Praedicat Blog – So, I can’t have my cake and eat it too?
by Dave Loughran
The first non-nutritive sweetener saccharin was discovered accidentally in 1878 by a Johns Hopkins researcher investigating new uses for coal-tar derivatives (yummy!).* With the help of the then fledgling Monsanto Corporation (yes, Monsanto!) saccharin was in widespread use in the U.S. food industry by the early 1900s. Today, a vast array of foods and beverages are “artificially” sweetened with saccharin and its progeny including aspartame, sucralose, stevioside, erythritol, d-allulose, and acesulfame potassium. (We’ll be making our exclusive analysis on the IARC’s recent evaluation of aspartame available next week.)
Non-nutritive sweeteners have come close to regulatory oblivion on several occasions. The Department of Agriculture first recommended banning saccharin in 1908 and it was only by the grace of Teddy Roosevelt that it wasn’t. Roosevelt, whose physician prescribed him a daily dose of saccharin, reportedly summed up his assessment of the Department’s Head Chemist’s regulatory proposal bluntly: “Anyone who says saccharin is injurious to health is an idiot.” With Roosevelt out of office, the Department of Agriculture succeeded in banning saccharin in processed food in 1912, but the ban was short lived. Regulators reversed their position during World War I when sugar was in short supply.
Saccharin had another near miss in 1977 on the heels of studies suggesting that it was a potential carcinogen. The Delaney Clause of the Food, Drug, and Cosmetic Act prohibits FDA from approving the use of any food additive found to cause cancer in animals or humans. FDA issued its ban, but then Congress, facing a public uproar, overrode the ban passing the Saccharin Study and Labeling Act. The Act mandated labeling of all foods containing saccharin and imposed a two-year moratorium on any government action to ban it. Congress renewed the moratorium every two-years until the National Institutes of Health finally declared it safe for human consumption in 2000.
Another non-nutritive sweetener, cyclamate, was not so fortunate. Cyclamate came on the market in the 1950s and helped usher in the age of diet soda (remember Tab?). Its association with bladder cancer, though, led to its ban in 1970. Although the evidence that cyclamate causes cancer is no more supportive than that for saccharin, cyclamate is still banned in the U.S.
Fast-forward to today and the World Health Organization (WHO) has now entered the fray publishing guidelines in May that recommend against the use of non-nutritive sweeteners as a means of achieving weight control. The WHO bases its recommendation on the conclusion that the evidence is weak that long-term consumption of non-nutritive sweeteners reduces body weight and other measures of body fatness and that non-nutritive sweeteners may increase the risk of cardiovascular disease and type 2 diabetes. While the WHO characterizes the evidence on adverse health outcomes as having “very low to low certainty,” they come down on the side of warning against the use of non-nutritive sweeteners for weight control because, in their estimation, a reduction in sugar intake can be achieved without the use of these products. So why take the risk?
Understandably, industry was not pleased with the WHO’s broadside. Bob Peterson, Chairman of the International Sweeteners Association, stopped short of calling the WHO a bunch of idiots, choosing a more diplomatic response: “Food and beverage companies have reformulated products as part of a comprehensive, global effort to meet public health recommendations for sugar reduction. Low/no calorie sweeteners have enabled this innovation and ultimately contribute to the creation of healthier food environments by allowing people to enjoy food and drinks with less sugar and fewer calories, while still meeting their taste preferences.”
From a liability perspective, the evidence that non-nutritive sweeteners cause bodily injury is moderate at best. The maximum general causation risk score* across seven non-nutritive sweeteners is 0.17, and this is not for lack of study. We record 170 studies – 60 of which are in humans – investigating specific non-nutritive sweeteners. A lot of this published evidence simply does not support the hypothesis that these substances cause bodily injury. The highest General Causation (GC) risk score is for erythritol – first marketed in the 1990s – and this score comes in large part from a study published this past February in Nature Medicine reporting a correlation between erythritol use and cardiovascular events. Study participants with erythritol levels in the top 25% were almost twice as likely to have cardiovascular events over three years of follow-up as those with erythritol level in the bottom 25%. The study also demonstrated that exposing human platelets to erythritol increased their sensitivity to blood clotting signals and that erythritol sped up blood clot formation and artery blockage in mice.
Our emerging risk software, CoMeta®, also profiles artificially sweetened beverages since there are many studies investigating their association with adverse health outcomes without reference to any particular non-nutritive sweetener. That literature includes some 53 studies, all of which are in humans. The GC risk score for artificially sweetened beverages and cardiovascular injury is 0.42 and, for endocrine injury, the score is 0.47. Our recently released liability catastrophe model, Nekomodel X, allows for correlations across these various non-nutritive sweeteners yielding a 3-4 percent chance bodily injury litigation could emerge over the next eight years. If litigation does emerge, the losses could be in the tens of billions.
So, can you have your cake and eat it too? No, I’m sorry, you cannot literally maintain possession of your cake and also eat it. But metaphorically speaking? The International Sweeteners Association says you can eat a delicious artificially sweetened cake confident that you’re making a healthy choice. The WHO, on the other hand, would advise the risk is not worth it; how about a piece of fruit instead? CoMeta will not provide you any dieting advice, but it will recommend you manage your aggregations of non-nutritive sweeteners. And Teddy Roosevelt? Well, he might just call you an idiot and leave it at that.
Author’s note: Many of the fun facts about saccharin included here come from a terrific piece of science history writing by Jesse Hicks, “The Pursuit of Sweet.”
* The General Causation (GC) risk score indicates the likelihood that a plaintiff can establish in a court of law that exposure to the Litagion agent can cause the hypothesized harm. A score of -1.0 indicates that the scientific literature overwhelmingly rejects the hypothesis that exposure to the Litagion agent causes the hypothesized harm; a score of 1.0 indicates that the scientific literature overwhelmingly accepts the hypothesis; and a score of zero indicates that the scientific literature is equivocal. The GC score is found in our software, CoMeta.