Artificial Sweeteners and the Risk of Cardiovascular Disease

More data regarding the risks associated with artificial sweeteners and cardiovascular disease has been accumulating. I decided to review the literature and post answers to some of my patients’ questions around this topic.

What is the relationship between artificial sweetener consumption and cardiovascular disease risk?

Recent studies suggest a potential link between higher artificial sweetener intake and an increased risk of cardiovascular diseases (CVD), particularly cerebrovascular diseases like stroke. This association was observed even after adjusting for factors like age, sex, physical activity, smoking, and dietary habits.

How was artificial sweetener intake measured in these studies?

Both studies utilized detailed dietary assessments. The NutriNet-Santé study in France used three non-consecutive days of 24-hour dietary records, repeated every six months. The UK Biobank study relied on repeated 24-hour diet recalls.

What types of artificial sweeteners were investigated?

The studies investigated a range of artificial sweeteners, including aspartame, acesulfame potassium, sucralose, cyclamates, saccharin, thaumatin, neohesperidine dihydrochalcone, xylitol and aspartame-acesulfame salt.

Were specific artificial sweeteners linked to particular CVD risks?

Yes, the research indicated that different artificial sweeteners might be associated with different CVD risks:

• Aspartame was linked to a heightened risk of cerebrovascular events
• Acesulfame potassium and sucralose were associated with an increased risk of coronary heart disease
• Patients with higher levels of erythritol had more cardiovascular disease risk and clotting activity. Although some erythritol occurs naturally in the diet, after eating it, it can go up thousands of times compared to normal.

What does the study on erythritol suggest?

Erythritol, a specific sugar alcohol, enhances platelet reactivity and thrombosis potential, indicating a possible mechanism for increasing cardiovascular risk.

Is there a connection between erythritol and mortality?

A separate study investigating serum erythritol levels in a cohort of men observed an association between higher erythritol levels and an increased risk of all-cause and cardiovascular disease mortality. However, this study couldn’t establish a direct causal relationship, and further research is needed.

Did these studies account for genetic predisposition to CVD?

The UK Biobank study specifically examined the role of genetic predisposition to CVD using polygenic risk scores (PRS). The findings showed that the CVD risk associated with artificial sweeteners appears independent of genetic susceptibility.

Were there any differences in risk based on demographic factors?

Subgroup analyses in the UK Biobank study revealed a potentially higher risk of CVD associated with artificial sweetener intake among non-white participants. There was also a suggestion of a greater risk for individuals without obesity (BMI < 30 kg/m2), though further research is needed to confirm this.

What are the possible mechanisms linking artificial sweeteners to CVD risk?

Explanations include:

• Alterations in gut microbiota composition and function
• Negative impacts on glucose metabolism. Insulin still goes up because the taste buds scented in your brain thinks you are eating sugar.  Elevated insulin is a coronary artery disease risk factor.
• Increased platelet reactivity and thrombosis (clot) risk

What are the limitations of these studies?

These studies are observational, meaning they can only show an association and not prove causation. More research is needed to establish a definitive causal link between artificial sweetener consumption and CVD risk. Other limitations include the reliance on self-reported dietary data, which can be subject to error, and the potential influence of unmeasured confounding factors.

 

Contact our office to make an appointment with Dr. Steve Parcell to discuss your heart health: 303-884-7557.