While vaccines may be the number one health topic on the internet that gets people arguing, artificial (or non-nutritive) sweeteners seem like a close second.
I got an angry email the other day regarding my recommendation in my book The Fat Loss Prescription to drink diet sodas instead of regular sodas (if you have to choose) for weight loss. Here is the screenshot:
The email exchanges went a bit further, ultimately telling me I needed to do my research, which meant reading blog articles written by fringe internet doctors.
The fact is I actually DID do my research and continue to stay up to date on the topic since it is one that comes up all of the time in the clinic. In fact, my brother, an endocrinologist and fellow obesity specialist, and I wrote an article together and published it on the well respected medical site Medpage Today (Click here to read).
The gist is that replacing sugar with non-nutritive or artificial sweeteners will likely help you to lose weight. In fact, there is some suggestion that replacing the sugar with these sweeteners may do better than replacing the sugary beverages with WATER.
Now before you get angry with me like the lady in that email above, I never suggest people actually choose diet drinks over water if they prefer water. However, if someone just doesn’t like water and they don’t mind drinking diet sodas (or other artificially sweetened beverages) instead of their sugar-sweetened beverages, the diet drink is the better choice.
We can now conclude that people actually LOSE weight when switching from regular sodas to diet sodas.
But what about those media headlines about diet soda being bad?!
There are many observational studies showing ill-effects in those who drink diet sodas. These observational studies (as opposed to interventional or experimental) look at groups of people who drink diet sodas vs. those who don’t drink them. These types of studies cannot prove causation (for the most part), but give us clues on possible effects (and associations) of certain exposures.
For example, there are observational studies showing those who drink more diet soda have more incidence of metabolic syndrome and vascular disease. This means that for some reason, those who drink diet sodas tend to also have these ill effects compared to those who do NOT drink diet sodas. Many think this is the Big Mac and large fries effect where you order the high-calorie food then go ahead and choose the diet drink. It wasn’t the diet drink that caused the weight gain and weight-related issues.
However, as discussed above, when we actually do experiments with people drinking diet sodas (and these sweeteners in general), these ill effects are not apparent.
Shut up and tell me what to do!
1. I always say that if you have to choose between diet and regular soda, always choose the diet.
2. From what we can tell in interventional trials, artificial sweeteners (and diet sodas) are safe.
3. There is a slew of epidemiological studies showing possible hazards as pointed out.
4. There is actual biological plausibility to sugar-sweetened beverages causing hazards eg endothelial function, increased apoB/cholesterol, increased blood pressure, and weight gain etc. The biological plausibility for artificial sweeteners is not there. At least from what we can tell right now.
5. It’s impossible to control for all of the confounders like weight, smoking, etc. (although they try) regarding diet drinks. Also, the food frequency questionnaires (where the researchers try to get the study participants to recall what they eat and drink) that these studies use aren’t the most reliable. Having said that, it is possible there is some sort of effect over the long haul that is causing the hazards discussed.
6. If worried, just drink water.
At the end of the day, if you’re scared to use these non-nutritive or artificial sweeteners because they seem scary, just stick to water (or unsweetened coffee/tea). If you don’t have weight issues and you like your fresh juice, you can do that too. Hell, if you’re not worried about weight then drink some wine (or a Bloody Mary – my favorite) for all I care.
Just don’t go telling people that artificial sweeteners are the devil. I will continue to have my diet sodas as a treat once in a while and I will tell my patients to do the same if they want (instead of regular) 🙂