The hidden costs of abandoning sugar substitutes
According to two separate reports from researchers affiliated with the World Health Organisation (WHO), the popular sugar substitute aspartame is safe to consume for humans – though is still ‘possibly carcinogenic’ when consumed in excessive quantities.
If this is sounding like old news, that’s because it is.
Reports of the new label for aspartame have been circulating for two weeks now, after anonymous sources leaked it to the press. The news triggered a heated debate between experts on the benefits and alleged risks of aspartame, and on the widespread use of sugar substitutes in general.
Aspartame is used in an estimated 6,000 products worldwide, making it one of the most popular yet controversial sweeteners on the market. This new label may dampen the volume a little, but is unlikely to bring a firm resolution to this perennial debate.
For the ‘pro sweetener’ camp, who claim the causal relationship between aspartame and cancer is shaky at best, many will be gratified to see the WHO recognise that in most doses, it poses little risk to users. This position has been reaffirmed by multiple government agencies in both the US and the EU, including the U.S. Food and Drug Administration (FDA), European Food Safety Authority (EFSA), Food Safety Ireland, the Norwegian Food Safety Authority, etc.
However, many in this camp may still find the ‘possible carcinogen’ label grating; and it remains to be seen whether this designation will hang over the product from now on.
Equally, the ‘nay’ camp will be pleased to see moves in the direction they have been pushing for, but will be disappointed that the WHO’s response has been so cautious. Some may even see it as symptomatic of the institutional inertia that led aspartame to be uncritically accepted for many years. Professor Erik Millstone at the University of Sussex says that “governments and committees are loath to admit they’ve ever made a mistake in the past… I don’t think [aspartame] should ever have been approved in the first place”.
Not wanting to get lost in the weeds here, I will simply say that the precise relationship between aspartame and cancer remains far from clear; more research is needed before a firm conclusion is reached.
Yet, in all the hubbub surrounding this debate, I worry that a far more practical question has been ignored. Namely: if sugar substitutes were to fall out of use altogether, would we be in a better or worse position health-wise than we are now? Professor Giles Yeo from the University of Cambridge puts it another way: ‘People ask: is Aspartame bad for you? And the question is, compared to what?’
For many, the answer to this is obvious: sugar. The reality is that human beings tend to be drawn to sugary, hyper-palatable foods which scratch a primordial need for sweetness.
The power of the infamous ‘sweet tooth’ to make us binge on biscuits, chocolate, and ice cream has long been the bane of diligent weight-watchers, not to mention professional dietitians and nutritionists.
I can tell you from personal experience that dentists also hold sugar in a kind of awe-struck horror. When we consume sugar, what we are essentially doing is feeding the population of bacteria in our mouth, which then produce as a by-product a form of acid which erodes the enamel around our teeth. If left unchecked, this leads to dental cavities and oral disease. This is true even of healthier, more natural forms of sugar – such as the fructose and glucose found in fruit.
In this respect, the great boon of sugar substitutes is that they satiate our cravings for sweetness, whilst removing the need to consume large quantities of high-calorie, tooth decaying sugar. In the case of sugar free gum – long recognised by dentists as a valuable oral health tooth – these benefits are even more pronounced.
By stimulating the production of saliva through chewing, gum helps us to readjust the chemical balance of the mouth by producing minerals like calcium and phosphates. This ‘remineralisation’ process reverses damage caused by cavity-making acids, and reduces levels of plaque.
The research bears this out. One 2019 study by King’s College London found that people who regularly chew SFG develop about 28% fewer cavities than those who don’t. For reference, the equivalent percentage for fluoride toothpastes and supplements was 24%. King’s also carried out a systematic review into the topic in 2022, which found that using SFG regularly reduces the quantity of plaque in the oral cavity compared to the non-chewing condition.
Of course, we should be wary about overstating the benefits of sugar free gum. Whilst it can be a useful tool, it is no substitute for the basics: brush your teeth, visit the dentist, floss once a day, and maintain a reasonably healthy diet. When taken together with these other preventative measures, SFG can nevertheless contribute to an effective defence against oral disease.
This is all to say: whilst the science is inconclusive on whether non-nutritive sweeteners like aspartame increase the risk of cancer, the oral health benefits of sugar free chewing gum are unequivocal.
Professor Liz Kay was President of the British Dental Association from 2021-23.
