Low/no calorie sweeteners do not affect heart rhythm

ISA statement in response to new observational study by Sun et al.

Brussels, 5^th March 2024: Robust evidence from randomised controlled trials and prospective cohort studies with rigorous analytical methods reaffirm that low/no calorie sweeteners have no adverse effect on heart health and may even offer some benefits for cardiometabolic health.^1,2 The recent observational study by Sun et al.³ may risk confusing consumers given observational research cannot establish a cause-and-effect relationship.

Additional information:

• Evidence from randomised controlled trials and of prospective cohort studies with rigorous analytical methods confirm no evidence of such adverse effects for low/no calorie sweetened beverages and actually shows some benefits for cardiometabolic health.^1,2
• The study by Sun et al did not examine nor provide any mechanistic evidence about how low/no calorie sweetened beverage consumption could be a cause of atrial fibrillation. Actually, risk factors of atrial fibrillation include obesity and type 2 diabetes, among others, and we know that people living with such conditions may use low/no calorie sweeteners as a risk reduction strategy in their effort to limit their sugars intake. In fact, participants with a higher body mass index and a higher prevalence of type 2 diabetes consumed more low/no calorie sweetened beverages in this study. In addition, the impact of residual confounding cannot be ruled out, as the study could not consider all potential confounders and known causes of atrial fibrillation. The results of this study could be a typical case of reverse causation which frequently affects observational research studying the health effects of low/no calorie sweeteners.
• It is also important to understand that these findings relied on participants recalling their own diets and beverage intakes, and only during the first years of the study, so changes of beverage consumption were not captured. However, it is well known that people change diets over time, and thus, the lack of repeated measures is an important limitation of this study.²
• Low/no calorie sweeteners are safe ingredients that play an important role in providing consumers choice with sweet-tasting options with low or no calories. As part of a balanced diet, low/no calorie sweeteners can be a useful tool to reduce sugar and calorie intake, as well as to manage blood glucose levels^4,5 and reduce the risk of dental caries.⁵

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