Today brought another example of how medical research can confuse the public and undermine its own credibility. Ambiguous reporting feeds skepticism, which in turn drives down compliance with legitimate scientific recommendations. That in turn hurts us all.
The current example is from a report on health risks of artificial sweeteners using data from a decade long study of nutrition in France. I’m not quibbling with the study design or sample size. Nothing is perfect, but these appear to be quite adequate.
No, the problem I have is with data interpretation and reporting. The headline that caught my attention was: Can zero-calorie sweeteners raise your risk for cardiovascular disease?(1) The conclusion presented in the report is that artificial sweeteners can increase the risk of cardiovascular disease and stroke.
For the record, the sweeteners included in the study were
- acesulfame potassium
- neohesperidine dihydrochalcone
- steviol glycosides
- salt of aspartame-acesulfame potassium
Of these, the researchers report particular concern with the consumption of aspartame, acesulfame potassium and sucralose, saying that
“Our results indicate that these food additives, consumed daily by millions of people and present in thousands of foods and beverages, should not be considered a healthy and safe alternative to sugar, in line with the current position of several health agencies.”
They further state that while occasional consumption of these additives isn’t a problem, daily consumption is.
In fairness, there has been some controversy about artificial sweeteners for decades, and the original version, saccharin, was back in the 1970s considered a potential cancer risk, although that is no longer the case. As noted above, saccharin was included in this study and was not identified as a key concern.
The problem comes when we look at the data. On a rate of cardiovascular disease (CVD) cases per 100,000 people basis, the study found
- 346 cases among consumers who made more frequent use of the listed artificial sweeteners, versus
- 314 cases among consumers who made less frequent use of these sweeteners.
That’s about a 10% increase in risk.
Now, from a societal standpoint, such an increase is a big deal. An extra 32 cases per 100,000 people per year would mean an extra 10,500 cases in just the US. The medical resources and money required to take care of this volume of extra CVD cases is significant.
However, we also need to know if reduced use of artificial sweeteners is associated with greater use of sugar. The study report doesn’t clarify that. We do know that sugar use is associated with obesity and Type II diabetes. While obesity and diabetes are associated with CVD issues, they facilitate other diseases as well. Focusing solely on CVD rates may be misleading.
For the individual or family, trying to figure out what to do with this study is complicated.
- First, is a 10% increase in risk worth changing behavior? That may and probably should depend on age and the other health issues present.
- Second, if you do make a change, do you make it for all family members or just for some? Pediatricians are particularly concerned about sugar consumption among children.
- Third, If you do want to change what you use, do you eliminate artificial sweeteners entirely or just move away from the three flagged as the most serious concerns?
Some other studies have suggested that artificial sweeteners may contribute to weight gain by stimulating food cravings.(2) Moving off sugar may not be a fix for excessive weight.
The Cleveland Clinic opines that
“It’s important to remember that “sugar-free” is not the same thing as healthy.”(3)
That may be especially true where kids are concerned.
Bottom line: Reports should provide clear guidance on what research says and does not say. However, just as important is to let both policy makers and consumers know what the research indicates they should do. Leaving the audience to guess may be great for academicians but doesn’t work for anyone else.