Is there evidence of an association?
What are they
Artificial sweeteners, or sugar substitutes, are food additives that impart a sweet taste to foods or drinks without adding calories. They are 200 to 700 times sweeter than sugar and work because the body cannot break them down into energy, which produces no calories.
The main artificial sweeteners used today are:
- Aspartame (brand name is Equal, blue packets)
- Sucralose (brand name is Splenda, yellow sachets)
- Saccharin (brand name is Sweet n’ Low, pink sachets)
Artificial sweeteners are used in many products, including diet sodas and the ubiquitous little yellow and pink packets found in every American coffee shop. However, they have a long and controversial history about their possible association with cancer.
The search for substances with a sweet taste
Prior to the 1950s, the primary reason for using artificial sweeteners was cost; it was often cheaper than sugar. Saccharin was first produced in 1879. In 1907, the director of the Bureau of Chemistry (the precursor to the FDA) declared it an illegal sugar substitution. He was so popular that Theodore Roosevelt responded to him by saying, “Anyone who says saccharin is harmful to health is an idiot”, quickly ending the director’s career.
In 1977, the FDA attempted to ban saccharin based on studies showing bladder cancer in rats. Public opposition was intense, and instead the FDA mandated new labeling,
“This product contains saccharin which has been determined to cause cancer in laboratory animals.”
In 2000, the label was abandoned. Later studies indicated that the bladder cancer found in rats was due to a mechanism that was not relevant to humans. Saccharin was removed from the National Toxicology Program’s (NTP) report list of carcinogens because it is no longer a “substance reasonably likely to be carcinogenic to humans.”
Another artificial sweetener, cyclamate, was approved by the FDA in 1951. It was banned in 1970 after a study found an increased rate of bladder cancer in rats. However, further evaluation caused the FDA to reverse its position again, stating that there is no evidence that cyclamate causes cancer in rats or mice. While cyclamate remains banned in the United States, it is a sweetener in at least 130 other countries.
In the 1950s, however, artificial sweeteners became a dietary aid, continuing to the present day.
How safe are they?
Aspartame entered the US food market in 1981. The FDA reviewed a large number of studies in the aspartame approval process. More recently, studies in laboratory animals have not shown an increased risk of cancer, even at very high doses, including a mouse study by the NTP. A study in children showed no association between aspartame consumption and brain cancer.
However, stories about its ability to cause cancer continue to appear in the media. This is not limited to the general press; just a few months ago the following article was published in a scientific journal: “Aspartame and cancer – new evidence for causation” The report states that new findings confirm that aspartame is carcinogenic in rodents.
What are these new discoveries? These are old findings from studies carried out in 2006 and 2007 by the Ramazzini Institute.  The Ramazzini Institute has been repeatedly criticized for its lack of quality control. This first came to light over a decade ago when it became clear that whatever substance the Ramazzini Institute tested, the results were always positive for carcinogenicity.
Several organizations have reviewed the Ramazzini Institute’s findings on aspartame and found them to be without merit. In 2013, the European Food Safety Authority (EFSA) concluded that due to uncertainties in the diagnosis of the tumor and health issues with laboratory animals, there was insufficient evidence to conclude that aspartame caused tumors in these studies.
Another article assessed the reliability of available studies examining possible links between aspartame and cancer. The Ramazzini Institute was the only organization among the nine to be rated “unreliable”, while all the others were found to be “reliable with restriction”.
These problems with the Ramazzini Institute are neither new nor unique to aspartame. In fact, in 2010 the EPA suspended four of its ongoing chemical assessments while it reviewed the Ramazzini Institute data used in its assessments. The EPA no longer uses the Ramazzini data.
Sucralose is the newest of the major artificial sweeteners, entering the market in 1998. It differs from other artificial sweeteners in that it is made from natural sugar. It can be used in a granulated form which allows it to replace sugar in baking. As with aspartame, the FDA approval of sucralose involved reviewing a large number of studies, with no evidence that it caused cancer. Studies since then have also found no cancer risk.
Once again, the Ramazzini Institute raised concerns about the safety of sucralose with the publication in 2016 of a study concluding that sucralose caused blood tumors in mice. A year later, EFSA reviewed the research and concluded that the available data did not support the authors’ conclusions due to
- the absence of a dose-response relationship
- no identifiable mode of action
- and the lack of data indicating a causal relationship.
The question for the informed reader is how to make sense of the constant stream of conflicting reports about carcinogens. It is extraordinarily difficult.
Let me offer two concrete steps that every consumer can take. “Google” the study authors and associated funding agencies. This often brings up surprising and enlightening facts! Also see the Conflict of Interest or Competing Interests section found at the end of each Reputable Study. It tells you who is funding the research and the relationship between authors and funding agencies.
Readers today are inundated with headlines meant to scare, scare, or stop you from using a helpful product or eating what you love. As a reader, you must be skeptical. In the case of artificial sweeteners, there is no evidence that they pose a cancer risk.
 The Competing Interests section of the article notes: “There is no financial conflict of interest. Both authors are members of the Scientific Advisory Board of the Ramazzini Institute.
Susan Goldhaber, MPH, is an environmental toxicologist with more than 40 years of experience working in federal and state agencies and in the private sector, focusing on issues concerning chemicals in drinking water, air and hazardous waste. Her current focus is on translating scientific data into usable information for the public.
A version of this article was originally published by the American Council on Science and Health and has been republished here with permission. ACSH can be found on Twitter @ACSHorg
This article was previously published on the GLP on September 21, 2021.
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