Artificial sweeteners: recent bad news

In My Humble Opinion
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I don’t want to fight the science, but I do want to understand its significance. So often we see one study that shows a worrisome relationship between Substance A and Effect B, and then we hear nothing more about it. I never know if further research couldn’t reproduce the results, or reproduced the results with revised and acceptable risk limits, or further research was never done.

The study on erythritol seems a little more concerning, because they seem to have been pretty thorough. I won’t miss it if it is banned, there are a lot of alternatives (my Stevia packets have dextrose, not for bulk but to alleviate the bitter aftertaste). I just don’t want to have to give up things I have been eating and for which there is no ready substitute because the manufacturers have thrown erythritol into it.

A side observation, not directed at anyone, is how often these discussions become religious in tone, by which I mean there is proclaimed virtue by the speaker, and implied bad behavior of other people. I am glad to see that most of this discussion has been focusing more on reality and less on virtue-signaling.

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Too many people defend their diet as being better (more virtuous) than some other diet. Some foods are certainly more or less healthy. People are built to be adaptable and have thrived on very different diets in many places. I suspect exercise may be roughly as important as diet to good health. There is no perfect diet. And what might be perfect for me might not be perfect for you. Don’t make your diet your identity!

Most nutritional biochemistry studies are low quality. To detect subtle differences, you need to study lots of people (“have adequate power”). To be relevant, the result must achieve statistical significance (which usually means the observed result is not likely due to chance, so the converse is not seen more than once if you repeated the experiment twenty times, p<5%). Many of these studies report relative risk as a mean and range. A relative risk whose range includes 1.0 means substance A does not much affect Effect B, since relative risks are meant to be multiplied.

Say a study shows eating goblins might increase the risk of Smurf Disease with a relative risk of 1.2 (between 1.09 and 1.31). If the study population is like you, this might mean eating goblins (How much? Which brand? With what? How often?) gives you a 20% higher risk. If Smurf Disease is rare, with a prevalence of 50 people out of 10 billion, increasing the risk 20% makes little difference to risk. If Smurf Disease is common, on the other hand, smurf smurf smurf.

These studies are very expensive. They ask people to join the study, sometimes for payment. The person is expected to accurately record their diet, not eat prohibited items, eat studied items, follow other requests and do this for weeks, months or years. Maybe weeks since studies are expensive - but is a result applicable to you given such a short study period? Not everyone does a great or accurate or even honest job of this. I can’t remember everything I ate last week, so some diligence is needed. There may be lots of other things that effect the result. One balances these into equal groups as best as one can, but maybe not everything is known about what affects the result.

So a study is done. We’ll say the results accurately reflect reality. The news article rarely says which population was studied (are they enough like you, so the result would apply to you?), or important details or even the cautions and caveats given in the scientific article.

If a study concludes “eating goblins has been shown to cause Smurf Disease”, the paper or TV news often goes for shock over accuracy. Science shows Smurf Smurf!!!. Media reports rarely says how common Smurf Disease is, or the difference between a relative risk of 1.05 (5% increased risk if the range does not include 1.0) or, like smoking and lung cancer, a relative risk of 10-25 (increasing risk by 1000-2500%). That’s a big difference. Some scientists as a ballpark ignore relative risks below 1.3 but it really depends on what you are talking about.

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Some astute comments on the science. (Excerpted below.)

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From the above link.

Except… in 2015, when the IARC made a similar announcement about the carcinogenic potential of meat, that’s not what the classification means at all. The IARC chops risk up into four categories: carcinogenic (Group 1), probably carcinogenic (Group 2A), possibly carcinogenic (Group 2B), and unclassified (Group 3). Those categories do one very specific thing: They describe how definitive the agency believes the evidence is for any level of increased risk, even a very tiny one. The category in which aspartame may soon find itself, 2B, makes no grand claims about carcinogenicity. “In practice, 2B becomes a giant dumping ground for all the risk factors that IARC has considered, and could neither confirm nor fully discount as carcinogens. Which is to say: most things”…

The categories are not at all intended to communicate the degree of the risk involved—just how sure or unsure the organization is that there’s a risk associated with a thing or substance at all. And association can mean a lot of things. Hypothetically, regular consumption of food that may quadruple your risk of a highly deadly cancer would fall in the same category as something that may increase your risk of a cancer with a 95 percent survival rate by just a few percentage points, as long as the IARC felt similarly confident in the evidence for both of those effects.

