Cassandra Vanderpool, MS, RDN, LD
Extension Diabetes Coordinator
Over the last two months, word has spread that sucralose (also known by the brand name Splenda®) is linked to leukemia. Sucralose has been on the US market since 1998 and is a popular choice for consumers who use artificial sweeteners because it does not have a bitter aftertaste and is heat stable so it can be used in cooking and baking. It is also a popular manufacturing ingredient, being used in over 4,500 products. Sucralose is made by chemically altering sugar molecules to replace three hydrogen-oxygen groups with three chlorine atoms. The resulting molecule is 600 times sweeter than sugar but is not broken down by the body, so it is considered a no calorie, non-carbohydrate sweetener.
The media was quick to feature alarming results from an article published on sucralose in the International Journal of Occupational and Environmental Health on January 29, 2016.1 Most of the headlines implied it is a proven fact that Splenda is linked to, or increases the risk of,
leukemia. As is usually the case when the media discusses a single study, the issue is not so conclusive or sensational.
The study tested the carcinogenic effect of sucralose in over 850 mice. The mice were divided into ten groups, five male and five female groups, each receiving a concentration of sucralose in their feedings equal to 0, 500, 2,000, 8,000, or 16,000 parts per million (ppm). The mice received the same dose daily from 12 days of gestation until they died. Sucralose consumption was associated with malignant tumors and blood cancers in the male mice. Those receiving 2,000 and 16,000 ppm experienced the highest incidences of blood cancers. The media rarely reported that sucralose consumption was associated with decreased incidences of cancer in the female mice.1
There are many debates regarding this research, which was done by the Ramazzini Institute in Italy. This is not the first sweetener it has studied and reported as carcinogenic. Yet, agencies such as the US Food and Drug Administration (FDA), European Food Safety Authority (EFSA), Health Canada, and the World Health Organization have consistently rejected research from the Ramazzini Institute as unreliable. Artificial sweeteners have been studied extensively. There are over 110 research studies on sucralose alone, and the results of those studies have been sufficient for most to deem sucralose as safe.
The Center for Science in the Public Interest (CSPI), a nonprofit food safety and nutrition watchdog group, gives more weight to the independent Ramazzini Institute study than these other studies, as many of them were industry funded and had fewer test subjects. Another reason is that most of the animal studies introduced sucralose feedings when the animals were adolescents and stopped giving sucralose long before the animals died. The Ramazzini Institute study gave sucralose throughout the life span, which seems appropriate since the FDA set an acceptable daily intake of sucralose for children at 5 milligrams per kilogram body weight.
The CSPI downgraded Splenda from its rating of “safe” to its “caution” category in 2013 when it learned of the Ramazzini Institute’s research, which was unpublished at the time but was presented at a conference. In February, little more than one week after the study was published, the CSPI further downgraded sucralose to its “avoid” category, which also includes the sweeteners saccharin, aspartame, and acesulfame potassium. CSPI president Michael F. Jacobson added, “That said, the risk posed by over-consumption of sugar and high-fructose corn syrup, particularly from soda and other sugar-sweetened beverages, of diabetes, heart disease, and obesity, far outweighs the cancer risk posed by sucralose and most other artificial sweeteners. Consumers are better off drinking water, seltzer, or flavored waters, but diet soda does beat regular soda.” 2
The bottom line is that sucralose will keep its current safety rating by regulatory agencies unless additional studies show results similar to those recorded by the Ramazzini Institute. The EFSA will conduct its own study on the issue at the request of the European Commission, which has asked the EFSA to provide a scientific opinion by the end of July. Even if further study produces similar results, safety ratings are likely to take into account the concentrations used in the
research. The Ramazzini Institute study used amounts that are far above what any human would consume, equivalent to 400-12,000 packets of Splenda every day for life.
Are sucralose and other artificial sweeteners beneficial for people with diabetes? The Academy of Nutrition and Dietetics provides an Evidence Analysis Library for its members that asks the same question. Experts regularly review nutritional research published in peer-reviewed journals. They use specific criteria to evaluate and grade the strength of evidence that interventions result in a desired (or undesired) outcome. In 2013 and 2014, it evaluated studies on the use of FDA-approved non-nutritive sweeteners (stevia, sucralose, saccharin, acesulfame potassium, aspartame and neotame) in adults with type 1 and type 2 diabetes. Few studies met the criteria for inclusion in these literature reviews, so there is limited evidence. The studies that met the criteria for inclusion do not support that FDA-approved non-nutritive sweeteners have a significant impact on A1C, fasting blood glucose, endogenous insulin, lipid, or blood pressure levels independent of weight loss.3 So, artificial sweeteners are likely beneficial only to the extent to which they aid consumers in weight loss.
The nutrition labeling on packages of artificial sweeteners may mislead some people into thinking they are completely free of calories. Because sucralose and most other artificial sweeteners are so sweet, only tiny amounts are in each packet. Sucralose sweeteners like Splenda (as well as other tabletop sweeteners) are mostly dextrose and maltodextrin, which provide the volume to make the sweeteners measurable and consistently sweet. These fillers provide some calories, but because there are less than five calories and one gram carbohydrate per serving (packet), the sweeteners are labeled as calorie free.
If people use larger amounts, for example in baking or sweetened beverages, the calories may add up to become substantial. One cup of Splenda provides 96 calories and 24 grams carbohydrate. The Splenda sugar blend contains more, providing 384 calories and 96 grams carbohydrate per cup. This is much less than the 774 calories and 200 grams carbohydrate provided in one cup of sugar, but people with diabetes need to be aware that consuming large amounts of artificial sweeteners does contribute enough carbohydrates to raise blood glucose.
1Soffritti M, Padovani M, Tibaldi E, Falcioni L, Manservisi F, Lauriola M, Bua L, Manservigi M, Belpoggi F. Sucralose administered in feed, beginning prenatally through lifespan, induces hematopoietic neoplasias in male swiss mice. Int J Occup Environ Health. 29 Jan 2016. DOI: 10.1080.10773525.2015.1106075. Accessed 6 April 2016: www.tandfonline.com/doi/full/10.1080/10773525.2015.1106075.
2Center for Science in the Public Interest. CSPI downgrades sucralose from “caution” to “avoid.” 8 February 2016. Accessed 6 April 2016: www.cspinet.org/new/201602081.html.
3Academy of Nutrition and Dietetic Evidence Analysis Library. DM: FDA-approved non-nutritive sweeteners (2014). Accessed 6 April 2016: www.andeal.org/topic.cfm?menu=5305&pcat=5488&cat=5145.