This study, which followed more than 100,000 adults for about a decade, is among the largest to date to identify cardiovascular health problems with sugar substitutes. Overall, artificial sweeteners were associated with a 9 percent higher risk of any type of cardiovascular disease event and an 18 percent greater chance of stroke, according to results published in The BMJ. “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,” the study authors wrote in The BMJ. At the start of the study, none of the participants had a history of cardiovascular disease or diabetes — and none of them were diagnosed with these conditions during the first two years of follow-up. Participants were 42 years old on average and most of them were female. Participants completed a series of about five food questionnaires over the first two years of the study, which showed 37 percent of them consumed artificial sweeteners. Those who did consumed an average of about 43 milligrams (mg) daily, roughly the amount in one tabletop sweetener packet or 100 milliliters (3.4 ounces) of diet soda, according to the study. People with the highest artificial sugar consumption took in an average of about 78 mg daily, while individuals with the lowest intake consumed about 7.5 mg daily on average. During the study period, participants had a total of 1,502 cardiovascular events, including heart attacks, strokes, damage and clogging in blood vessels, and medical procedures to restore blood flow in obstructed arteries or veins. The annual absolute risk of cardiovascular disease was 314 cases per 100,000 people among participants who didn’t consume artificial sweeteners, compared with 346 cases for those with the highest consumption of sugar substitutes. Certain risks were higher with specific sweeteners, the study also found. For example, aspartame, sold under the brand names NutraSweet and Equal, was tied to a 17 percent higher risk of stroke. Acesulfame potassium, sold under the brand names Sweet One and Sunett, was linked to a 40 percent greater risk of coronary heart disease. The study wasn’t a controlled experiment designed to prove whether or how artificial sweeteners might directly cause cardiovascular disease events. It’s also possible that results were skewed by participants’ poor recollection of what they ate and drank, since this was determined using questionnaires. Several artificial sweeteners have been approved as safe as food additives by the U.S. Food and Drug Administration (FDA). Recommended daily limits vary by sweetener type, but the equivalent of at 23 table top packets a day is considered safe, according to the Harvard T.H. Chan School of Public Health.
