Artificial sweeteners are associated with increased cancer risk | Hacker News Reader

Artificial sweeteners are associated with increased cancer risk

technologynetworks.com

79 pointscachecrab48 comments

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.

If anything, it shows that there isn’t a huge effect.

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.

They link directly to the study

>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%.

As far as breast cancer is concerned – they said that there is an overrepresentation of women in the study:

> Debras highlights that 78.5% of the participants included in the analysis were women

That doesn't necessarily mean that breast cancer can be dismissed. It seems that there are increased numbers of women in both the control and artificial sweetner/cancer populations.

Those bounds are fairly wide. Also, my other frustration was an article that has provocative headline, great for sending to your friends, but doesn't do anything but link the study. What are the odds someone is going to read the study? What are the odds they are going to go and learn what HR rate is?

Seems to me all good things for this article to do.

What would be a good boundary here, in your opinion?

The 95% CI lower boundary for most of the cancer risks are still > HR 1.00, which seems significant enough to call out an increased risk correlation.

Note that if you divide the total cases by the number of study participants, you get a total cancer incidence rate of 0.0326. If we assume roughly equal numbers of participants using versus not using artificial sweeteners and solve for AVG(x, 1.15x) = 0.0326, we get 0.0303 for non-users and 0.0348 for users. So your risk goes from about 3% to 3.5%.

Not nothing, but I'm not sure that really ticks off a worry box for me. Though I don't personally eat much sweetened food at all, artificial or otherwise (work from home and enjoy cooking, so I make most everything from raw ingredients).

One problem with nutritional studies is that they don't control for all of the other things the patients eat or drink.

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?

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).

How can they cause weight gain when they contain no or a tiny amount of calories?

They don't satisfy your hunger or craving for sweets, so you end up eating more

But he compared it with a subjectively equal amount of sugar,so no additional food is eaten.

The involuntary part of your brain gets confused because it received an "I ate" signal from your mouth but not your stomach. It responds by panicking: lowered metabolism and increased appetite.

Both effects have been shown separately. For instance, mice on fixed calorie diets become lethargic and gain weight if artificial sweeteners are added to their water.

Has this been shown in humans? A lot of mice results don't replicate in humans.

They still cause insulin release, and a resultant hormonal response

I don't think that's true. Here's a recent study disproving that: https://pubmed.ncbi.nlm.nih.gov/29982723/

In an extreme example, mood stabilizers such as Depakote strongly cause weight gain despite having no calories.

I think the research is mixed on this. Here's one study debunking this theory: https://pubmed.ncbi.nlm.nih.gov/23364015/

Playing baseball is associated with oral cancer. But I would guess it's probably the chewing tobacco and not the baseball.

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?

What makes the first three "more artificial", in your view?

They are made in a lab and not from an actual fruit or plant?

well considering there's a million different plants or fruits that will kill you quite easily, im not exactly sure that is something worth caring about.

That's not it. If it's made by a plant it's more likely your body has enzymes and pathways to metabolize the item (the chemical structure is "familiar" or "compatible" with yours if you will). This means it doesn't build up and cause low toxicity over time. i.e. it's pretty obvious if it's poisonous.

Not so with lab created stuff - your body may not have the ability to do anything with it, so it either sits and causes slow damage, or gets excreted very slowly, and can cause hard to detect damage.

For example acetone is not very toxic because the body can metabolize it.

Well, sucralose is made by replacing hydroxy groups in sucrose with chlorine, and does not exist independent of industrial production processes, while erythritol (for example) is made by fermenting glucose with yeast, and occurs in nature.

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.

Isn't this just the appeal to nature fallacy? Assuming that artificial things are bad and natural things are good.

There’s one sugar the FDA has allowed to stay off the total sugars list

https://www.fda.gov/news-events/fda-brief/fda-brief-fda-allo...

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.

Allulose seems to work fine for many, and is widely available.

According to a reference to a NASA article on the Wikipedia page for L-glucose, it was too expensive to make in large quantities.

Does erythritol fall under this category? It has effectively zero carbs, and does not spike insulin levels.

It's also naturally occurring

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?

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.

"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.

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.

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...

Title could be like “one investor said Tesla goes up”.

For some reason I thought this was a known or suspected thing from over a decade ago. I may be thinking of something else

I think I'll stick with low sugar or Monkfruit for now

If I remember correctly, Monkfruit was more highly associated with cancer than artificial sweeteners in early studies. I've been avoiding it since.

https://pubmed.ncbi.nlm.nih.gov/12893428/

This and other studies contradict your assertion. Do you have a reference?

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