Worth noting the artificial sweetners found to have correllations with increased risk of cancer are aspartame and acesulfame-K.
Sucralose, stevia, and others were not found to have an increased risk, but they were only present in a much smaller segment of the population (i.e. 10% used Sucralose) so they may not have enough representation to be ruled out.
I was looking for the same point, specifically about Sucralose. Here's the point for anyone else thats curious (from the study itself; not the article):
> In particular, the absence of a relationship between sucralose and cancer risk in this study should be considered with caution since exposure to sucralose was very low compared to the exposures for aspartame and acesulfame-K.
I can never really take the results of nutritional epidemiology studies too seriously. How can you possibly control for all the confounding variables? People who are avoid artificial sweeteners likely make many other decisions in their diet and lifestyle. It's a healthy user bias. The study controls for some factors like weight and smoking but there's just no way to control for everything, you need randomization - especially when the final hazard ratios are ~1.15.
How much more risk? Is this a hit piece by big sugar or something? This article is so sparse on details. Exposure to the sun increases the risk of cancer. Emissions let off by cars increases the risk of cancer. I’m just curious…
The HR has fairly large bounds... 1.03 to 1.25 so there is increased risk but this still does not tell you if people who consume a lot of sugar substitutes also exhibit behaviors that increase their risk of cancers. Such as also consuming highly processed food.
>Compared to non-consumers, higher consumers of total artificial sweeteners (i.e., above the median exposure in consumers) had higher risk of overall cancer (n = 3,358 cases, hazard ratio [HR] = 1.13 [95% CI 1.03 to 1.25], P-trend = 0.002). In particular, aspartame (HR = 1.15 [95% CI 1.03 to 1.28], P = 0.002) and acesulfame-K (HR = 1.13 [95% CI 1.01 to 1.26], P = 0.007) were associated with increased cancer risk. Higher risks were also observed for breast cancer (n = 979 cases, HR = 1.22 [95% CI 1.01 to 1.48], P = 0.036, for aspartame) and obesity-related cancers (n = 2,023 cases, HR = 1.13 [95% CI 1.00 to 1.28], P = 0.036, for total artificial sweeteners, and HR = 1.15 [95% CI 1.01 to 1.32], P = 0.026, for aspartame)
A HR of 1.15 means it increases your risk of cancer by 15%.
Not even just consumption, the healthy user bias also effects lifestyle factors. People who try to avoid artificial sweeteners because they think they are unhealthy likely make many other decisions to promote their own health (increased exercise, avoiding other carcinogens). The study attempts to control for some of these factors (exercise, smoking), but given the HR is only 1.15, I have trouble believing the correlation here is anything but spurious.
It's probably worth mentioning that they also cause weight gain (vs a subjectively equivalent amount of sugar). Some are psychoactive and interfere with e.g., seizure drugs. Some cause migraine headaches in a subset of the population.
If it weren't for diabetics, I'd argue they all should be summarily banned (even, and especially, the "natural" / "organic" sugar alternatives, since those are mostly being produced in labs and are just enabling deceptive labeling).
The study appears to focus on aspartame, sucrolose, and acesulfame-k, which to my mind (which is admittedly uneducated in this domain) seem heavily artificial, and the findings are not surprising.
What about plant-based sweeteners such as stevia, monkfruit etc, or sugar alcohols?
That's what I was looking for, too. With the proliferation of low-carb diets, sweeteners like erythritol, monk fruit, chicory, and allulose have seen significant increases in popularity. I'd really like to see some study that treats them as first-class subjects rather than just retreading the aspartame and acesulfame-k questions.
stevia, monkfruit etc are not "artificial", are just different -ose sources. Sugar is C₆H₁₂O₆ the rest are just "impurity", there is no difference between sugar from sugar beet, sugar cane, fructose, ... they are the same C₆H₁₂O₆ + extras.
Artificial sweeteners are byproduct of petroleum refining, witch means they do not contain C₆H₁₂O₆ + something but completely different molecules that happen to taste like it for us.
