Study: Do artificial sweeteners increase the risk of cancer?
Contents
At a glance | Questions for your doctor |
Study findings | Guidelines |
Strengths and limitations | Clinical trials |
What does this mean for me? | Related resources |
In-depth |
STUDY AT A GLANCE
What is this study about?
Whether artificial sweeteners increase cancer risk.
Why is this study important?
Artificial sweeteners are used widely in foods and beverages as an alternative to added sugars. Recent estimates suggest that about 40 percent of adults in the US regularly consume artificial sweeteners.
Studies looking at links between artificial sweeteners and cancer have had conflicting results. Most human studies have focused only on artificially sweetened beverages, which may underestimate the total intake of artificial sweeteners due to their wide use in processed foods.
This study looked at different types of artificial sweeteners and evaluated the risk of cancer associated with total intake from all sources. Knowing whether artificial sweeteners affect the risk of cancer could help people make healthy lifestyle choices.
Study findings
The researchers looked at information from more than 102,000 French adults enrolled in the NutriNet-Sante study—a large, ongoing effort looking at the complex links between nutrition and health. Participants filled out web-based diet records every six months. None of the participants had cancer when the study began. Among the participants:
- Most (almost 80%) were women.
- The average age was about 42 years old.
- Artificial sweeteners were used by over one-third (37%) of participants.
- The most common artificial sweeteners used were NutraSweet/Equal (aspartame), Sunett/SweetOne (acesulfmame-K) and Splenda (sucralose).
- The most common foods or drinks with artificial sweeteners were artificially sweetened beverages, table-top sweeteners and yogurt/cottage cheese.
After an average of nearly eight years, 3,358 participants were diagnosed with cancer; 982 participants were diagnosed with breast cancer and 403 were diagnosed with cancer. The researchers used statistics to determine whether there was a link between the type and quantity of artificial sweeteners used and cancer risk. Their results showed that:
- a higher total intake of artificial sweeteners was linked to a 13% increase in risk for overall cancer compared to no intake of artificial sweeteners. Over several years of follow-up, about 3 in 100 people who consumed no artificial sweeteners got cancer compared to 3 to 4 in 100 people who consumed artificial sweeteners.
- a higher intake of NutraSweet/Equal (aspartame) was linked to a 22% increase in risk for breast cancer compared to no intake of artificial sweeteners. During the study, about 1 in 100 women who consumed no artificial sweeteners developed breast cancer compared to 1 to 2 in 100 women who consumed artificial sweeteners.
- no link was found between artificial sweeteners and prostate cancer.
- no link was found between intake of Splenda (sucralose) and any type of cancer.
Strengths and limitations
Strengths
- The study included more than 102,000 participants and followed them for several years, allowing researchers to determine if long-term use of artificial sweeteners may impact cancer risk.
- The participants provided detailed diet records. Portion sizes were validated via photographs or serving container size, allowing researchers to examine each type of artificial sweetener and look at total intake. These are improved methods compared to most human studies that just consider intake of artificially sweetened beverages as an approximation of total use.
- The researchers tried to adjust for several factors (e.g., age, sex, BMI, physical activity, smoking, etc.) to help determine the impact of artificial sweeteners on cancer risk.
- The study was funded by academic research institutions and European cancer institutes, rather than companies that might have had a potential conflict of interest.
Limitations
- The participants were limited to French adults, the majority of whom were white. About 80% of the participants were women. Therefore, the results of the study may not apply to the overall population or specific populations such as men or people from different racial or ethnic backgrounds or different countries.
- The participants were asked to report their artificial sweetener intake sporadically and at random. A lot of intake data can be missed by this approach.
- The study looked at participants’ family history of cancer but did not look at whether they had a hereditary genetic mutation that increases cancer risk.
- Finding links between individual foods (or food additives) and cancer risk is difficult. The design of this study did not allow researchers to prove that artificial sweeteners cause cancer. It is possible that cancer risk could be increased due to other factors in people who uses artificial sweeteners, rather than by the artificial sweetener itself.
What does this mean for me?
This study found that artificial sweeteners were linked to a 13 percent increase in cancer risk. To illustrate how this affects risk, in the US, the average person’s lifetime risk of developing any type of cancer is about 40 percent. Using artificial sweeteners would increase that to about 45 percent. The study also found that NutraSweet/Equal (aspartame) increased breast cancer risk by 22 percent. In the US, the average woman’s lifetime risk of breast cancer is about 13 percent. Using artificial sweeteners would increase that to about 16 percent.
