This document discusses educating the public about potential health risks of artificial sweeteners. It provides examples of common artificial sweeteners like aspartame, sucralose, and saccharin. While artificial sweeteners are popular as low-calorie sugar substitutes, some studies have linked them to health issues like migraines, cancer, and neurological effects. The approval and continued use of artificial sweeteners is controversial given potential issues found in animal studies. Educating patients about healthier alternatives and full risks could motivate some to reduce artificial sweetener consumption.

1. EDUCATING THE PUBLIC ABOUT POTENTIAL SIDE
EFFECTS OF ARTIFICIAL SWEETENERS
Deborah Hong
10/16/2014

2. What are some artificial sweeteners
that we know?
• Aspartame (better known as Equal and NutraSweet)
• Sucralose (better known as Splenda)
• Saccharin (better known as Sweet N’ Low)
• Acetasulfame K (better known as Sweet One)
• These chemicals aren’t just in those packets at the
coffee shop counter! They’re in more than 6,000
products, including foods, medications, and even
cosmetics! Without the proper education and
motivation, it is very challenging to remove these
products from our diet.

3. Why are artificial
sweeteners so popular?
• To aid in battling obesity, many individuals use low-calorie
artificial sweeteners as a substitute for high-calorie
foods.
• Artificial sweeteners make the promise of providing
as much sweetness of sugar without the unwanted
calories.
• “86% of Americans use low-calorie, reduced-sugar or
sugar-free foods and beverages” (Whitehouse, 253).

4. Case 1
14 year old boy complaining of severe
migraines associated with photophobia
(sensitivity to light) at least twice
monthly
Case 2
36 year old woman suffered from
migraines along with nausea, vomiting
photophobia, and osmophobia (severe
aversion to smells) at least twice
monthly

5. • By process of elimination of foods from their
diets, both these patients’ migraines were found
to be triggered by aspartame-containing foods
“usually within 2 hours following ingestion”
(Newman, 899).
• Both these patients were provided with oral
rizatriptan pills and wafers to treat their
migraines. After taking the rizatriptan pills, the
patients’ migraines resolved within 45 minutes.
However, both these patients complained that
after they took the rizatriptan wafers, their
migraines steadily worsened, lasting up to 6
hours.
• So what gives? How could the same exact
medication produce such different results
depending on what form it was given in?

6. • A review of the two rizatriptan formulations revealed
that the wafer formula contains 3.75 mg of aspartame!!
• In 1981, the United States Centers for Disease Control
reviewed consumer complaints related to the use of
aspartame. 67% of those filed complaints concerned
neurologic and behavioral symptoms. “The most frequently
mentioned single complaint, headache, was reported in
22%” (Newman, 900).

7. What have studies shown about
artificial sweeteners?
• In rats “exposed to diets containing 5 or 7.5
% saccharin from the time of conception to
death, an increased frequency of urinary
bladder cancer was found” (Whitehouse,
3).
Sacharrin
(Sweet N’ Low)
• “Toxicology studies of sucralose show little
effect, the most significant finding being
shrunken thymus glands with diets of
sucralose” (Whitehouse, 4)
Sucralose
(Splenda)
• Research on fetal rats demonstrated a
significant increase of malignant tumors, an
increase in the incidence of lymphomas and
leukemias in males and females
Aspartame
(Equal and
Nutrasweet)

8. So why are artificial sweeteners still
on the market??
• Biologically, following ingestion, saccharin is not absorbed or
metabolized. It is excreted, unchanged, via the kidneys. Since saccharin is
not metabolized, the FDA considers this compound safe.
• All of the FDA’s approval of acesulfame K were grounded on
the conclusion that safety studies carried out in the Netherlands in the
1970s, were adequate and the test results indicated safety.
• However these tests carried out in rats are inadequate to establish lack of
potential carcinogenicity, because “subchronic tests were not conducted
for the rats and mice used in the tests” (Karstadt, 1).
• Mice were held on test for only 80 weeks, rather than the 104 weeks
characteristic of National Toxicology Program (NTP) bioassay.

