Drinking artificially-sweetened beverages instead of sugar-sweetened beverages is linked to improved colon cancer outcomes

Zina McSweeney

The consumption of sugar-sweetened beverages is associated with worse colon cancer outcomes, according to research published by Brendon Guercio et al. on July 19th, 2018. Among 1,018 patients with stage III colon cancer, researchers found that replacing one 12-ounce sugar-sweetened beverage (SSB) with an artificially-sweetened beverage (ASB) was estimated to lead to a 23% reduction in risk of cancer recurrence or death.

Prior studies have noted an association between various lifestyle factors and colon cancer, such as: a sedentary lifestyle, diets including red and processed meats, diabetes, consumption of alcohol, and consumption of SSBs. In the study by Guercio, the group sought to hone in on the impact of SSBs on outcomes for patients with stage III colon cancer. There is an ever-growing base of evidence to support links between SSB consumption and diabetes, obesity, cardio-metabolic disease, and various cancers. The World Health Organization (WHO) has recommended that countries implement a value-added tax of at least 20% on the sale of SSBs as a measure to discourage their consumption. This strategy has been tested with considerable success in several cities across the United States, as well as in Mexico, Portugal, France, Spain, and numerous other jurisdictions across the world, with reductions in SSB demand ranging from 10 to 50% in response to SSB taxes.

Given the significant evidence supporting the negative health outcomes associated with SSB consumption, measuring the effect of replacing SSBs with ASBs was a logical decision. At the beginning of the study, the research group made careful measurements of the levels of ASB consumption among study participants via questionnaires. Dietary exposures over the course of study enrollment were updated, and weighted averages were used to sort study participants into various tiers of ASB consumption. They found that patients who were drinking ASB daily (on average) were less likely to have negative cancer outcomes. This effect was hypothesized to be due to replacing consumption of SSBs with ASBs.

It is important to point out that every patient in the study received the usual standard of care: surgical resection along with chemotherapy. The results from this study do not suggest that drinking ASBs can help treat colon cancer. Rather, the results likely suggest that drinking fewer SSBs can improve outcomes, yielding less tumor recurrence and lower chances of mortality.

This was an observational study, which means that this evidence is insufficient to suggest a causal role of SSBs or ASBs in colon cancer aggression. These findings would have to be confirmed in a separate clinical trial in which patients are randomly assigned to drink specific amounts of ASBs and SSBs, instead of simply monitoring their natural preferences. A randomized trial design would help eliminate the chances that results are confounded by hidden correlations.

The sweeteners used in ASBs can include aspartame (180x sweeter than sugar), saccharin (300x sweeter than sugar), or sucralose (600x sweeter than sugar), among others. Despite popular myths, there is no convincing evidence for a link to suggest that ASBs cause cancer or cardiovascular disease, however, there is convincing evidence linking sugary beverages to cardiovascular disease. Despite population-scale evidence for the safety of artificial sweeteners, ~64% of survey respondents reported that they were concerned about the safety of artificial sweeteners.

This Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Zina McSweeney is a 4th-year medical student who is passionate about pediatrics and patient-family education. She is interested in the application of research in economics and behavioral sciences to address the obesity epidemic.

Work Discussed:

Guercio, B. J., Zhang, S., Niedzwiecki, D., Li, Y., Babic, A., Morales-Oyarvide, V., . . . Fuchs, C. S. (2018). Associations of artificially sweetened beverage intake with disease recurrence and mortality in stage III colon cancer: Results from CALGB 89803 (Alliance). PLoS One, 13(7), e0199244. doi: 10.1371/journal.pone.0199244

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