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Can Sugar Substitutes Increase Cancer Risk?

Sugar is considered fuel for cancer cells. Artificial sweeteners are also associated with an increased risk of cancer. What about the sweeteners that are considered healthy? Can sugar substitutes in the form of xylitol, erythritol, stevia, and yacon possibly also promote the development of cancer?

Sugar substitutes and cancer

If sugar and artificial sweeteners increase the risk of cancer, might not other sweeteners do the same? Many people replace sugar with xylitol, erythritol, or stevia (or mixtures thereof) in the hope that this will result in a healthier enjoyment of desserts or sweet drinks.

The influence of these sugar alternatives on the blood sugar level is most well researched. They do not allow this to rise at all or only slightly and this alone has a positive effect on health. But what about the risk of cancer?

Sugar and Cancer: A Myth?

Before we get to the possible cancer risk of alternative sweeteners, we would like to point out that conventional sugar is not officially considered a cancer risk. The German Cancer Research Center even says: “A balanced diet with all nutrients – including sugar and carbohydrates in general – is extremely important for cancer patients.”.

The statement that sugar promotes cancer is officially presented more as a myth:

  • At best, sugar can increase the risk of cancer because sugar (consumed in excess) promotes obesity – and obesity is considered a risk factor for cancer.
  • Sugar is not a carcinogenic substance.

Does sugar only increase the risk of cancer because it leads to obesity?

It is true that sugar increases the risk of cancer because it can lead to obesity. Because people who are overweight undoubtedly have a higher risk of developing cancer. 480,000 new cancer cases worldwide are said to be attributable to obesity every year.

Nevertheless, a study that was published in November 2020 in The American Journal of Clinical Nutrition states that sugar can play a role in the development of cancer – not only through obesity but also because it has an inflammatory and oxidative effect that causes stress. He does this regardless of weight gain.

In this study, the data of over 100,000 participants were evaluated. They were over 18 and had an average age of 40.8 years. The risk of cancer was 17 percent higher in those with the highest sugar intake. In the case of breast cancer, an even clearer connection was recognizable. Here, high sugar consumption increased the risk by 51 percent (as mentioned above: regardless of whether the person was overweight or not).

Is sugar a carcinogenic substance?

Of course, sugar is not necessarily a carcinogenic substance. Because sugar occurs naturally in many foods – and cells then use the blood sugar as fuel to generate energy. When that fuel comes from vegetables, whole grains, or moderate amounts of fruit, that’s not a problem with cancer in general either.

The problem, however, is the consumption of large amounts of household sugar (sucrose) and other types of industrial sugar (glucose-fructose syrup, glucose, etc.), which are contained in large quantities in numerous beverages, sweets, baked goods, and convenience products.

However, this important differentiation is made far too seldom – and anyone who reads at the Cancer Research Center that sugar is extremely important could see this as a free ticket for all kinds of sweetened drinks and sweets. Recent studies show, however, that this would not be a good idea.

Sugar increases the risk of cancer

In October 2021, a study with 7056 participants (average age 67 years) was published in the journal Clinical Nutrition. It showed that the risk of cancer increased by 8 percent for every 5 g of sugar (per day). If it was glucose, the risk of getting cancer increased by 19 percent, with fructose it was 14 percent. Fruit consumption did not affect cancer risk. As sugar consumption increased, not only did the risk of cancer increase, but also the risk of dying from cancer and dying from other diseases.

We also report elsewhere (please follow the links) how sugar increases the risk of lung cancer or how sugar promotes a recurrence of cancer that has been overcome.

Artificial sweeteners and cancer

Artificial sweeteners are similar to sugar. The data is inconsistent, as we explain here: Is aspartame harmless? Nevertheless, sweeteners are officially rated as unproblematic and also harmless in terms of cancer risk.

On the subject of aspartame, EFSA states: “The current Acceptable Daily Intake (ADI) of 40 mg/kg BW/day has been considered adequately protective for the general population, although consumer exposure is well below this level”.

In March 2022, however, a French epidemiological study by scientists e.g. the International Agency for Research on Cancer (WHO Cancer Research Centre). Based on more than 100,000 participants, high consumption of artificial sweeteners (aspartame, acesulfame-K, sucralose) increased the overall risk of cancer and a 22 percent increased risk of breast cancer (compared to people who did not consume any artificial sweeteners).

Daily consumption of more than 19 mg of sweetener in women and more than 17.4 mg in men was considered high consumption, which is well below the above-mentioned intake level considered safe by the authorities (40 mg/kg body weight and day). You can read more about this in our article Study: Sweeteners increase the risk of cancer.

Since the matter seems to be more than unclear, even the EFSA has been collecting new data on the safety of sweeteners since 2019 and wants to publish a reassessment at the end of the year (2022).