Any reason L-glucose could cause cancer compared to R-glucose? I know it's incredibly hard to isolate and distill L-glucose, but to me that seems like the ideal artificial sweetener because it's chemically the same as natural glucose, just with a different geometry that prevents it from being metabolized.
The obvious objection to almost every study of this sort is that associated with doesn't imply causality, and it could be that some third factor like "propensity to consume highly-processed food products" is responsible for the observed correlation. But from the abstract:
> Associations between sweeteners and cancer incidence were assessed by Cox proportional hazards models, adjusted for age, sex, education, physical activity, smoking, body mass index, height, weight gain during follow-up, diabetes, family history of cancer, number of 24-hour dietary records, and baseline intakes of energy, alcohol, sodium, saturated fatty acids, fibre, sugar, fruit and vegetables, whole-grain foods, and dairy products
So I have a more interesting question here: how effective are these sorts of statistical methods? Is it plausible to start out with a highly-biased population [1], adjust for twenty or so distinct factors, and get results that are actually meaningful?
[1] As I understand it, the study population consists of 102k French adults, self-selected via finding the relevant website and their willingness to go fill out a bunch of surveys. As TFA notes "[...] 78.5% of the participants included in the analysis were women, which could be considered a selection bias. Additional biases noted by the researchers were that participants were more likely to have higher educational levels, and to demonstrate health-conscious behaviors."
> some third factor like "propensity to consume highly-processed food products" is responsible
Even with the significant controls in the study, I still completely believe this is the case. People who avoid artificial sweeteners likely make many other health-promoting decisions (healthy user bias) that are far too granular to control against using simple factors like weight and smoking status. The HR is only 1.15. Are you really confident enough in the controls to see this as a real association?
"how effective are these sorts of statistical methods?"
Exactly they are so many variables to take into account that each population subset is becoming very small. I would love to have the insight of a stats nerd on the study.
Btw if you look at the raw data, they are for instance less cases per subject in the high consumer than in the low or none consumer (table 2), but they get a higher hazard ration, meaning that other correction were taken into account. It is very difficult to interpret such results.
There is research showing artificial sweeteners can spike insulin, so even if not the cause but coincidentally associated with highly processed foods which are more closely linked to the cause of cancer itself, by triggering insulin spikes artificial sweeteners would feed/enlarge cancer cells.
While I choose a very different path (sysadmin) I came from a II generations of doctors, and I hear about stomach cancers increased by both artificial sweeteners and junk food for decades, the refrain was: until few years after WWII stomach cancers were common, then they almost disappear than came back when artificial sweeteners and junk food came to life.
Long story short: it's nothing new, only for many years industry needs and desire have prevailed (read also the equally recent https://news.ycombinator.com/item?id=30793352 so to speak) now something start to pops up.
bduerst|3 years ago
Sucralose, stevia, and others were not found to have an increased risk, but they were only present in a much smaller segment of the population (i.e. 10% used Sucralose) so they may not have enough representation to be ruled out.
throwoutway|3 years ago
> In particular, the absence of a relationship between sucralose and cancer risk in this study should be considered with caution since exposure to sucralose was very low compared to the exposures for aspartame and acesulfame-K.
slymon99|3 years ago
layer8|3 years ago
ProjectBarks|3 years ago
The HR has fairly large bounds... 1.03 to 1.25 so there is increased risk but this still does not tell you if people who consume a lot of sugar substitutes also exhibit behaviors that increase their risk of cancers. Such as also consuming highly processed food.