9. And now, a little history lesson!
• January 1981-- Donald Rumsfeld, CEO of Searle (the company that owns the patent to aspartame),
states in a sales meeting that “he will use his political pull in Washington, rather than scientific
means, to make sure it gets approved” (Murray, 1).
• January 21, 1981– Donald Rumsfeld is part of Reagan's transition team when he is elected president.
Dr. Arthur Hull Hayes Jr. is selected to become the new FDA Commissioner.
• May 1981-- An FDA commissioner's panel is established to review issues raised by the Public Board
of Inquiry. “Three of six in-house FDA scientists, Dr. Robert Condon, Dr. Satya Dubey, and Dr. Douglas
Park, advise against approval of NutraSweet, stating on the record that the Searle tests are
unreliable and not adequate to determine the safety of aspartame” (Murray, 1).
• July 15, 1981– Dr. Arthur Hayes Jr., the new FDA commissioner, overrules the Public Board of Inquiry
and approves NutraSweet for dry products.
• July 8, 1983-- The National Soft Drink Association says that Searle has not provided responsible
certainty that aspartame and its' degradation products are safe for use in soft drinks.
• September, 1983-- FDA Commissioner Hayes resigns. Burson-Marsteller, Searle's public relation firm
immediately hires Hayes as senior scientific consultant.
• Fall 1983-- The first carbonated beverages containing aspartame are sold for public consumption.

10. WHAT CAN WE DO TO EDUCATE PATIENTS ABOUT
ARTIFICIAL SWEETENERS?

11. Knowledge is power!
• We can teach patients about healthier substitutes for artificial sweeteners such as honey, maple syrup,
agave, sliced fruit, and date sugar.
• You know that saying that “If it’s too good to be true, it probably is”? The same goes for artificial
sweeteners. We should always advocate that when it comes to diet, natural is always better than artificial.
Yes, real sugar has more carbs but in the long run, it is always better than artificial sweeteners. Health is
about balance, so make up for sugar intake with consistent physical exercise! You are also less prone to get
sugar cravings if you consume adequate protein and fiber throughout the day.
• We need to remember that all of our patients are adults and reserve the right to eat what they want.
However when provided with complete education about the risks of artificial sweeteners and healthier
alternatives, several patients will be motivated to make the lifestyle change.

12. QUESTIONS?

13. REFERENCES
HANCOCK, M. (2004). SWEET, WHITE AND DEADLY. CANADIAN JOURNAL OF HEALTH & NUTRITION. 44-48.
KARSTADT, M. (2006). TESTING NEEDED FOR ACESULFAME POTASSIUM, AN ARTIFICIAL SWEETENER.
ENVIRONMENTAL HEALTH PERSPECTIVES. 114 (9), 516.
NEWMAN, L.C & LIPTON, R.B. (2001). MIGRAINE MLT-DOWN: AN UNUSUAL PRESENTATION OF MIGRAINE IN
PATIENTSWITH ASPARTAME-TRIGGERED HEADACHES. THE JOURNAL OF HEAD & FACE PAIN. 41. 899-901.
SCHERNHAMMER, E.S., BERTRAND, K.A., BIRMANN, B.M., SAMPSON, L., WILLETT, W.C., &
FESKANICH, D. (2012). CONSUMPTION OF ARTIFICIAL SWEETENER– AND SUGAR-CONTAINING
SODA AND RISK OF LYMPHOMA AND LEUKEMIA IN MEN AND WOMEN. THE AMERICAN JOURNAL OF CLINICAL
NUTRITION, 96 (6), 1419-1428. HTTP://DRAWEB.NJCU.EDU:2371/CONTENT/96/6/1419.FULL
WHITEHOUSE, C.R., BOULLATA, J., & MCCAULEY, L.A. (2008). THE POTENTIAL TOXICITY OF ARTIFICIAL
SWEETENERS. AAOHN JOURNAL. 56 (6), 251-261.