• Posted September 9, 2022

Could Artificial Sweeteners Be Bad for Your Heart?

Artificial sweeteners are a popular way to try to keep slim, but French researchers suggest they may also increase your risk for a heart attack or stroke.

The finding stems from tracking heart health among more than 103,000 men and women in France for close to a decade.

"We observed that a higher intake of artificial sweeteners was associated with an increased risk of cardiovascular diseases," said study author Mathilde Touvier. She is director of the nutritional epidemiology research team at the French National Institute for Health and Medical Research and Sorbonne Paris Nord University, both in France.

Roughly 80% of participants in the NutriNet-Santé cohort were women (average age: 42). The study began in 2009 to investigate links between nutrition and health.

At the outset, nearly four out of 10 participants reported they regularly used artificial sweeteners, including Nutrasweet (aspartame), Splenda (sucraclose) and Sunett or Sweet One (acesulfame potassium). They added them to food or beverages and also consumed them in processed products.

Those who said they used such sweeteners were generally younger; less active; more likely to be overweight or obese; more likely to smoke; and more likely to be dieting. They also tended to consume more red meat, dairy, salt, and sugar-free drinks. They drank less alcohol and ate fewer fruits and vegetables, less carbs and fats, and fewer calories overall, dietary records showed.

Participants' heart health was then tracked and compared for an average nine years.

During that time, more than 1,500 heart problems occurred, including heart attacks, strokes, severe chest tightness or pain (angina), and/or the need for surgery to widen blocked arteries (angioplasty).

After stacking artificial sweetener consumption up against heart trouble, the researchers concluded that the former was associated with the risk for the latter.

The Calorie Control Council, which represents the artificial sweetener industry, did not respond to a request for comment.

Touvier and her team stressed that their work does not definitively prove that sweeteners directly undermine heart health, only that there's a link between the two.

And that should give people pause before drawing firm conclusions, said Connie Diekman, a St. Louis food and nutrition consultant who is former president of the Academy of Nutrition and Dietetics.

"The challenge with most of the studies, and that is true here, is that studies have yet to provide a cause-and-effect outcome,"Diekman said. "When looking at non-nutritive sweeteners it is hard to tease out how much the overall health of the subjects is a factor in the disease outcome."

For example, she pointed to study participants' own description of their diet and health habits.

"The authors state that higher consumers of non-nutritive sweeteners had higher BMI's [a measure of body fat based on height and weight], smoked more, had less physical activity, and ate more sodium and red meats, with fewer fruits and vegetables,"Diekman noted.

She also stressed the importance of accounting for the "trade-off"factor, in which someone who uses a no-calorie sweetener for an iced tea, for example, might then rationalize indulging in a bowl of ice cream. That, Diekman said, is why "the whole diet is what must be assessed."

While the authors said they took such factors into account when determining risk, Diekman had reservations.

"Can we really determine how one single variable impacted the health of the body?"she asked. "The answer is no."

Still, if artificial sweeteners do pose trouble for the heart, why might that be?

Lead author Charlotte Debras, a doctoral candidate at both the French National Institute for Health and Medical Research and Sorbonne Paris Nord University, suggested a number of possibilities.

One, she said, is the promotion of metabolic syndrome, which encompasses an array of conditions that raise the risk for heart attack and stroke. Among those are high blood pressure, high blood sugar, excess waist fat and high cholesterol.

"Another potential pathway could involve the interaction of artificial sweeteners with intestinal sweet taste receptors,"which can affect both insulin levels and sugar absorption, Debras said.

Artificial sweeteners may also alter the makeup of microbes found in the gut, drive up systemwide inflammation and trigger vascular malfunction, she added.

"But these are hypotheses, notably from experimental studies, that need to be confirmed,"Debras said.

Meanwhile, Diekman said the French findings do not change her dietary recommendations.

"Focus on an overall healthful eating plan,"she advised. "More plant foods, leaner or low fat animal foods, and if you enjoy something sweet, think about portions, frequency of consumption, and try to vary the types of sweeteners you use. No single food or ingredient is the 'bad guy.' It is how all of this comes together into your day in, and day out, eating plan."

The report was published online Sept. 7 in the BMJ.

More information

The Cleveland Clinic has more about artificial sweeteners.

SOURCES: Mathilde Touvier, PhD, director, nutritional epidemiology research team, French National Institute for Health and Medical Research and Sorbonne Paris Nord University, France; Charlotte Debras, doctoral candidate, nutritional epidemiology research team, French National Institute for Health and Medical Research and Sorbonne Paris Nord University, France; Connie Diekman, MEd, RD, food and nutrition consultant, St. Louis, and former president, Academy of Nutrition and Dietetics; The BMJ, Sept. 7, 2022, online