27 August,2023 06:54 AM IST | Mumbai | Arpika Bhosale
Not just your favourite diet carbonated cold-drink, but even your toothpaste, cough drops and chewing gum have aspartame, that the World Health Organisations says might “possibly” be carcinogenic. Illustration/Uday Mohite
At 14, Afreen El-Siddique could polish off a one-litre tub of her favourite ice cream in one sitting. She also would be one of the first to try out the newest chips available at the local kirana store and had a steady supply of refined sugar in the form of carbonated drinks and sugar-rush inducing pastries that we know all too well.
By the time she was 16, El-Siddique, one of the many Indian teens who are the target audience of the packaged food industry, weighed 100 kg. Today, at 26, El-Siddique practices mindful eating and admits that her relationship with food was toxic - she didn't know any better. The Sanpada resident has now cut out refined sugar in all forms.
"I believe in a moderate diet and have first-hand experience of the follies of an unbalanced diet, including a high protein diet recommended by trainers when I began to gym in my first year of college," says El-Siddique, who now practices business law. It has taken a decade of work, but her body is now free of packaged food. "I am not as militant as some other people are when it comes to diet, but yes, by and large, processed and packaged food and artificial sweeteners are out of my life for good," she tells us over the phone.
The artificial sweeteners part, in particular, has been a subject of intense debate lately, with latest research connecting aspartame, a widely used sugar substitute, to possible cancer. The once hot favourite ingredient is often found in anything that wants to mimic sweetness without the calorie bomb, but is now dangerous because, according to latest research, it could possibly be carcinogenic.
The revelation was made in a joint report released on July 14 by the World Health Organisation (WHO), along with the International Agency for Research on Cancer (IARC) and the Food and Agriculture Organisation's (FAO) Joint Expert Committee on Food Additives (JECFA) about the possible links of aspartame with cancer. In the report, titled Aspartame Hazard And Risk Assessment, IARC classified aspartame as possibly carcinogenic to humans on the basis of limited evidence for cancer in humans, specifically, for hepatocellular carcinoma, which is a type of liver cancer. There was also limited evidence for cancer in experimental animals.
The IARC, though, has made sure to use the term "possibly", while JECFA, in the same report has stated that, there is "no sufficient reason", adding that a person weighing 70 kg would need to consume more than nine to 14 cans of diet soft drink per day to exceed the acceptable daily intake, given that there are no other sources of food providing the chemical as well.
"The findings of limited evidence of carcinogenicity in humans and animals, and of limited mechanistic evidence on how carcinogenicity may occur, underscore the need for more research to refine our understanding on whether consumption of aspartame poses a carcinogenic hazard," observes Dr Mary Schubauer-Berigan of the IARC Monographs programme.
But this ambiguity, says Professor Shailesh V Shrikhande, deputy director of Tata Memorial Hospital and the Head of Division of Cancer Surgery, is what has caused a wave of confusion and panic among the general public.
"The current evidence is weak, so we definitely need further studies to be absolutely certain that there is a link between aspartame and cancer." Ask him why this link is difficult to establish and Shrikhande tries to simplify it.
"One of the reasons it is difficult to conduct a study for the chemical is that even if we study two groups of people each, with the first group having those who consume aspartame, there are other factors beyond our control. This includes other substance like tobacco and liquor that are known to be carcinogenic and other confounding factors that would make it hard to lay the blame definitively. Also, how do we know that the other study group that does not consume aspartame, is
actually not doing so, because it is present in a lot of products and will be impossible for scientists to monitor. Furthermore, a detailed long term follow up would be essential to reach definitive conclusions."
And then, he adds, there is also the ethical conundrum that has hindered research since the 1980s.
"Knowingly exposing humans to a chemical without knowing just how harmful it is or isn't poses an ethical conundrum, which is why studies have only been conducted on people who already have cancer, deep diving into their lifestyle and eating habit," Shrikhande says.
Earlier this week, this writer was part of a heated discussion in the newsroom, where those who earlier slept easy knowing they had replaced cola with diet cola were now wondering if anything is safe at all.
The answer, unfortunately for them, was, not really. Not according to the research in question, at least. The joint report also lists out other products that use aspartame, and these include chewing gum, gelatin, ice cream (that one didn't go down well in the newsroom), yogurt, breakfast cereal, cough drops, chewable vitamins and even toothpaste.
