By Karen Kier
Pharmacist on behalf of the ONU HealthWise team

"How sweet it is" was a signature phrase of comedian and actor Jackie Gleason.  Born in Brooklyn, John Herbert Gleason became a success in several well-known shows such as The Honeymooners and The Jackie Gleason Show. His biography written by James Bacon was published in 1986. Jackie Gleason starred in several movies later in his life including The Hustler with Paul Newman and Smokey and Bandit with Burt Reynolds.

The Gleason signature phrase was the inspiration for the song How Sweet It Is (To be Loved by You) sung by Marvin Gaye. This American soul singer recorded and released the song on his fifth studio album in 1965. The song peaked at number six on the Billboard charts. James Taylor released a version of this song on his 1975 album titled Gorilla. His easy listening version hit number one on the charts.

How sweet it is explains why artificial sweeteners are popular for reducing calories in many foods and beverages. Artificial sweeteners can be 200 to 20,000 times sweeter than regular table sugar (sucrose) with little to no added calories.

The history of the development of artificial sweeteners is quite interesting. The first artificial sweetener was discovered in 1878 known today as saccharin and was used as a substitute during World War I due to the shortage of sugar.  

The artificial sweetener cyclamate was discovered by an accidental contamination in 1937 in a research laboratory at the University of Illinois.  The DuPont company obtained the patent in 1940 with the product becoming commercially available in 1950. The first pink packets (Sweet‘N Low) contained cyclamates as did popular sodas such as Diet Rite and Tab, which combined saccharin with cyclamates.

In 1969, cyclamates were banned for food consumption by the FDA due to animal studies showing an increase risk of cancer.  Later studies demonstrated a lack of cancer occurring directly from cyclamates, but the sweetener may increase the cancer risk of other substances when they are combined.  Cyclamates were replaced in the United States by saccharin.  

Saccharin was banned in 1981 because of rat studies published in 1978 indicating an increased risk of bladder cancer. The rats were provided a large dose of saccharin equivalent to about 800 twelve-ounce cans of saccharin-containing soda or pop. Ultimately, the ban was overturned and saccharin is still available in over 100 countries. 

Aspartame was discovered in 1967 and approved by the FDA in 1981 as a table sweetener and in 1983 for use in carbonated beverages. The US market has over 5,000 food and beverage products containing aspartame as the sweetener.  In addition to food, over 21 medications contain aspartame to improve the taste of the drug.

The medications containing aspartame include both prescription and nonprescription drugs.  The aspartame is used in both chewable tablets as well as tablets that disintegrate and dissolve in the mouth to overcome the bitter taste of the drug.  Reading package labeling or asking your pharmacist is important if you want to know if the inactive aspartame ingredient is in a medication.

Knowledge of aspartame is important for individuals who have a trait for phenylketonuria (PKU).  Their bodies are unable to break down the aspartame to the amino acid phenylalanine, which the body can eliminate.  In the United States, babies are tested for PKU at birth to reduce the risk of exposure to aspartame, which will accumulate in the body if not broken down.

On July 13, 2023, the World Health Organization’s (WHO) International Research Agency on Cancer (IARC) announced they were placing aspartame as a possible agent causing cancer (carcinogen). The decision was based on limited evidence from 3 published studies. 

A 2014 study in the European Journal of Nutrition indicated a potential increased risk of liver cancer when they evaluated 477,206 people over 11 years who consumed aspartame beverages.  A 2022 study published in Cancer Epidemiology found a slightly higher risk of liver cancer in those who consumed aspartame and had diabetes.  A 2022 French study in PLOS Medicine linked aspartame to breast cancer in women.  All of these studies were observational and had the potential for limitations.

The IARC does not set dietary regulations on exposure amounts of additives such as aspartame.  The WHO Expert Committee on Food Additives is responsible for this threshold.  Based on the limited data from the studies, the Committee did not change the recommendation of 40mg/kg/day of aspartate, which is equivalent to about 14 cans of diet soda a day.  The FDA limit is set at 50mg/kg/day and was not changed with the WHO announcement.  A kilogram is equivalent to 2.2 pounds in the United States.

Agencies and scientists are suggesting additional research needs to be done before pulling aspartame from food and beverage products and changing how sweet it is!

Please consult your healthcare professional for more information about aspartame or medications containing aspartame. 

ONU HealthWise is offering bivalent mRNA COVID-19 vaccines Monday through Friday from 10:00 a.m. to 5:00 p.m. Please call the pharmacy for more information. 

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