artificial sweeteners and cancer

Nonnutritive Sweeteners and Cancer: Evaluating the Evidence

This article was written for the dietetic practice group of Nutrition Education for the Public and published in the 2017 summer issue of their newsletter, Networking News. You can read the original post here.

Research to find a cure for cancer is matched only by the efforts to find the cause. Studies have shown that the types and amounts of food eaten over time, or our dietary pattern, can both increase the risk of certain types of cancer and decrease the risk for others. If individual foods or additives are suspected of causing cancer, they are removed from the food supply when evidence confirms their carcinogenicity. And other factors, such as genetic predisposition and environmental exposures, can influence whether someone will develop cancer regardless of diet.

Establishing the safety of any food, additive,or even drinking water must consider exposure and risk. Dietary Reference Intakes(DRI) and Acceptable Daily Intakes(ADI) . provide safety thresholds for nutrients and food additives, respectively,by determining the risk associated with their consumption over a lifetime. These are valuable references for registered dietitian nutritionists (RDNs) who want to provide evidence-based answers to questions,such as how much Vitamin A or aspartame can be safely consumed.

Where does the public get answers to their questions about artificial sweeteners? If someone asks, “Do artificial sweeteners cause cancer?”, they will get over three million search engine results. The first one in my Google search was from the National Cancer Institute, the federal government’s principle agency for cancer research. The second was from the site of Dr. Mercola, whose mission statement says, in part, to expose government hype that diverts you away from what is truly best for your health. The answers offered by these two sources could not be more opposed. Other articles in my search included one with quotes from“actress and health expert” Suzanne Somers to those embedded among the recipes on Delish.com.

Is it any wonder the public is confused about the safety of low- and no-calorie sweeteners (LNCS)? Even people who never search for nutrition information online are being influenced by the extreme results found there, and this is a challenge for RDNs and health professionals. According to the International Food Information Council’s 2017 Food & Health Survey, consumers feel personal healthcare professionals are more trustworthy than looking online about what to eat or not eat, but they turn to family and friends more often to guide their food choices.

What does the science say about low- and no-calorie sweeteners?

Consumers may be confused about the safety of LNCS, but there is no reason for RDNs to be. Our education in a science-based curriculum prepares us to understand the merits of different types of study design and the interpretation and application of their results. We know we can rely on the findings reported in systematic reviews and meta-analyses to assess whether the amount and quality of evidence on a subject is sufficient to guide client decisions. And as members of the Academy of Nutrition and Dietetics (AND), we can also access the Evidence Analysis Library to find practice guidelines drawn from completed systematic reviews that answer specific questions based on the quality and extent of the evidence. Our training and these resources allow us to provide the public with consistent, accurate and ethical information within our scope of practice.

So when asked if LNCS cause cancer, one of the first sources we can check is the Surveillance, Epidemiology, and End Results Program (SEER) of the NCI. It collects, analyzes, interprets and disseminates data on cancer prevalence. Here we can see if the incidence of any type of cancer can be attributed to the worldwide increase in the use of LNCS over the past several decades or to any one of them as an individual sweetener. To date, there is no data to support either query.

The next source is, “Guidelines on Nutrition and Physical Activity for Cancer Prevention” from the American Cancer Society (ACS) and published in CA: A Journal for Clinicians. It states:

Current evidence does not show a link between these compounds [nonnutritive sweeteners and sugar substitutes] and increased cancer risk. Aspartame,saccharin and sucralose are a few of the nonnutritive, synthetic sweeteners approved for use by the FDA. Current evidence does not demonstrate a link between ingestion of these compounds and increased cancer risk.”

These Guidelines reflect the scientific consensus on cancer prevention from the ACS and are comparable to the Position Paper: Use of Nutritive and Nonnutritive Sweeteners. They are also supported by the National Cancer Institute, Food and Drug Administration, European Food  Food Safety Authority, and many other food safety authorities around the world.

Why all the controversy over low-and no-calorie sweeteners and cancer risk?

Despite the approval of LNCS for use by populations in more than 100 countries, questions about possible cancer risks are still raised. I have two explanations to help you address this with your clients and consumers.

The early history of saccharin and cyclamate, the first two artificial sweeteners widely used in the U.S., is riddled with cancer claims, warning labels, bans, moratoriums and research reversals. When new research proved they posed no cancer threat for humans, only saccharin was reapproved in the U.S. by the FDA, while cyclamate remained banned. It is, however, approved in 130 other countries. Ever since, suspicions have remained that use of any LNCS might increase cancer risk. This is the result of what I call the“Satan Effect.”

