Information sheet: Intense sweeteners and cancer risk

Key messages

The food supply in Australia is strictly regulated
The intense sweeteners used in the Australian food supply have not been found to increase the risk of cancer
While intense sweeteners are often used to assist with weight management, the evidence for this is not strong.
Foods and drinks that contain intense sweeteners are usually highly processed and therefore are not products that Cancer Council recommends consuming regularly.

Background

Intense sweeteners (sometimes called artificial sweeteners, non-nutritive sweeteners, sugar substitutes or low-calorie sweeteners) are used to replace added sugar in food and drink products. These products may be labelled as ‘diet,’ ‘low joule,’ ‘no sugar,’ ‘zero sugar’ or ‘sugar free.’

Intense sweeteners are much sweeter than sugar and so are able to be used in small quantities. Some are completely synthetic or artificial (man-made) and some are extracted and concentrated from plant sources (e.g. Steviol glycoside from stevia rebaudiana). The use of intense sweeteners in food and drink products reduces their energy content (kilojoules) relative to the full sugar versions of these products and are therefore often referred to as non-nutritive sweeteners.

The sweeteners approved for use in Australia are strictly regulated by Food Standards Australia and New Zealand (FSANZ).⁽¹⁾ FSANZ carries out safety assessments based on evaluations and acceptable daily intake levels set internationally.

The peak organisation for research into the role of diet in cancer, the World Cancer Research Fund, notes that there is no strong evidence that drinks made with intense sweeteners are a cause of cancer.⁽²⁾

Current consumption levels in Australia

FSANZ has not assessed the consumption levels of intense sweeteners in Australia since 2003. At that time, the average exposure to each of the intense sweeteners under investigation was well below the Acceptable Daily Intake. A survey of the Australian population intake in 2011/12 found 18% of adults and 9% of children had consumed intense sweeteners the previous day. Drinks, tabletop sweeteners, and yoghurts were the top sources of intense sweeteners in the Australian diet.⁽³⁾

There is limited information on current intake levels.⁽⁴⁾ Globally, use of intense sweeteners is increasing although information on their use and effect on dietary patterns is limited.⁽⁴⁾A study into the Australian food supply found an increase in the proportion of food and beverage products containing intense sweeteners from 2015 to 2019.⁽⁵⁾ Dunford et al 2022 found “a large increase in the use of steviol glycosides (from 33.7% to 50.2%) and a large decrease in the use of sucralose (from 42.4% to 30.5%), aspartame (from 21.0% to 14.4%), and acesulfame K (from 57.4% to 27.7%)”.⁽⁵⁾

Dietary recommendations

There is no evidence that the intense sweeteners permitted in the food supply cause cancer or are unsafe in the doses typically consumed.

Intense sweeteners are often assumed to be useful for weight management. It seems logical that having less sugar and kilojoules would result in weight loss (or at least less weight gain). Surprisingly, the evidence for this is not strong, with some research suggesting intensely sweetened foods and drinks are not useful for weight management. (6-11). The World Health Organization has recently reviewed the evidence of the health effects and found that replacing sugars with non-nutritive sweeteners in the short-term results in reductions in body weight, but in the longer term is associated with increased risk of obesity, type 2 diabetes, cardiovascular diseases, and mortality. (12)

As with all additives, the presence of intense sweeteners indicates that a food is more heavily processed. Artificial sweeteners are usually present in foods which aren’t recommended as “every day” foods; for example, snack foods and confectionary products. To reduce the risk of cancer (and keep in good health), follow the Australian Dietary Guidelines and choose a wide variety of whole foods and minimally processed foods.

The most common way that people use intense sweeteners is in drinks. If you drink sugary drinks and think a “no sugar” or “diet” version might help you cut down on sugar, that may be a first step to reducing your intake of sugary drinks. However, no/low sugar soft drinks are still bad for your teeth, so aim to make water your preferred drink every day and drink intensely sweetened drinks only occasionally and as a step towards cutting back on sugar-sweetened soft drinks.

Policy context

Cancer Council supports continued monitoring of intense sweeteners in the Australian food supply. Ongoing research into the role of intense sweeteners in weight management is recommended.

References

Food Standards Australia and New Zealand. Intense Sweeteners 2021 [updated July 202127/04/2022]. Available from: https://www.foodstandards.gov.au/consumer/additives/Pages/Sweeteners.aspx.
World Cancer Research Fund/ American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Recommendations and public health and policy implications. 2018. Available from: dietandcancerreport.org.
Grech A, Kam CO, Gemming L, Rangan A. Diet-Quality and Socio-Demographic Factors Associated with Non-Nutritive Sweetener Use in the Australian Population. Nutrients. 2018;10(7):833.
Russell C, Grimes C, Baker P, Sievert K, Lawrence MA. The drivers, trends and dietary impacts of non-nutritive sweeteners in the food supply: a narrative review. Nutrition Research Reviews. 2020:1-24.
Dunford EK, Coyle DH, Louie JCY, Rooney K, Blaxland A, Pettigrew S, et al. Changes in the Presence of Nonnutritive Sweeteners, Sugar Alcohols, and Free Sugars in Australian Foods. Journal of the Academy of Nutrition and Dietetics. 2022;122(5):991-9.e7.
Toews I, Lohner S, Küllenberg de Gaudry D, Sommer H, Meerpohl JJ. Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies. BMJ. 2019;364:k4718.
Bellisle F, Drewnowski A. Intense sweeteners, energy intake and the control of body weight. Eur J Clin Nutr. 2007;61(6):691-700.
Laviada-Molina H, Molina-Segui F, Pérez-Gaxiola G, Cuello-García C, Arjona-Villicaña R, Espinosa-Marrón A, et al. Effects of nonnutritive sweeteners on body weight and BMI in diverse clinical contexts: Systematic review and meta-analysis. Obesity Reviews. 2020;21(7):e13020.
Mosdøl A, Vist GE, Svendsen C, Dirven H, Lillegaard ITL, Mathisen GH, et al. Hypotheses and evidence related to intense sweeteners and effects on appetite and body weight changes: A scoping review of reviews. PLOS ONE. 2018;13(7):e0199558.
Azad MB, Abou-Setta AM, Chauhan BF, Rabbani R, Lys J, Copstein L, et al. Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2017;189(28):E929-e39.
Hodge AM, Bassett JK, Milne RL, English DR, Giles GG. Consumption of sugar-sweetened and artificially sweetened soft drinks and risk of obesity-related cancers. Public Health Nutrition. 2018:1-9.
Rios-Leyvraz M, Montez J. Health effects of the use of non-sugar sweeteners: a systematic review and meta-analysis. Geneva: World Health Organization; 2022.