Aspartame is up to 200 times sweeter than sugar. Pictured is a man pouring pills of an artificial sweetener into a tea.towfiqu ahamed (Getty Images/iStockphoto)
The World Health Organization (WHO) believes that the sweetener aspartame, found in low-calorie soft drinks, sweets and even medicines, is “possibly carcinogenic” to humans. The International Agency for Research on Cancer (IARC), the WHO body responsible for determining the carcinogenic potential of substances, has, after reviewing the available scientific evidence, concluded that this sweetener may cause cancer in the population. Yes, it is classified at Level 2B, which is the penultimate step in the hazard identification pyramid: This means the evidence is very limited and while safety is not an issue at the doses commonly used, there are potentially harmful effects described. However, the Joint FAO/WHO Expert Committee on Food Additives (JECFA), which is responsible for identifying these risks to the population and setting an acceptable daily intake, has also evaluated the available evidence and decided to maintain the recommendation of “acceptable” daily intake that he already had: 40 milligrams per kilo of weight per day.
Aspartame, which is up to 200 times sweeter than sugar, is found in thousands of products. It is used as a tabletop sweetener or to sweeten low-calorie soft drinks, chewing gum, jellies, breakfast cereals, yogurt, ice cream, toothpaste, or in some medicines. The JECFA evaluated the safety of this substance in 1981 and set the maximum recommended dose at 40 milligrams per kilogram of body weight per day: below this level, the consumption of this substance was safe. Now, however, and “given the availability of new research,” said IARC, a committee of 25 independent experts has assessed aspartame’s carcinogenic potential for the first time. For its part, JECFA has also carried out a re-analysis of the studies in order to assess the risks and, if necessary, to refine the recommended intake on the road. A portion of these reviews were published in The Lancet Oncology this Friday.
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The results of the new IARC scientific review conclude that aspartame is “possibly carcinogenic” to humans. This corresponds to level 2B on the agency’s rating scale. By the IARC standard, this means there is either limited but inconclusive evidence for cancer in humans, or convincing evidence for cancer in experimental animals, but not both. Or it may also be that only the evidence for the carcinogenic mechanisms of action of this active substance is reliable. In this case, IARC found that the evidence in the three study strands (humans, experimental animals, and mechanistic evidence) was limited, but saw indications inviting a warning.
“This classification reflects the strength of scientific evidence on whether an agent can cause cancer in humans, but does not reflect the risk of developing cancer at a given exposure,” said Mary Schubauer-Berigan, director of the IARC monograph program . during the press conference. In fact, aspartame is not the only food additive analyzed by IARC: it has already examined more than 70 of them, including saccharin or cyclamate, both of which are classified as level 3, the last in the classification, and suggesting that there is no evidence to support this there they are carcinogenic.
Aspartame is on the same level as lead or exhaust from a gasoline engine. That said, the scientific evidence for its potential to cause cancer is similar, but that doesn’t mean the risk is the same. Because this classification does not indicate the level of cancer risk at a given exposure, “the cancer risk (at typical exposure levels) associated with two substances classified in the same IARC group can be very different,” warns the body of the WER. For example, tobacco and processed meat are at the top of the scale – they are “carcinogenic” – but the actual risk from regular exposure is not the same.
Schubauer-Berigan explained that analysis of aspartame in three studies involving cohorts from the US and Europe found an association between consumption of artificially sweetened beverages and one type of liver cancer. However, he pointed out: “Despite the consistently positive results in these three studies, the task force concluded that chance, bias and confusion could not be ruled out with reasonable certainty and therefore concluded that the evidence was limited.” .” In three studies involving experimental animals, experts found that mice and rats had a higher incidence of tumors, but ultimately also concluded that there was “limited” evidence due to doubts about the design of the studies and the interpretation of the results give data. IARC also considered the mechanistic evidence (whether the compound displayed key carcinogen properties) to be limited, although there was some evidence that aspartame induces oxidative stress or chronic inflammation.
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The Head of the IARC Monograph Programs noted that this scientific review and the classification of this substance as a possible carcinogen, not as a direct statement that aspartame has known cancer risks, “can serve as a “call to the research community to seek elucidation and improvement”. understand the carcinogenic hazard that consumption of aspartame may or may not entail.”
It was precisely the lack of strength of the scientific evidence linking aspartame and cancer that led JECFA to keep its recommendations unchanged, explained Francesco Branca, director of the WHO Division of Nutrition and Food Safety: “The main conclusion” was that there was no convincing evidence There was no experimental or human data to show that aspartame had harmful effects after ingestion within the limits set by the previous committee, which was 40 milligrams per kilogram of body weight.” Branca argued that analysis of genotoxicity studies—the ability of a substance to bind DNA to cause damage – in vitro and in vivo yielded conflicting results. “A genotoxic effect could not be demonstrated. “It has also not been possible to get consistent or convincing evidence from animal studies,” he said.
The JECFA committee also reviewed randomized trials and epidemiological studies to examine the association between aspartame and health effects such as cancer or diabetes, and found statistically significant increases in hepatocellular, breast and some hematological cancers in cohort studies consuming aspartame firmly. However, he added that “no consistent association” could be demonstrated between consumption of the sweetener and any specific tumor type and that there were limitations in the studies, for example in the way exposure to this sweetener was estimated.