The scepticism, however, is still strong. Dr Salil Patkar, medical oncologist, Fortis Hiranandani Hospital, Vashi concurs with Dr Shrikhande that the evidence is not strong enough, because studies around aspartame consumption were conducted with mice being fed the chemical continuously, with a gradual increase. The key to unlocking the riddle, he says, is the dosage, and this has been confounding researchers for ages.
"You might have to consume more than 100 cans of diet soft drink per day, as compared to those consuming other harmful substances like refined sugar or nicotine for it to be actually considered harmful. People are hyper-focusing on the chemical, even though factors like obesity, smoking, alcohol consumption and even too much stress or too little sleep are found to have a direct connection with cancer," he says.
But, well, toothpaste? we ask, more than a little panicky.
"I think spreading this kind of panic, that using toothpaste will give you cancer, is quite unnecessary. One can be eating entire tubes every day and yet not reach the unsafe mark, where it might cause some harm. And we are still not sure if the harm is cancer. Instead, I would advise people to kick other habits that we know are directly linked with cancer. We are seeing that people find this harder, as it involves sugar, alcohol and tobacco."
Besides, as Pune-based nutritionist Amita Gadre says, that any packaged food that might not necessarily be a sweet might still have aspartame.
"Pretty much any ultra-processed food these days has some form of a sweetener. With food labelling standards growing stricter, and because of more awareness, people are checking the quantity of added sugar in the products they buy. But at the same time, manufacturers want you to buy their products and not be scared of it. Hence, if you, as a consumer, would be wary of a product that says it has sugar, you would not think twice if it says it contains aspartame," says Gadre.
Although sugar has not been directly found to be carcinogenic, its contribution to building insulin resistance and the culminating effects resulting in liver cancers have been well documented.
"This is why doctors often ask cancer patients to cut out refined sugar completely," he says.
With regard to why a detailed clinical trial for aspartame has not taken place yet, Patkar feels it's about the money. "The challenges of such studies are always more about the economics than anything else. If you look back at the research that proved that cigarette smoking can be cancerous - this was known more than 40 years ago. The tobacco industry would suppress evidence and studies by buying off scientist and doctors who conducted this survey, and if they wouldn't take these bribes they would then ruin their careers. The tobacco industry then came out with their research and they hid that research from the public as well. The reason behind this gap in empirical data is that today the biggest multinational companies use aspartame and this been a problem for us to firstly see in what products the chemical is used and finally, what is it doing to us in the long run. Because if conducted properly, these studies will require a decade of monitoring of the participants and the long-term effects of it."
What we must concentrate on, says Dr Sewanti Limaye, director of medical and precision oncology at Sir HN Reliance Foundation Hospital, is that the fact that the link between weight and cancer has long been established.
"Losing five per cent of body weight has also shown to be connected to being at less risk of getting cancer. We still need to work to get hard evidence on aspartame, but what we should surely do is to shun processed foods. Also, eat less than your hunger. This basically means one should eat 20 per cent less than how hungry they feel, if they are of normal weight," says Dr Limaye.
And even if your diet is largely comprised of home-made food, that, alone, is not enough to put your worries to rest. Shivam, for instance, is an emotional intelligence coach from Chandigarh, with a family history of heart attacks. A routine check-up a couple of years ago brought forth an interesting revelation for him.
"As I suspected, my cholesterol was high. I realised that even though I was largely eating home made food, I had favourites like malai chaap, which has soya but also a lot of sugar. I have managed to reduce my cholesterol levels by a fair bit, but the fact remains that what we call normal Indian food is equally risky," he says.
So what next, you wonder? Well, Big Brother is watching. Or more specifically, IARC and WHO are. The organisations will continue to monitor new evidence and encourage independent research groups to develop further studies on the potential association between aspartame exposure and consumer health effects.
Until then, practise moderation, say experts.
To quote the German-Swiss physician Paracelesus, "all things are poisons, for there is nothing without poisonous qualities. It is only the dose which makes a thing poison."
Aspartame, which is a sweetener, is made of two amino acids - phenylalanine and aspartic acid. It is synthetically manufactured; it is not a naturally-occurring sugar, unlike stevioside, a natural sweetener. It's made in a lab and has a very sweet taste, but zero calories. That was the reason, essentially, why aspartame became popular among diabetes patients, as a table sweetener, because it does not break down into sugars in the body.
