Just when my client was on the verge of giving up her daily Diet Coke habit after the WHO report last month, aspartame is cool again. Don’t get me wrong. I’d rather my clients drink water for hydration than anything else. But perhaps we can all relax a bit (1).

The WHO’s recommendation stemmed from the International Agency for Research on Cancer’s (IARC) conclusion that aspartame may be carcinogenic to humans. But like most nutrition science, the research on artificial sweeteners is evolving and not 100% conclusive. Need I remind everyone of the egg conundrum?

According to Dr. Arnold Baskies, the former chair of the national board of directors of the American Cancer Society, surgical oncologist, and member of the Coalition for Safe Food and Beverage Choices Expert Advisory Committee, “WHO Joint Expert Committee on Food Additives (JECFA) review says that aspartame is safe for human consumption” (2).

JECFA is the top agency when food safety is involved. JECFA’s evaluations are used by the FDA to decide which and how much of an additive is safe for human consumption (2).

Recently, the IARC classified aspartame as “possibly carcinogenic to humans,” citing limited evidence for its carcinogenicity, specifically liver cancer. IARC is a research organization that evaluates evidence on the causes of cancer but doesn’t make health recommendations. There were three large studies on the intake of artificial sweeteners and cancer (3).

Studies were done within the European Prospective Investigation of Cancer and Nutrition (EPIC) cohort, 2 a pooled analysis of the National Institutes of Health (NIH)-American Association of Retired Persons (AARP) cohort and the Prostate, Lung, Colorectal and Ovarian Cancer Screening (PLCO) cohort, 3 and the Cancer Prevention Study (CPS)-II cohort (3).

While a positive association was observed between the intake of artificial sweeteners and the risk of a type of liver cancer, bias or confounding variables were not ruled out for the link (3).

Animal studies were also inconclusive. An increased incidence of cancer or a combination of carcinogenic and benign neoplasms in mice and rats was observed with intake of aspartame. However, evidence of cancer in experimental animals was limited due to questionable study design and data analysis (3).

The FDA recently released this statement, “Aspartame being labeled by IARC as possibly carcinogenic to humans does not mean that aspartame is actually linked to cancer. The FDA disagrees with IARC’s conclusion that these studies support classifying aspartame as a possible carcinogen to humans. FDA scientists reviewed the scientific information included in IARC’s review in 2021 when it was first made available and identified significant shortcomings in the studies on which IARC relied. We note that JECFA did not raise safety concerns for aspartame under the current levels of use and did not change the Acceptable Daily Intake” (4).

According to WHO, this is the first time the IARC has studied aspartame and the third time for JECFA. The JECFA noted that the acceptable daily intake is 40 mg/kg body weight, which has not changed from the original FDA level. This amounts to 20 cans of Diet Coke for a 165-pound person. That’s a lot of diet soda (3).

If nothing else, the headlines about aspartame and cancer should wake people up about the impact of their dietary choices and the risk for cancer. We do know that there is a positive association between processed and red meat and cancer as well as alcohol intake and risk for multiple types of cancer including esophagus, breast, liver, pancreas, head and neck, and colorectal cancer (5)

Lettuce focus on what we should eat to prevent cancer:

• Green leafy and cruciferous vegetables. Brussels sprouts, broccoli, cabbage, kale, spinach. These contain sulforaphane, vitamin C, vitamins, polyphenols, sulfides, glucosinolates, and other phytochemicals to protect against cancer (6).

• Green tea and cocoa-based beverages contain flavonoids, compounds found to have anticancer effects (7).

• Berries and other fruit—these colorful gems provide vitamins, minerals, fiber, flavonoids, and other bioactive compounds and are linked with the reduction of breast and other cancers (8).

• Whole grains—whole grains aid in weight management, which is important in reducing the risk of cancer. Fiber in whole grains also positively impacts the gut microbiome, which affects immunity (9).

