) while cautioning about aspartame. I cite this not to fault the earlier advice, but to show how new information might alter that advice — that is, of course, assuming the findings of this latest study are valid, and that’s a big “if.” I retain my skepticism about institutional claims, whether they were to evaluate drug (or additive) safety, or follow-up reserach by an independent team. Giving the earlier research the benefit of the doubt however, a large number of studies were done. Assuming they were honestly done and no cover-ups, then, I would assume that any serious short-term health adverse effectsw would have been discovered in the earlier testing.

In the meantime, I won’t lose any sleep over how much sucralose I’m consuming.

Aspartame now a cancer risk — or is it?

https://timesofindia.indiatimes.com/business/international-business/whos-cancer-research-agency-to-say-aspartame-sweetener-a-possible-carcinogen-sources/articleshow/101364239.cms

Just my usual editorializing: The chemical has been in use for decades. It’s been extensively tested. That, of course doesn’t mean that it is perfectly safe. It’s long off patent so no one’s getting rich selling it. It is one of the most widely used, so there’s a conspriacist reason to suspect that big business (use it in products) might suppress adverse news. But what about the end user? That’s me. I drink lots of diet soda. Bottom line: maybe it’s safe, maybe it has risks. I do note in passing, and a comment I don’t think I’ve made before, that other sweeteners have been accused of being carcinogenic and were later exonerated (so I believe): saccharin and cyclamate. A final criticism: the WHO is proven itself to be, shall we say, somewhat less than reliable. Remember the Covid-19 pandemic? Urgent promotion of novel mRNA “vaccines”? By traditional standards, scarcely tested for safety or even efficacy, yet dispensed by the billions of doses? Why would any sane person trust any pronouncement from such an organization? The Covid-19 jabs are likely the most egregious failing, but far from the only one.

A Rarity: Mainstream article, Harvard authority speaking common sense!

https://www.dailymail.co.uk/health/article-12247161/Doctors-say-possible-carcinogen-aspartame-better-sugar.html

Only comment I’ll make; I think I’ve said this earlier: critics note that asparatame breakdown products include formic acid and methanol, but toxic to the body. Granted that is the case. If one wikipedias those two substances, one will find they occur naturally in trace amounts, in normal foods and/or produced by our bodies.

Conclusion

Artificial sweeteners will always have their risks; all substances do. So the bottom line is which is the lesser of two evils? I’ve chosen what I hope are the small risks posed by the fake stuff rather than the bigger risks inherent with sugar consumption. I am however, willing to adjust the particular substances and the quantity of each, as I find new information on their risks and benefits.

Footnotes

[1] Kendrick, Malcolm. A Statin Nation. Chapter 12.