Like the “Health Halo” that imbues foods of questionable nutritional value with a more righteous reputation because of the company they keep, the “Satan Effect” does the opposite. It disparages an otherwise safe food because it is associated with a negative trait and cannot shake the bad reputation, even if undeserved. In the case of LNCS, the effect is reinforced by news outlets that continually exploit any study that finds tumors in lab animals exposed to huge quantities of LNCS, even when the findings cannot be extrapolated to humans, or studies that report associations based on methodology that cannot demonstrate causality. This leads to the second explanation for all the controversy.

All low- and no-calorie sweeteners are not the same

One thing all LNCS sweeteners have in common is their intense sweetening power compared to sugar, but that is where their similarities end. Nine LNCS have been approved for use in the U.S. by the FDA or meet the standards for Generally Recognized As Safe (GRAS) exemptions. They are acesulfame potassium, advantame, allulose*, aspartame, monk fruit extract (GRAS), neotame, saccharin, stevia (GRAS), and sucralose.

As reported in the Special Article, “Biological fate of low-calorie sweeteners” published in Nutrition Reviews in 2016, LNCS do not have the same structures and chemical compositions, are not derived from the same sources, and do not have the same metabolic outcomes or excretion pathways once ingested. Some are digested and indistinguishable from amino acids consumed in any other protein source. Some are not metabolized by humans and excreted unchanged in feces. Others are partially absorbed into the systemic circulation before being excreted in the urine.

These unique features of LNCS are critical, yet are often overlooked in the headlines and tweets that proclaim “artificial sweeteners cause cancer” (or any other disease). As translators of science for the public, our job is to read the studies, or consult with colleagues who have,to get the story right.We need to confirm which LNCS were used, or the product containing them, and not rely on headlines regarding the findings. We must also compare the study design and results to the existing body of research in order to evaluate the impact of new evidence.

A final point worth noting is level of exposure, as discussed earlier in this article. The available LNCS are 200 to 20,000 times sweeter than sugar,which greatly limits the amount found in any product. They are also regularly used in combination with one another, further minimizing the amount of any one likely to be consumed over a lifetime. At present,the Estimated Daily Intakes for LNCS fall below 10 percent of the Acceptable Daily Intakes, as explained in my article, “It’s the Dose that Matters.”With market reports showing a steady increase in the number of new LNCS expected to become available over the next 20 years, there is little reason for anyone to be concerned about over exposure to LNCS in the food supply.

Doing what we do best

Knowing that RDNs are one of the most trusted sources of nutrition information in the eyes of the public gives us a valuable opportunity to redirect the conversations surrounding LNCS from those steeped in opinions and inaccuracies to ones based in facts and truth. This effort is greatly enhanced when we are all sharing the same evidence-based information. I hope this article will strengthen your resolve to do just that.

*A low calorie sugar

References

World Health Organization. International Agency for Research on Cancer. Accessed June 20, 2017. https://www.iarc.fr/en/about/index.php

U.S. Department of Health and Human Services. National Institutes of Health. Nutrient Recommendations: Dietary Reference Intakes (DRI). Accessed June 26, 2017. https://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx

European Union Food Information Council. Acceptable Daily Intakes (ADIs) Q&A. Posted December 1, 2013. Accessed June 20, 2017. http://www.eufic.org/en/understanding-science/article/qas-on-acceptable-daily-in takes-adis

National Cancer Institute. Artificial Sweeteners and Cancer. Reviewed August 5, 2009. Accessed June 22, 2017. https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/artificial-sweeteners-fact-sheet

Mercola.com. Artificial Sweeteners Cause Cancer http://articles.mercola.com/sites/articles/archive/2016/03/30/artificial-sweetenerscause-cancer.aspx

Newsmax.com/health.Do Artificial Sweeteners Cause Cancer? Ask Suzanne Somers http://www.newsmax.com/Health/Headline/Somers-artificial-sweeteners-cancer/2 011/12/22/id/477953/

Delish.com. The Truth About Splenda Causing Cancer http://www.delish.com/food-news/a46349/is-splenda-really-linked-to-leukemia/

International Food Information Council. 2017 Food & Health Survey Executive Summary on Food Confusion. Accessed June 21, 2017. http://www.foodinsight.org/sites/default/files/2017-ExSum-FoodConfusion.pdf

Tappenden KA. A Unifying Vision for Scientific Decision Making: The Academy of Nutrition and Dietetics’ Scientific Integrity Principles, JAcadNutriDiet. 2015;115(9):1486-1490. https://www.andeal.org/vault/2440/web/files/EAL/Tappenden_et_%20al_%20201 6_SIP.pdf

Handu D, Moloney L., et.al (4). Academy of Nutrition and Dietetics Methodology for Conducting Systematic Reviews for the Evidence Analysis Library JAcad Nutri Diet. 2016;116(2):311-318 http://jandonline.org/article/S2212-2672(15)01705-0/pdf

