Are sweeteners worse for you than sugar?

Much of the food and drink we consume these days contains artificial sweeteners. They most commonly appear in sugar-free soft drinks, tabletop sweeteners for our teas and coffees, and dairy products like yoghurt. These chemicals and additives allow food companies to make products which have a sweet taste without pumping them full of sugar. But now a study published in the British Medical Journal connects a high rate of consumption of these sweeteners with cardiovascular diseases among 171,000 French participants. James Tytko spoke with Mathilde Touvier, Doctor in Epidemiology in Public Health, and principal investigator of the NutriNet-Santé cohort.

Mathilde - During the follow up of about 1,500 incidents of cardiovascular diseases occurred. And to give you an idea in the group of the highest consumers in this cohort, there was the equivalent of 346 incident cases for 100,000 participants a year followed compared to the equivalent of, 314 cases in the non-consumer group. But really the important point here is that the association between artificial sweeteners and increased cardio disease risk was robust and statistically significant in analysis models.

James - I read recently that around half of an average person in the UK's calorie intake is ultra-processed food and drink and that's food that's most likely to contain these artificial sweeteners.

Mathilde - Yes. In France, the proportion of energy brought by ultra-processed food is about 30, 35% so lower than in the UK or the US, for instance, which is more than 50, 58%. But yes, indeed participants who enter these cohorts also tend to have globally healthier health behaviors in, and also dietary intake. So we make the hypothesis that in real life, in a real population setting, and maybe in the UK, we would have even higher amounts of exposure to ultra-processed food. So maybe the associations in real life would be even stronger than the one we observe in the cohort yet it's still an hypothesis that we will never be able to verify. But yes, it would be possible to think about that.

James - It seems to me, there's a growing body of evidence to suggest that ultra-processed food is having a severely negative impact on public health. And a lot of these diseases are related, aren't they, to Obesity and cardiovascular disease, but yet they're still so prevalent in all of our diets. When are the food standards agencies going to do something about this public health disaster that it feels like we are sleeping walk into?

Mathilde - Research interest in ultra-processed food. And so the epidemiological studies about that are quite recent. We now have about 50 studies showing an association between ultra-processed food and adverse health outcomes. Yes, indeed. Evidence is accumulating. We still don't know exactly and precisely, within these ultra-processed foods, what are the substances, the types of additives or other substances and contaminants created during processing or contaminants from food packaging and so on which substances may cause problems. And so this is really what we want to investigate now, and to advance knowledge on this topic. Even if we don't know exactly where the problem comes from, from which substances and so on to reduce this overall intake, there are already some countries in Brazil, in France, which have already introduced this in their official recommendation. The fact that ultra-processed food intake should be reduced in the population. This is one type of action recommendation to the population, but the other one would be to act on the regulation of the products. It can't be to forbid ultra-processed food. This is why we need some precise research saying this type of molecule, this type of additive and so on may cause a risk for the population.

James - Are there any potential obstacles in the way of limiting the presence of these additives? I'm imagining some potential corporate interests that might slow the progress.

Mathilde - Even when scientific evidence is very, very strong, which is not the case for the moment. I mean not only with this study, but with the topic. When we begin to have more and more scientific evidence, there are often barriers from powerful lobbies and the food industry that don't want things to change and see these type of results that are not in line with their economic interests. So it's not always easy. We really had the case currently with the food label nutrient score, this food label provides an overall idea of the nutritional quality of the food product. And so it's very useful for citizens that don't have the time to read the labels, which are very complicated and so on. So here at the glance, you have the idea of the nutritional quality of the food with the very simple color label. And so there is a strong battle between science, which validated this logo with epidemial studies and experimental studies showing that participants are more inclined to select food healthier for their health. They understand the way that we could rank produce against nutritional quality, but yet various strong barriers by the food industries really don't want this logo to be put on back. So, and here, of course, with food additives, we have the same kind of opposition with some industries that don't want to remove these additives from their process. And so it's not always easy to win the battle of public health against economic interests.