These designations about carcinogenicity are just one example of how health information can arrive to the general public in ways that are functionally useless, even if well intentioned. Earlier this year, the WHO [advised against] all use of artificial sweeteners. At first, that might sound dire. But the actual substance of the warning was about the limited evidence that those sweeteners aid in weight loss, not any new evidence about their unique ability to harm your health in some way. (The warning did nod to the links between long-term use of artificial sweeteners and increased risks of cardiovascular disease, Type 2 diabetes, and premature death, but as the WHO noted at the time, these are understood as murky correlations, not part of an alarming breakthrough discovery.).

The same release quotes the WHO’s director for nutrition and food safety advising that, for long-term weight control, people need to find ways beyond artificial sweeteners to reduce their consumption of real sugar—in essence, it’s not a health alert about any particular chemical, but about dessert as a concept. How much of any sweetener would you need to cut out of your diet in order to limit any risks it may pose? The release, on its own, doesn’t say.

The media, surely, deserve our fair share of blame for how quickly and how far these oversimplified ideas spread. Many people are very worried about the food they eat… At best, the research that many such stories cite is rarely definitive, and at worst… incapable of producing useful information.*

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Depends?

Which is part of the point you’ve been making.

How big are the risks balanced against the costs of avoiding them? What alternative choices are there? Some risks are worth it. Some not. And those choices will vary by market individual.

I don’t see any benefit to identifying non-modifiable risks.

But I don’t think that recognizing how we are entrained to absurd and fairly constant levels of added sweetness from early ages on, and how that is problematic, individually and societally, with the problems not completely absolved by low calorie non nutritive sweetener substitution, is virtue signaling.

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I agree. When discussing diets and “virtue signalling”, I mean people who are keto, vegan, paleo, raw or limited in an arbitrary way (which is fine), but for whom this is such a major part of their identity that they inform everyone they know and feel this way of eating is the only option.

I use the term somewhat ironically, but it is not meant to refer to reasonable changes and I agree sweetness is ideally enjoyed occasionally.

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I’m also going to comment on this. Personally I think the emphasis is best less on more or less healthy individual foods or ingredients, and on more or less healthy dietary patterns and lifestyles (which includes activity patterns), of which there are many good choices.

The unhealthy/healthy ingredient path leads to avoiding sugar (sometimes foolishly extended to whole fruits) or choosing “low fat” or “high protein” and ignoring that the choices are still sparse in minimally simply processed more whole foods and often hyperprocessed crap low or high in the ingredient of focus but filled with other shit of dubious nutritional value and devoid of the package of more whole food simply processed, the substrate that delivers it in certain ways, the untold cast of healthy players …

There is a parallel to your longstanding weightlifting thread: debating which exact exercise or combination of exercise, exactly how often and how much, is “healthiest” matters much less than doing some in some combination. A little effort goes a long way.

Similarly the exact “best” diet matters little. It is not an item of virtue but of public health though to say that an overall pattern not heavy in hyperprocessed crap (be it sweetened with added sugar or non-nutritive sweeteners or other) is a step in the preferred direction.

ETA since I was writing while you were posting: I wholeheartedly agree with you on those whose identity is their nutrition plan. They are nutritional cross fitters! :grinning:

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Dr. Steven Novella’s take on aspartame reclassification, just published in Science-Based Medicine:

“Even if we can quibble about the evidence and whether or not there is the possibility of a carcinogenic effect from aspartame, it is not controversial that exposure levels would have to be much higher than what most people consume to confer any risk. At the end of the day the evidence still supports that conclusion that aspartame is safe at human levels of consumption.”

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There are now two assessments from different World Health Organization agencies.

“The first report, penned by the WHO’s International Agency for Research on Cancer (IARC), found “limited evidence” that aspartame may cause liver cancer. The second, from the Joint FAO/WHO Expert Committee on Food Additives (JECFA), reconfirmed the WHO’s previous recommendations that the sweetener is generally safe up until very large doses.”