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA:Cancer J Clin. 2016;66(1):7-30 http://onlinelibrary.wiley.com/doi/10.3322/caac.21332/full

Kushi LH, Doyle C. et. al (8) Guidelines on Nutrition and Physical Activity for Cancer Prevention. CA: Cancer J Clin. 2012;62:30-77. https://sinaitemple.org/pdf/STMC/ACSGuidelines.pdf

Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweeteners. J Acad Nutr Diet. 2012;112(5):739-758 http://jandonline.org/article/0002-8223(93)91762-F/pdf

National Institutes of Health. National Cancer Institute. Common Cancer Myths and Misconceptions. Posted February 3, 2014. Accessed June 26, 2017. https://www.cancer.gov/about-cancer/causes-prevention/risk/myths

European Food Safety Authority. Sweeteners. Accessed June 20, 2017. https://www.efsa.europa.eu/en/topics/topic/sweeteners

U.S. Food & Drug Administration. Additional Information about High-Intensity Sweeteners Permitted for use in Food in the United States. Last updated 05/26/15. Accessed June 23, 2017. https://www.fda.gov/food/ingredientspackaginglabeling/foodadditivesingredients /ucm397725.htm

National Research Council (US) Committee on Comparative Toxicity of Naturally Occurring Carcinogens. Carcinogens and Anticarcinogens in the Human Diet: A Comparison of Naturally Occurring and Synthetic Substances. Washington (DC): National Academies Press (US); 1996. 4, Methods for Evaluating Potential Carcinogens and Anticarcinogens. Available from: https://www.ncbi.nlm.nih.gov/books/NBK232624/

Calorie Control Council. Worldwide Approval Status of Cyclamate. Posted September 29, 2009. Accessed June 23, 2017. http://www.cyclamate.org/pdf/Cyclamate_worldwidestatus.pdf

Magnuson BA, Carakostas MC, Moore NH, Poulos SP, Renwick AG. Biological fate of low-calorie sweeteners. Nutr Rev. 2016;74(11):670-689 Accessed June 22, 2017 http://nutritionreviews.oxfordjournals.org/content/nutritionreviews/74/11/670.full.pdf

Marinovitch M, Galli CL, et. al (3). Aspartame, low-calorie sweeteners and disease: regulatory safety and epidemiological issues. Food Chem Toxicol. 2013;60:109-115 https://www.ncbi.nlm.nih.gov/pubmed/23891579

Flipse R. It’s the Dose that Matters. CalorieControl.org. Posted June 14, 2016. Accessed June 23, 2017. http://caloriecontrol.org/its-the-dose-that-matters/

Green M. Sweeteners Round-up. PreapredFoods.com. March 23, 2017. Accessed June 21, 2017 http://www.preparedfoods.com/articles/119583-sweeteners-round-up?

Tray of vegetables kebabs ready to put on the barbecue grill

Is a Plant Based Diet a Good Diet Plan?

This post was originally written during my 2 1/2 year tenure as a blogger for Health Goes Strong. This site was deactivated on July 1, 2013.

FOLLOWING A PLANT BASED DIET IS A GOOD PLAN WITHOUT GOING VEGETARIAN

It’s the first day of summer, let the harvest begin! This is my favorite time of year because it makes eating a plant based diet so easy. With so many more seasonal fruits and vegetables to choose from during the summer months, having meatless meals is the default menu option in my house.

You don’t have to become a full-fledged vegetarian to have the benefits of aplantiful” diet, just head in that direction by making more of your meals plant centered.

I not only get to reap the bounty from my own vegetable garden this time of year, I also enjoy the variety that shows up in my local farmer’s market. See my tips for shopping at farm stands to take advantage of this wonderful source of locally grown crops.

Why is a Plant Based Diet a Good Diet Plan?

Edible plants, which include fruits, vegetables, grains, nuts and seeds, provide us with the ideal combination of high nutrient-density and low caloric-density. That means you get more nutrients per calorie you eat, a great strategy for staying properly nourished without gaining weight. Plus, the high water and fiber content of plants helps us feel full, without filling us out.

Then there are all the phytonutrients (plant compounds that have health benefits but are not essential nutrients) you can only get from plants foods. Things like beta-carotene, lutein, lycopene, quercetin and resveratrol can’t be found in beef, poultry or fish but are valued for their cancer-fighting, immunity-building, anti-aging, free-radical-fighting properties.

No matter what the Paleo Diet crowd may say, you are better off living exclusively on plants than on animals in this day and age.

How to Enjoy More Meatless Meals

As I said before, the goal isn’t to eliminate meat, but to eat less meat at meals. It’s not as hard as you may think. You can start by approaching every meal with a focus on what fruit, vegetable, grain, nut and/or seed you will feature in that meal, and treat the animal portion as a side-dish. This can be as simple as cutting the meat serving size in half while doubling up on the plants you normally serve.