Many people use artificial sweeteners to avoid excess sugar, which comes with its own health risks. Most data indicate that artificial sweeteners are unlikely to have a large effect on cancer risk. Other lifestyle factors (drinking alcohol, obesity, lack of exercise, smoking) have similar or greater effects. In addition, this study did not include stevia, a no-calorie natural sweetener made from the stevia plant. It is possible that stevia could be a safer way to reduce sugar intake without increasing cancer risk, but more studies are needed. Although not enough evidence suggests that people who stop using artificial sweeteners can reduce their cancer risk, talking with a nutritionist about your overall diet may be helpful.
References
Debras C, Chazelas E, Srour B, et al. Artificial sweeteners and cancer risk: results from the NutriNet-Santé cohort. PLoS Medicine 2022;19(3): e1003950
Debras C, Chazelas E, Srour B, et al. Total and added sugar intakes, sugar types, and cancer risk: results from the prospective NutriNet-Santé cohort. American Journal of Clinical Nutrition 2020;112(5):1267-79.
Sylvetsky AC, Jin Y, Clark EJ, et al. Consumption of low-calorie sweeteners among children and adults in the United States. Journal of the Academy of Nutrition and Dietetics 2017;117(3):441-48.e2
Toews I, Lohner S, de Gaudry DK, et al. Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies. British Medical Journal 2019;364:k4718.
This article is relevant for:
People who consume artificial sweeteners
This article is also relevant for:
healthy people with average cancer risk
Be part of XRAY:
The American Cancer Society (ACS) guidelines on exercise, nutrition and weight for cancer prevention recommend the following:
Diet and nutrition
- Follow a healthy eating pattern, including:
- foods that are high in nutrients in amounts that help you acheive and maintain a healthy body weight.
- a variety of vegetables, fiber-rich legumes (beans and peas) and whole fruits in a variety of colors. Consume at least 2½ to 3 cups of vegetables and 1½ to 2 cups of fruit each day, depending on your calorie requirements.
- whole grains rather than refined grains. At least half of the grains you eat should be whole grains.
- A healthy eating pattern that limits or does not include:
- red and processed meats.
- sugar-sweetened beverages.
- highly processed foods and refined grain products.
- It is best not to drink alcohol. People who choose to drink alcohol should:
- have no more than 1 drink per day (women) or 2 drinks per day (men).
Exercise
- Exercise regularly.
- Adults should get at least 150 minutes of moderate-intensity activity (equal to a brisk walk) or 75 minutes of vigorous activity (heart rate is increased, breathing is faster and you are sweating) each week, preferably spread throughout the week.
- Physical activity has been shown to lower the risk of several types of cancer, including breast, endometrial, prostate and colon. It also reduces the risk of other serious diseases including diabetes and heart disease.
Weight
- Achieve and keep a healthy weight.
- Being overweight or obese is a risk factor for many cancers, including breast, colon, endometrial and pancreatic. You can control your weight through regular exercise and healthy eating.
Other experts, including the following, also provide guidelines for exercise, nutrition and health:
- The Academy of Nutrition and Dietetics
- The United States Office of Disease Prevention and Health Promotion
- The American Institute for Cancer Research
Updated: 07/19/2022
- What is the safest way for me to limit my sugar consumption?
- Should I avoid any specific foods or beverages?
- Can you refer me to a nutritionist?
The following studies focus on nutrition and cancer prevention:
Colorectal cancer
- NCT05396846: My Best GI Eating Study. This study tests three diets in people who are overweight and who have an increased risk of colorectal cancer.
Visit our Featured Research Page and Research Search and Enroll Tool to find additional studies enrolling people with or at high risk for cancer.
Updated: 05/29/2024
The following resources can help you locate a nutritionist near you or via telehealth
Finding nutritionists
- You can find a registered dietician in your area through Eatright.org, the website for the Academy of Nutrition and Dietetics. Search for nutritionists by specialty, including "cancer," "weight management" and "heart health."
Related experts
- The Livestrong at the YMCA program includes a free 12-week membership and fitness training with certified exercise experts. You can search by zip code for a program near you.
Other ways to find experts
- Register for the FORCE Message Boards and post on the Find a Specialist board to connect with other people who share your situation.
- The National Cancer Institute (NCI)-Designated Comprehensive Cancer Centers have specialists to manage the symptoms and side effects of cancer prevention or treatment.
- FORCE partners with Savor Health® to provide free, personalized, evidence-based nutrition support 24/7 and “on-demand" through their text-based Intelligent Nutrition Assistant (Ina®). You can subscribe here.
Updated: 11/20/2023
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Medical Xpress
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