Moderate consumption
In practice, little changes. Branca pointed out that the findings of the WHO reviews go beyond the alert to monitor consumption and step up research on this sweetener and “do not suggest that consumption of products containing sweeteners automatically has health effects “. Within the maximum intake threshold set by the JECFA, consumption is “acceptable” with no “appreciable health effects”, but experts recommend controlling the use of these sweeteners. “We do not advise companies to recall products, nor do we advise consumers to stop using them entirely. We just advise moderation,” concluded Branca. The senior WHO official emphasized that the maximum recommendation of 40 milligrams per kilo body weight per day is a high upper limit and gave an example: If an adult weighs 70 kilos, his maximum permissible intake is about 2,800 milligrams per day aspartame. And if the proportion of this sweetener in a regular soda is between 200 and 300 milligrams per day, that means that between nine and 14 cans of soda must be consumed per day to exceed the acceptable limit (assuming no other food source is added). taken).
For occasional consumers of products with aspartame there is no problem in the first place, assured Branca. “Until we have more robust data recommending reductions in the acceptable daily intake, we are confident or satisfied that occasional exposure well in excess of the acceptable daily intake is safe or does not pose a significant risk to human health.” “The problem lies with the bulk consumers,” warned the expert, who focused on the increased consumption of artificial sweeteners as sugar substitutes and their use, especially among children.
We are not advising companies to recall the products, nor are we advising consumers to stop using them entirely. We only advise some moderation”
Francesco Branca, Director of the WHO Division for Nutrition and Food Safety
Branca urged food manufacturers to avoid overuse of sugar or salt, noting that sweeteners are probably “not the way to go” either. He offered further advice to the public: “When consumers are faced with the decision to drink a cola with sweeteners or one with sugar, I think a third option should be considered, which is to drink water instead and cut down on consumption altogether .” of sweetened products”.
The external experts surveyed also urge caution when interpreting the WHO decision. “All of this can be scary and misinterpreted. But if JECFA doesn’t change the allowable daily intake, it’s because the evidence is very small,” laments Carmen Vidal, professor of nutrition and bromatology at the University of Barcelona. The expert fears a repeat of the controversy sparked by the same WHO panel in 2015 by also classifying red meat as a possible carcinogen: “I’m worried about the unnecessary alert.”
Vidal emphasizes the need to distinguish between risk and danger – ultraviolet light is dangerous, but risk depends on exposure and protection – and warns that observational and association studies tend to have “many confounding variables” that make it difficult to find a clear connection between the pathogen and the disease. Ramon Estruch, head of the Cardiovascular Risk, Nutrition and Aging research group at Hospital Clínic-Idibaps, agrees: “The main problem with these types of additives is that the relationship between them and health is in some aspects difficult to measure The researcher, coordinator of the Predimed study on the Mediterranean diet in health, gives an example: “At the cardiovascular level, it seems that they have an impact on diabetes and mortality and may not be useful for weight loss. The evidence is solid. But with cancer, it’s more complicated because the factors that trigger cancer are more complex and the time that elapses between exposure and the occurrence of the event is very long, making it difficult to draw any conclusions.”
The fewer additives, the better.
The doctor claims that all foods or supplements, such as aspartame, are part of a larger dietary pattern and that it is “very difficult” to isolate the action of a single element and attribute cancer to the action of a particular supplement. “The health recommendation is definitely: the less, the better. And if it’s possible that it’s zero, then zero. “The general recommendation is to eat a Mediterranean diet, and there is no place for additives of any kind,” he recommends. While Estruch suggests that the WHO assessment is positive “to raise an alarm for companies to vary the composition of the products or reduce the amount of sweeteners”: “That seems good to me.” [la decisión] to improve the quality of the products,” he says.
In any case, the amount consumed is always decisive. And as long as it’s below the limit recommended by health authorities, “there’s safety,” Vidal emphasizes. For example, some medicines may contain aspartame, but the amounts are far from the maximum recommended daily dose, explains Miguel Villaronga, hospital pharmacist in Sant Joan de Déu de Barcelona: “In pharmacies, aspartame is a must-have excipient.” . It is a sweetener that is used in the formulation, for example, when the drug is very bitter and you want to make it taste nicer.” Villaronga is the author of a list of drugs containing aspartame, a compendium for patients with phenylketonuria, a rare inherited disorder that causes phenylalanine, an amino acid found in aspartame, to build up in the body. For this group of people, exposure to this sweetener can have health consequences, but for the general population the amounts contained in these drugs are negligible: for example, a 100 milligram Viagra chewable tablet contains barely 8.6% aspartame, Biodramina chewing gum contains three milligrams and a shell of ibuprofen, about 30.
In Europe, the European Food Safety Authority (EFSA, acronym in English) will have the final say on any regulatory change affecting manufacturers or consumers. This institution is responsible for regulating the conditions of the products consumed by the consumer and can set new limits in the formulation of food or beverages. In a 2013 review, EFSA experts concluded that “given the current estimates of aspartame exposure or the accepted daily intake of 40 milligrams per kilogram of bodyweight per day, aspartame does not pose a safety risk.” People with phenylketonuria for whom this acceptable daily intake is not applicable “since they require strict adherence to a low-phenylalanine diet,” they reasoned.
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