"The seemingly contradictory findings stem from the two groups’ differing remits. The IARC, which found that aspartame was possibly linked to cancer, studies whether a substance has the potential to cause harm. The second group, JECFA, aims to estimate the actual risk that cancer or other potential harms will actually occur…
“Somebody who drinks a soda every once in a while … shouldn’t have a concern [about cancer],” said Francesco Branca, director of the Department of Nutrition and Food Safety at the World Health Organization. “We’re not advising companies to withdraw products nor are we advising consumers to stop consuming altogether, we’re just advising for a bit of moderation.”

“Branca also recommended that heavy consumers of aspartame cut down on their consumption — though it’s unclear how many people in the U.S. currently come close to the recommended maximum daily dose, which is 40 milligrams of aspartame per 1 kilogram of body weight. For a 200-pound person, that would mean they would need to drink more than 18 Diet Coke cans per day to hit the daily limit.”

Well alrighty then, I’ll stop drinking 19+ cans of Diet Coke a day. It’ll cut down on bathroom trips. :laughing:

The W.H.O., more specifically IARC should be glowing red with embarrassment over how its image has been damaged in this affair.

The F.D.A. meanwhile reiterates its positiion that aspartame is safe, at least if you’re not continually infusing it via intravenous solution.

*at some point in life, when your DNA has long been fried by exposure to sun, bacon, diet drinks and lord knows what else, warning such as these tend to fly on by. As a great person (my dentist, Liljana) once said, “You gotta eat.”

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At a high enough dose, pretty much everything either causes cancer or kills you outright. I guess 16 cans of soda a day is close enough to what some people consume to be barely interesting? I mostly drink water, but if i do a lot of physical work i might drink nearly that much over a day.

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As it happens, since this thread was last active, I was visiting some relatives. They offered me a drink, with root beer as one of the options, and I accepted. Only then did I realize that it was sugar-free, at which point it would have been impolite for me to refuse, so I drank it. And… it wasn’t bad. Checking the label, it was sweetened with a combination of aspartame and ace-K. I’m pretty sure that aspartame was one of the ones that I had tried before and found distasteful, but maybe somehow the combination with ace-K makes it better. But anyway, I retract my earlier statement that all artificial sweeteners taste bad to me.

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They have improved.

Despite all the noise, what the IARC says with its 2B designation is almost useless. “There is a possible dose so high that some sweeteners may potentially be involved in cancers, with some evidence”.

I don’t object to people eating any sweet food less often. This is not always easy to unlearn.

Cancer literally requires glucose to build materials for replication, to such an extent you can scan for cancers by seeing which areas of the body have a much higher than expected metabolism of glucose.

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I needed sweet relish. Seeing a jar proclaiming “NO ADDED SUGAR”, I grabbed it. I assumed it was made using sweet pickles. Actually, it had some artificial sweetener added and tasted horrible.

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Which, IIRC, is not unlike the warnings about saccharin back in the 1970s; studies found that lab rats which ingested very large amounts (i.e., amounts that were unrealistic for normal human consumption) were more likely to develop cancers.

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Yet as you stated: they accurately answered the actual question of their remit. I’m not sure how much of the problem here is on them and how much is on the horrible job the media does as it tries to sex up fairly boring releases, or just fails to understand them.

The end result downside is that the push back against relatively hysterical reporting results in ignoring items of more likely significance (e.g. the erythritol data).

And I’ll maintain my position that the use of added sweeteners of any sorts, cane sugar, HFCS, or non nutritive sweeteners, should be limited in kids in particular. I don’t require evidence of direct health risks to see the harms associated with entraining our brains to increasingly large hits of very sweet and of consumption of the hyperprocessed foods that added sweeteners facilitate.

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True enough.

It’s worth noting however, that advice to cancer patients to cut out or drastically reduce sugar intake (a favorite theme of cranks) to “starve cancer” is off base.

Both, it seems. Part of any health agency’s job is to communicate its findings in a way the public can understand. At least (to this point, anyway) no evidence has emerged that IARC suppressed data that conflicted with its message, which is what happened when it presented glyphosate as a suspected carcinogen.

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An update. This time xylitol.

The association but also

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God damn it. I am diabetic, switched from sugar to xylitol years ago and ended up having a stroke anyhow. And here I was thinking it was on account of drinking heavily, smoking weed and using my ADHD medication as a hangover cure. Turns out I could have been doing that this whole time if I had only just cut the xylitol out.