New research found that consuming regular soft drinks and sugary fruit beverages every day may increase the risk of liver cancer and death from chronic liver disease.
Recently, the World Health Organization (WHO) warned consumers that artificial sweeteners could harm a person's health. The organization also suggests that aspartame, a popular sugar substitute, may be carcinogenic to humans. What's more, studies indicate that some of these zero or low-calorie sweeteners may damage DNA or pose heart health risks.
However, 2022 research found associations between habitual consumption of beverages with sugar and a higher incidence of type 2 diabetes, cardiovascular diseases, and some types of cancer.
So, which drinks are better for one's health — sugar-sweetened or beverages containing artificial sweeteners?
Researchers look at sugar, artificial sweeteners, and liver health
In a new study published on August 8 in JAMA, scientists wanted to determine whether consuming sugar-sweetened beverages or artificially sweetened drinks could be linked to health conditions that impact the liver, namely liver cancer and chronic liver disease.
To conduct the study, researchers recruited 98,786 postmenopausal females aged 50 to 79 enrolled in the Women's Health Initiative from 1993 to 1998. The team assessed the participants' intake of sugary soft drinks and fruit drinks via a food frequency questionnaire. However, the scientists did not include fruit juice in the assessment.
The team assessed the participants' intake of artificially sweetened drinks at a 3-year follow-up.
During an average 20.9-year follow-up, the researchers looked at incidences of liver cancer and mortality due to chronic liver diseases, such as hepatitis, fatty liver disease, and cirrhosis.
Overall, 207 participants developed liver cancer during the follow-up period, and 148 died from chronic liver disease. The team found that women consuming one or more sugar-sweetened beverages daily had significantly higher rates of liver cancer and mortality from chronic liver disease than those who consumed three or fewer servings per month.
Specifically, the rate of liver cancer among females who drank one or more sugary soft drinks or fruit drinks per day was 18.0 per 100,000 person-years. In contrast, rates among those who consumed three or fewer sugar sweetened drinks per month were 10.3 per 100,000 person-years.
In addition, chronic liver disease mortality rates were 19.8 per 100,000 person-years in females who consumed one or more sugary soft drinks per day and 7.2 per 100,000 person-years in those who consumed three or fewer regular soft drinks per month.
However, fruit drinks were not significantly associated with death from chronic liver disease.
When they examined artificial sweeteners, the scientists discovered that participants who drank one or more artificially sweetened beverages per day did not have an increased incidence of liver cancer or chronic liver disease mortality compared to females who consumed three or fewer of these beverages per month.
The study authors note that this research was observational, so the results do not prove regular soft drinks and sugary fruit beverages cause liver problems. In addition, other factors that increase the risk of liver disease and cancer could have played a role in the findings.
Are artificial sweeteners safer than sugar?
In a recent FDA statement, the agency stated that aspartame is safe, contradicting the WHO's assessment that the compound may potentially cause cancer.
Some research does suggests that both sugar and artificial sweeteners may harm health. For example, a 2019 study published in Circulation, a journal of the American Heart Association, says long-term consumption of sugar-sweetened and artificially-sweetened drinks is associated with mortality — mainly caused by cardiovascular disease.
With so much conflicting evidence, it appears that scientists and health experts will continue to debate the health impacts of sugar vs. artificial sweeteners — leaving the public still wondering which sweetener is best.
For those looking to reduce their sugar and artificial sweetener consumption, there are several natural sugar alternatives that might be worth considering. These include monk fruit, stevia, erythritol, and others.
However, despite their natural origins, the jury is still out on whether some of these plant-based sugar alternatives — such as erythritol — have any adverse long-term health effects.
- British Journal of Sports Medicine. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction.
- Nature Reviews Endocrinology. The role of sugar-sweetened beverages in the global epidemics of obesity and chronic diseases.
- JAMA. Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Liver Cancer and Chronic Liver Disease Mortality.
- Circulation. Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults.