Q&A: What to tell your patients about aspartame

Key takeaways:

• A WHO committee recently announced that aspartame is a potential carcinogen.
• An expert said that carbonated water and flavored protein powder are healthier alternatives to sugar.

Last month, WHO’s International Agency for Research on Cancer declared aspartame — a popular artificial sweetener that is used in products like soft drinks, chewing gum and ice cream — a potential carcinogen.

A separate entity — the Joint WHO and Food and Agriculture Organization's Expert Committee on Food Additives — simultaneously issued a recommendation that individuals should consume only up to 40 mg/kg of body weight daily.

According to WHO, the decision to classify aspartame as a possible carcinogen was based on limited evidence indicating an increased risk for hepatocellular carcinoma, a type of liver cancer.

Crystal Scott, MS, RD, LD, CDCES, CSP, CSSD, a registered dietician at Top Nutrition Coaching, spoke with Healio about what clinicians should know about the recommendation, which patients — if any — should avoid aspartame, potentially healthier alternatives to aspartame and more.

Healio: Based on the WHO report, are you recommending that patients avoid consuming aspartame?
Scott: No. If I start working with someone and we start restricting it ... unless there is a medical condition that would deem it necessary to remove it altogether, it is moderation. I really stress moderation because the more restrictive you are ... at some point, they’re going to drink it and then usually they end up binging on it.

So, why not have one a day or one a week and have that flexibility vs. getting rid of it? And then 6 months down the road, they end up saying, “I can't do this anymore. I am going to drink all the diet soda that I possibly can.” Then they end up drinking an astronomical amount per day.

Healio: Are there certain patients who should definitely avoid it?

Scott: If you read the entire research on aspartame ... [WHO] has to label it as possibly carcinogenic because there is a lack of evidence to say that there is any direct effect to human consumption. When I'm working with someone, I like to give them evidence that they can make a decision based off what is good for them and their body, and with that recommendation, there's not a particular group of individuals that needs to say yay or nay with it. It is a conversation, I think, that most individuals can have with their health care provider.

Healio: What is the maximum amount of aspartame that patients can consume before being at an increased risk for cancer?
Scott: There's so many different factors that come into it. If I have an individual who's drinking only diet soda and they're not drinking anything else, we're going to talk about compromising because they need some water. We’re going to talk about water intake, or maybe electrolytes or something depending on what they're doing. So, I look at how much they're doing and compromise.

If you look at the recommendation, you have to consume 40 mg/kg of body weight daily. So, if you take an average person who is about 150 pounds, that would mean they would have to consume 2,700 mg to come even remotely close to an increased risk. In each can of diet soda, there's about 200 mg. Most individuals who are diet soda drinkers come within 5% of the daily intake. Even that is a safety mechanism of where they're saying 40 mg/kg.

If patients are doing something very close to the maximum or are at that threshold, then it would be a conversation of saying, “Hey, why don’t we look at compromising?” Because if they’re drinking 13 diet sodas a day, they’re probably not drinking anything else.

Healio: What is the less risky option: diet or regular?

Scott: It’s such a gray area because there are so many different components that come into play here. If I have an individual with diabetes, I would rather them drink a diet soda than drink a full-fledged Coke because the amount of sugar that’s in it is going to spike their blood sugar.

For individuals who may not have any health concerns, it may be a conversation of what are the risks. If you have someone who is obese or overweight and who needs to get into a healthy weight management, a full-fledged soda may not be appropriate because of the number of calories that come into it.

At the end of the day, I'm going to give the person who I'm working with a lot of education so they can make a decision. But I will stress water above anything else.

Healio: What is a safe alternative to sugar?

Scott: Water is my number one for anybody who I’m working with. But if they are somebody who loves carbonation, carbonated waters are a great option, as well monk fruit if they want that sugar taste to it. Crystal lights are great. Sports drinks are great, too, for electrolyte purposes.

Water is probably my biggest thing, and one of the biggest things that most individuals don’t drink enough of. So, we start there and maybe we add something to it to flavor it.

There is a protein powder that just came out called SEEQ. It is a clear protein powder, and if patients are looking for a great alternative, you can add a little bit of that to your water and it adds flavor. There's no aspartame.

Reference:

• Aspartame hazard and risk assessment results released. www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released. Published July 14, 2023. Accessed Aug. 9, 2023.