Artificial sweeteners are associated with increased cancer risk (opens in new tab)

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 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.

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.

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?

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).

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?

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.

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."

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