Healthy sugar substitutes and cancer What about the sweeteners that are considered healthy and that many people have long been using as sugar substitutes? How do the sugar substitutes xylitol and erythritol, how do the sweeteners from stevia, and how does yacon, the syrup from the South American root, affect the risk of cancer?

Xylitol and cancer

Xylitol is a sugar substitute (sugar alcohol) that has third fewer calories than sugar, but tastes just as sweet and can therefore be substituted 1:1 for sugar in recipes. Xylitol has two disadvantages:

  • If you eat too much xylitol (or at the beginning if you are not used to xylitol yet), the sugar substitute can lead to flatulence, stomachache, or diarrhea, which is why you should not exceed certain consumption levels. You can read more about this in our article Sugar substitutes: The healthiest sweeteners.
  • Xylitol is toxic to dogs, so never give any food sweetened with xylitol to dogs!

However, xylitol does not have a carcinogenic effect; on the contrary, the sugar substitute has a cancer-inhibiting effect. (Excursion: xylitol even has an inhibitory effect on viruses. Together with grapefruit seed extract and a salt solution, the sugar substitute in the form of a nasal spray was successfully used in patients with a mild course of Covid 19. Their condition improved quickly, and the time, until the PCR test was negative again, could be shortened.

Xylitol has an anti-cancer effect without damaging healthy cells

In 2017, while studying a cordyceps extract (Cordyceps militaris), Japanese scientists accidentally discovered that it also naturally contained a large amount of xylitol. Cordyceps is a well-known medicinal mushroom whose main active ingredient, cordycepin, has numerous health-related properties, e.g. B. relieves joint pain, strengthens the immune system, increases libido and potency, and also inhibits cancer growth.

The study mentioned showed that not only cordycepin was responsible for the anti-cancer effect of the fungus, but also xylitol contributed to the anti-cancer effect of the extract. In the cell experiment, the sugar substitute led to the death of skin cancer cells but did not harm healthy connective tissue cells.

The same research team published further results in 2020, namely on the specific anti-cancer mechanism of action of xylitol. It was shown that xylitol had a cancer-inhibiting effect not only in cell experiments but also in the organism (mouse). However, the substance was injected to do so. Xylitol was even able to sensitize the cancer cells, which means that they could now be switched off more easily by cancer drugs.

Xylitol instead of sugar prolongs the lifespan of cancer patients

In May 2022, Nutrients stated that accelerated sugar metabolism can be observed in many types of cancer so the search for healthy alternatives that do not fuel the cancer is an important approach in cancer research.

When a part of the glucose content in the feed of mice with tongue cancer was exchanged for xylitol, the tumor size decreased or tumor growth was inhibited and the animals in the xylitol group lived for 30.5 days, while the control group, which had not received any xylitol, lived longer died 19 days ago. Numerous cancer markers improved under the influence of xylitol.

What amount of xylitol is the right one?

The amount of xylitol administered to mice would be equivalent to 10 g per day in humans. Further studies are now planned to possibly develop products containing xylitol for cancer patients.

Only very large amounts of xylitol, when the animals’ feed consisted of 10 to 20 percent xylitol, had a carcinogenic effect in mice – according to a study from 1977. But even then, a smaller dose of 2 percent no longer showed any harmful effects.

If you wanted to include 10 percent xylitol in your diet, you (as a woman) would have to have an energy requirement of e.g. B. 1900 kcal eat 80 g xylitol daily, and 20 percent would be 160 g. With an energy requirement of e.g. For example, 2400 kcal, eat 100 to 200 g of xylitol daily — which is unrealistically high amounts, namely 8 to 20 times the anti-cancer dose.

Erythritol and cancer

Like xylitol, erythritol also belongs to the sugar substitutes and thus to the sugar alcohols. In contrast to xylitol, erythritol is almost calorie-free but has a lower sweetening power than that of sugar (only 75 percent of the sweetening power of sugar).

Erythritol is mostly excreted unchanged in the urine. A small portion is converted to short-chain fatty acids in the gut (which promotes gut health) or excreted in the stool.

Erythritol is not carcinogenic, even in large quantities

On the subject of erythritol and cancer, there is an older rat study from the 1990s that did not show any cancerous changes caused by erythritol – not even at high consumption levels of up to 10 percent erythritol in the total diet, which was between 4.6 and 5.4 g per kilogram of body weight and fed for more than 100 weeks.

Even these completely unrealistically high doses showed no effect on the risk of death in the animals and did not change the blood values. All that was observed was increased mineral levels in the urine and calcium deposits in the kidneys – but only when the mentioned high amounts were fed, not at lower amounts of erythritol.

Erythritol does not cause mutations

If mutations and chromosomal damage (DNA damage) accumulate, this development can lead to cell degeneration and thus to cancer, according to the current assumption about the development of cancer. In 2013 cell and mouse studies, erythritol was shown to be non-mutagenic (i.e., does not cause mutations) and does not cause chromosomal damage.