Imagine a sandwich on whole wheat bread spread with hummus, stacked with layers of grilled vegetables and topped with sliced avocado. You don’t need, and won’t miss, the deli meat and cheese one bit. But if you want some, a single slice will do.

How about a baked potato (yes, it’s a vegetable) stuffed with black beans (another vegetable) and salsa (a 3rd vegetable), topped with shredded cheese?

For some great outdoor dinner ideas try assorted vegetable pieces threaded onto kebab skewers with just a few cubes of chicken or salmon basted with a flavorful marinade and grilled to serve over a bulghur pilaf. Or you can grill eggplant and tomato slices and stack them up with a bit of parmesan cheese and fresh basil in between for a satisfying summer appetizer.

You can find entrée ideas in vegetarian cookbooks that are easily embellished with a few ounces of meat or cheese, if needed, or just add a few shrimp or some diced turkey to your salad.

Summer is here. It’s time to start moving toward a plant based diet while the pickings are good!

Help yourself to some of these other posts on eating more vegetables, too.

  • 9 Nutritious Salad Toppers From Your Pantry Shelf
  • Make a Healthy Homemade Salsa – It’s Easy!
  • Quick Healthy Meals Begin With Pasta
  • Need Dinner Ideas? Soup Makes Quick Easy Meals
  • Winter Vegetables Make Meatless Meals More Satisfying
  • Focus on Healthy Eating Habits, Not Superfoods
Older man in a kitchen wearing an apron and cooking at stove

Father’s Day Gift Idea: Help Him Learn to Cook

This post was originally written during my 2 1/2 year tenure as a blogger for Family Goes Strong. This site was deactivated on July 1, 2013, but you can read the post here.

ANYONE CAN LEARN TO COOK WITH SOME BASIC COOKING LESSONS AND SIMPLE COOKING TIPS

I grew up in a household with very a clear division of labor when it came to the household chores done by my parents. My mother did everything inside of the house and my father did everything outside.

The kitchen and all of the food that passed through it was my mother’s domain.

If my dad was home when my mom returned from the grocery store he would help carry the bags from the trunk of the car into the kitchen, but that’s as close as he ever came to putting a meal on the table.

I never saw him cook anything. On a few occasions I believe he made himself a sandwich.

Then after 52 years of marriage and eating the three meals a day my mother prepared for him, she died suddenly. How was my dad ever going to able to fend for himself in the kitchen?

If this sounds familiar, or possible, in your world, I’ve got a great Father’s Day gift idea for you. Teach your dad (husband, boyfriend, son) to cook. In fact, everyone you care about should learn to cook.

Here’s how I taught my dad to cook.

Cooking Tips For All First-Time Cooks

My dad’s cooking lessons did not begin with a cutting board and knife. They began with a pad and pencil.

Cooking requires planning.

Even though there was plenty of food in the house when my mother died, my father had no idea what was on hand or what to do with all those random ingredients in the pantry, refrigerator and freezer. To figure it out and provide a template for his future food shopping trips, I divided a piece of paper into six sections and headed them according to the basic food groups:

  • Meats/Poultry/Fish
  • Milk/Dairy
  • Fruits/Vegetables
  • Breads/Cereals/Pasta/Rice
  • Oils/Spreads
  • Seasoning/Sauces/Condiments

Once we completed the inventory, we were able to plan a menu for the coming week using simple recipes I found online. (My mother’s cookbooks and recipe card index were no help.) As we reviewed each recipe I showed him what pot or pan they called for and any small appliances mentioned. We then made a shopping list of what was needed to execute the week’s menu.

Navigating the grocery store was the next lesson in my dad’s training program. Unlike the chefs in those well-stocked kitchens on the cooking shows he loved to watch, if he wanted to learn to cook he had to buy the food. It definitely helped to have the shopping list arranged according to the store layout and cross off things as they went into the cart.

Learning how to properly store all the groceries when we got them home was an equally important lesson. All this happened before he actually prepared anything he could eat.

Cooking 101: Skills for a Lifetime

One of the skills my dad had going for him when his cooking lessons began was that he could carve a roasted turkey. I decided to build on his knife skills and teach him to cut, chop, slice and dice a variety of vegetables. Once he could do that, it was a natural progression for him to learn how to sauté those vegetables.

Sautéing vegetables led to sautéing meats, which led to making finishing sauces in the pan. He could now make pork chops smothered in onions, skillet chili and a chicken and broccoli stir-fry.

The skills we focused on after that were ones that allowed him to make the foods he liked best. Since he enjoyed stews, he learned to use the slow-cooker. He also liked pancakes, so learned to measure and mix the batter (but not over mix) and use the electric griddle. And since he didn’t like pasta, he didn’t need instructions for the colander.