weberer|3 years ago
>Compared to non-consumers, higher consumers of total artificial sweeteners (i.e., above the median exposure in consumers) had higher risk of overall cancer (n = 3,358 cases, hazard ratio [HR] = 1.13 [95% CI 1.03 to 1.25], P-trend = 0.002). In particular, aspartame (HR = 1.15 [95% CI 1.03 to 1.28], P = 0.002) and acesulfame-K (HR = 1.13 [95% CI 1.01 to 1.26], P = 0.007) were associated with increased cancer risk. Higher risks were also observed for breast cancer (n = 979 cases, HR = 1.22 [95% CI 1.01 to 1.48], P = 0.036, for aspartame) and obesity-related cancers (n = 2,023 cases, HR = 1.13 [95% CI 1.00 to 1.28], P = 0.036, for total artificial sweeteners, and HR = 1.15 [95% CI 1.01 to 1.32], P = 0.026, for aspartame)
A HR of 1.15 means it increases your risk of cancer by 15%.
shtopointo|3 years ago
How can you tell that it was the artificial sweetener that led to cancer? And not one of the other hundred things people consumed during the day?
slymon99|3 years ago
hedora|3 years ago
If it weren't for diabetics, I'd argue they all should be summarily banned (even, and especially, the "natural" / "organic" sugar alternatives, since those are mostly being produced in labs and are just enabling deceptive labeling).
jimbob365|3 years ago
cinntaile|3 years ago
rhinoceraptor|3 years ago
colordrops|3 years ago
What about plant-based sweeteners such as stevia, monkfruit etc, or sugar alcohols?
bwestergard|3 years ago
cheald|3 years ago
kkfx|3 years ago
Artificial sweeteners are byproduct of petroleum refining, witch means they do not contain C₆H₁₂O₆ + something but completely different molecules that happen to taste like it for us.
jimbob365|3 years ago
umvi|3 years ago
philg_jr|3 years ago
manmal|3 years ago
syspec|3 years ago
It's also naturally occurring
wgd|3 years ago
> Associations between sweeteners and cancer incidence were assessed by Cox proportional hazards models, adjusted for age, sex, education, physical activity, smoking, body mass index, height, weight gain during follow-up, diabetes, family history of cancer, number of 24-hour dietary records, and baseline intakes of energy, alcohol, sodium, saturated fatty acids, fibre, sugar, fruit and vegetables, whole-grain foods, and dairy products
So I have a more interesting question here: how effective are these sorts of statistical methods? Is it plausible to start out with a highly-biased population [1], adjust for twenty or so distinct factors, and get results that are actually meaningful?
[1] As I understand it, the study population consists of 102k French adults, self-selected via finding the relevant website and their willingness to go fill out a bunch of surveys. As TFA notes "[...] 78.5% of the participants included in the analysis were women, which could be considered a selection bias. Additional biases noted by the researchers were that participants were more likely to have higher educational levels, and to demonstrate health-conscious behaviors."
slymon99|3 years ago
Even with the significant controls in the study, I still completely believe this is the case. People who avoid artificial sweeteners likely make many other health-promoting decisions (healthy user bias) that are far too granular to control against using simple factors like weight and smoking status. The HR is only 1.15. Are you really confident enough in the controls to see this as a real association?
greatpatton|3 years ago
Exactly they are so many variables to take into account that each population subset is becoming very small. I would love to have the insight of a stats nerd on the study.
Btw if you look at the raw data, they are for instance less cases per subject in the high consumer than in the low or none consumer (table 2), but they get a higher hazard ration, meaning that other correction were taken into account. It is very difficult to interpret such results.
throwawaycities|3 years ago
kkfx|3 years ago
Long story short: it's nothing new, only for many years industry needs and desire have prevailed (read also the equally recent https://news.ycombinator.com/item?id=30793352 so to speak) now something start to pops up.
The issue I suspect it's not only Bad Capitalism©®™ but also a practical issue: we (humans) are many and natural sugar production while far expanded since the colonial era is still far from sufficient to satisfy the demand. Similarly for many junk/ultraprocessed foods: in part they exists to satisfy food industry interest, in part because we can't satisfy the demand of quality products...
szundi|3 years ago
edgyquant|3 years ago
Melatonic|3 years ago
copperx|3 years ago