Erythritol has an antioxidant effect

Since oxidative stress can contribute to cancer development and erythritol has antioxidant properties, the sugar substitute could even have anti-cancer effects via this mechanism.

We are currently not aware of any other studies on this subject. Epidemiological studies will certainly also be carried out and published in the future, which we will then supplement here.

Yacon and Cancer

A sweet syrup can be made from the Yacon root (Yacon for short), which has an unusual composition compared to other syrups. It consists of 30 to 50 percent of so-called FOS (fructooligosaccharides). These are sweet-tasting dietary fibers that have a prebiotic effect, i.e. they serve as food for the intestinal flora and thus improve intestinal health.

Yacon reduces cancer risk via improved gut health

Because when the bacteria in the intestinal flora metabolize the FOS, so-called short-chain fatty acids are formed (which we have already mentioned above with erythritol). In animal studies, these improve the performance of the immune system in the intestine, optimize the colon pH value and inhibit inflammatory processes in the intestine. All of these properties reduce the risk of colon cancer as well as breast cancer, according to a study published in Nutrients in November 2019.

Yacon supports weight loss – and thus reduces the risk of cancer

Since yacon syrup can also help you lose weight, it also reduces the risk of cancer in this way (remember, obesity increases the risk of cancer). In one study, overweight women were given 0.14 g of yacon syrup per kilogram of body weight daily for 120 days. Her belly fat percentage decreased and her LDL cholesterol levels dropped as well.

At the same time, FOS can lower fasting insulin levels, which also has a protective effect, since chronically elevated insulin levels promote the development of cancer—at least in the colon and uterus.

Concrete studies in which the cancer risk of regular consumption of yacon syrup would have been examined are not yet available. However, the above information suggests that the syrup is unlikely to promote cancer development, although it does have a protective effect.

Stevia and Cancer

Stevia is a sweet-tasting plant native to South America that is used to make artificial sweeteners. To do this, sweet substances (steviol glycosides) are extracted from the plant. They are up to 450 times sweeter than table sugar.

So the plant is not dried and pulverized. There is such a powder. However, since it is not very practical (does not dissolve, turns green, and is actually only suitable for tea), the isolated steviol glycosides are mainly available commercially as a white powder or in tab form.

Various studies and analyzes have shown that stevia has no carcinogenic potential, which e.g. B. can be read in a paper from April 2021 in Food and Chemical Toxicology.

In the meantime, stevia has even shown a protective effect against cancer in numerous studies. For example, a comprehensive study from February 2022 states that precisely because of the cancer-promoting effect of sugar, one of the most important rules of a cancer-inhibiting diet is the reduction of sugar consumption, which is why stevia could be integrated into the diet as a sugar alternative – from the following reasons:

  • Stevia is calorie-free, so it does not contribute to obesity and thus reduces the risk of cancer associated with obesity.
  • Stevia does not allow blood sugar and insulin levels to rise, has anti-inflammatory and antioxidant effects, and thus reduces the risk of cancer associated with increased insulin levels, oxidative stress, and chronic inflammatory processes.
  • In cell experiments, stevia has a strong inhibitory effect on cancer cell growth. Some researchers even report a strong cytotoxic effect that is comparable to that of conventional cancer drugs. In contrast to these, stevia is less toxic to healthy cells.

Nevertheless, further studies are of course necessary, in particular, to find out the specific stevia dose for a cancer-protective effect. In any case, stevia is more than just a sweetener, namely more of a food additive with numerous health benefits, and can – combined with conventional cancer therapies – contribute to the prevention and treatment of cancer as part of a plant-based diet.

Conclusion: sugar alternatives do not increase the risk of cancer

In summary, it can be said that the four sugar alternatives presented do not increase the risk of cancer and can therefore be used very well instead of sugar. However, keep in mind that it is often not just the sugar that makes a dish or product unhealthy. Most of the other ingredients are not particularly healthy either, e.g. B. in baked goods, sweets, convenience products, etc., so that if you want to eat healthily and change your diet, you will discover that you no longer need a sugar substitute as often.

Feel free to take a look around our ZDG cooking studio, where you will now find over 2000 delicious, healthy, wholesome, and vital substance-rich, purely plant-based recipes from all categories and from all over the world. You can also look over the shoulder of our professional chefs during the preparation on our YouTube cooking channel. Here e.g. B. when baking healthy cakes and tarts, which are of course free of table sugar. Enjoy your meal!

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Written by Kelly Turner

I am a chef and a food fanatic. I have been working in the Culinary Industry for the past five years and have published pieces of web content in the form of blog posts and recipes. I have experience with cooking food for all types of diets. Through my experiences, I have learned how to create, develop, and format recipes in a way that is easy to follow.

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