Artificial sweeteners are food additives designed to provide a sweet taste without the calories found in traditional sugar. These synthetic or plant-derived compounds are significantly sweeter than table sugar, meaning only tiny amounts are needed in products. They are commonly used in “sugar-free” or “diet” foods and beverages, such as soft drinks, baked goods, and desserts, appealing to individuals seeking to reduce calorie intake or manage blood sugar levels. Despite their widespread use, public concern has persisted regarding their potential health effects, particularly a possible link to certain cancers, including bladder cancer.
Early Concerns and Research
Concerns about artificial sweeteners and cancer first emerged from early animal studies in the 1970s. Research involving cyclamate, especially in combination with saccharin, indicated an increased incidence of bladder tumors in laboratory animals. These initial findings prompted regulatory action, leading to cyclamate being banned in the United States in 1969.
Further laboratory studies also connected high doses of saccharin with bladder cancer development in rats, resulting in its listing in the US National Toxicology Program’s Report on Carcinogens in 1981. However, subsequent mechanistic studies revealed that the way saccharin caused cancer in rats does not apply to humans. This understanding led to saccharin’s removal from the Report on Carcinogens in 2000.
Current Scientific Evidence
Recent large-scale human epidemiological studies and meta-analyses provide a clearer understanding of the relationship between artificial sweeteners and bladder cancer. A review of recent epidemiological studies indicates no detectable association between artificial sweetener consumption and bladder cancer. A meta-analysis of case-control studies supported the conclusion that saccharin is not related to bladder cancer in humans.
Another meta-analysis found no significant risk difference in bladder cancer incidence between artificial sweetener users and control groups. While some older studies suggested a possible link between heavy artificial sweetener use and increased bladder cancer risk in humans, these findings have not been consistently replicated in more robust, recent research. Although the International Agency for Research on Cancer (IARC) classified aspartame as “possibly carcinogenic to humans” in 2023, this does not establish a direct link to cancer, and the US Food and Drug Administration (FDA) has disagreed with this conclusion due to shortcomings in the studies.
Regulatory Perspectives and Safety
Major health and food safety regulatory bodies, such as the US Food and Drug Administration (FDA), the World Health Organization (WHO), and the European Food Safety Authority (EFSA), have reviewed the scientific evidence on artificial sweeteners. The FDA has approved six artificial sweeteners as food additives in the US: saccharin, aspartame, acesulfame potassium (acesulfame-K or Ace-K), sucralose, neotame, and advantame. Before approval, the FDA assesses numerous safety studies for each sweetener, and their current stance is that these sweeteners do not cause cancer or other harms when used as approved.
These organizations establish Acceptable Daily Intake (ADI) levels, representing the amount of a substance that can be consumed daily over a lifetime without health risks. For example, the FDA’s ADI for aspartame is 50 mg per kilogram of body weight per day, and for sucralose, it is 5 mg per kilogram of body weight per day. The EFSA recently increased the ADI for saccharin from 5 mg/kg body weight per day to 9 mg/kg body weight per day. The Joint FAO/WHO Expert Committee on Food Additives (JECFA) also reaffirmed aspartame’s safety in 2023, concluding no convincing evidence of adverse effects or cancer risk in humans at current use levels.
Making Informed Choices
Making informed choices about artificial sweeteners involves a balanced approach to diet and overall consumption. While artificial sweeteners can help reduce calorie and sugar intake, especially for individuals managing weight or blood sugar, their long-term effects are still being studied. It is advisable to consume them in moderation as part of a varied diet.
Focusing on reducing overall sugar intake, rather than simply replacing it with artificial sweeteners, can be a beneficial strategy. Prioritizing whole, unprocessed foods like fruits, vegetables, and whole grains, which naturally contain no added sugars or artificial sweeteners, is a sound dietary practice. Reading food labels to identify hidden sugars and sweeteners can also guide healthier choices. If you have specific health concerns, consulting with a healthcare professional or a registered dietitian is recommended.