• Nuts and tree nuts—an inexpensive staple in several dietary patterns, nuts, and tree nuts have been linked with an overall reduction in cancer mortality, specifically colon and pancreatic cancer (10).

• Beans and lentils—these fiber and protein-packed plants have been linked with the reduction of cancer as well as heart disease and diabetes. They’re also inexpensive and versatile (11).

• Soy—a recent meta-analysis found a protective effect with soy isoflavone intake and the risk of breast cancer and pre-and post-menopausal women. Researchers caution against isoflavone supplements. Like other nutrients, it’s best to get it from food versus pills (12).

Lisa Andrews, MEd, RD, LD

Handout: 7 Foods that Decrease Cancer Risk — Download PDF

References:

1.       https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released.

2.      https://safechoicesforall.com/dr-arnold-baskies-who-aspartame-report/.

3.      jecfa-summary-of-findings-aspartame.pdf (who.int)

4.       https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food.

5.      Farvid MS, Sidahmed E, Spence ND, Mante Angua K, Rosner BA, Barnett JB. Consumption of red meat and processed meat and cancer incidence: a systematic review and meta-analysis of prospective studies. Eur J Epidemiol. 2021 Sep;36(9):937-951. doi: 10.1007/s10654-021-00741-9. Epub 2021 Aug 29. PMID: 34455534.

6.     Nandini DB, Rao RS, Deepak BS, Reddy PB. Sulforaphane in broccoli: The green chemoprevention!! Role in cancer prevention and therapy. J Oral Maxillofac Pathol. 2020 May-Aug;24(2):405. doi: 10.4103/jomfp.JOMFP_126_19. Epub 2020 Sep 9. PMID: 33456268; PMCID: PMC7802872.

7.      Kopustinskiene DM, Jakstas V, Savickas A, Bernatoniene J. Flavonoids as Anticancer Agents. Nutrients. 2020 Feb 12;12(2):457. doi: 10.3390/nu12020457. PMID: 32059369; PMCID: PMC7071196.

8.      Golovinskaia O, Wang CK. Review of Functional and Pharmacological Activities of Berries. Molecules. 2021 Jun 25;26(13):3904. doi: 10.3390/molecules26133904. PMID: 34202412; PMCID: PMC8271923.

9.     López-Plaza B, Loria-Kohen V, González-Rodríguez LG, Fernández-Cruz E. Alimentación y estilo de vida en la prevención del cáncer [Diet and lifestyle in cancer prevention]. Nutr Hosp. 2022 Sep 1;39(Spec No3):74-77. Spanish. doi: 10.20960/nh.04317. PMID: 36040006.

10.  Naghshi S, Sadeghian M, Nasiri M, Mobarak S, Asadi M, Sadeghi O. Association of Total Nut, Tree Nut, Peanut, and Peanut Butter Consumption with Cancer Incidence and Mortality: A Comprehensive Systematic Review and Dose-Response Meta-Analysis of Observational Studies. Adv Nutr. 2021 Jun 1;12(3):793-808. doi: 10.1093/advances/nmaa152. PMID: 33307550; PMCID: PMC8166551.

11.    Papandreou C, Becerra-Tomás N, Bulló M, Martínez-González MÁ, Corella D, Estruch R, Ros E, Arós F, Schroder H, Fitó M, Serra-Majem L, Lapetra J, Fiol M, Ruiz-Canela M, Sorli JV, Salas-Salvadó J. Legume consumption and risk of all-cause, cardiovascular, and cancer mortality in the PREDIMED study. Clin Nutr. 2019 Feb;38(1):348-356. doi: 10.1016/j.clnu.2017.12.019. Epub 2018 Jan 9. PMID: 29352655.

12.   Boutas I, Kontogeorgi A, Dimitrakakis C, Kalantaridou SN. Soy Isoflavones and Breast Cancer Risk: A Meta-analysis. In Vivo. 2022 Mar-Apr;36(2):556-562. doi: 10.21873/invivo.12737. PMID: 35241506; PMCID: PMC8931889.