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In pursuit of better health, many people have been led by marketing and media to make the switch from sugar to artificial sweeteners. But, though eliminating sugar is undoubtedly a good health move, it is not so clear that replacing it with artificial sweeteners is. A large new Canadian study has uncovered the genuinely sour side to artificial sweeteners.
This large systematic review and meta-analysis put together the data from 30 studies that followed 405,907 people with 7 controlled studies of 1,003 people. The results were not good. In the controlled studies, artificial sweeteners did not have any significant benefit for body mass index. In the 30 studies that followed people for an average of 10 years, artificial sweeteners actually led to an increase in body mass index. That is, food and drinks marketed for weight loss led to greater weight gain.
And while the controlled studies found no effect on other health measures--positive or negative--the studies that followed people found that artificial sweeteners are associated with increases in weight, waist circumference, obesity and--get this--high blood pressure, cardiovascular events, metabolic syndrome and type 2 diabetes.
This study provides evidence that artificial sweeteners do not provide their intended benefits, according to controlled studies, and, worse, that, according to studies that follow people long term, they may actually increase the risk of obesity, cardiovascular disease and diabetes (CMAJ 2017;189(28):E929-39).
This research may also explain the disturbing conclusion of a number of studies that people who switch to artificially sweetened diet soft drinks with the best of health intentions may be being misled: they are actually increasing their risk of weight gain and glucose intolerance and receive no benefit over regular soft drinks for heart disease, kidney disease or osteoporosis.
Diet Soft Drinks & Dieting
Presumably, the entire rationale for creating diet soft drinks is that they are better for weight loss than are regular soft drinks; hence, the name. But the research seems to discredit this rationale and remove the justification for marketing diet soft drinks.
Researchers followed 749 people over the age of 65 for 9.4 years. To their surprise, they found that the ones who drank a daily diet soft drink added around 3.04cm to their waist circumference while occasional drinkers added only 1.76cm and people who never drank diet soft drinks added only .77cm. People who drank drinks with added sugars added none. The researchers called these results "striking". The inches added to their waistlines was dose dependent and significant.
This study may not be the final word, though. There may be other reasons why the diet soft drink drinkers added more inches to their waists. It may be, for example, that people who are already struggling with weight gain are more likely to choose diet soft drinks. The researchers, however, did control for some weight gain factors, like physical activity and diabetes (Journal of the American Geriatric Society 2015;63(4)708-15).
Artificial sweeteners in soft drinks may increase weight by stimulating sweet taste receptors, which could increase appetite or appetite for sweet foods. A systematic review of eighteen observational studies found that artificially sweetened drinks increase body mass index in children (Int J Pediatr Obes 2010;5(4):305-12). A separate meta-analysis found the same result in nine observational studies of adults (Am J Clin Nutr 2014;100(3):765-77). This meta-analysis did find modest reductions in weight and body mass index in controlled studies. Controlled studies have arrived at mixed results but have suffered from methodological limitations and publication bias (PLoS Med 2017;14(1): e1002195). As we saw in the recent CMAJ systematic review and meta-analysis, in controlled studies, artificial sweeteners did not have any significant benefit for body mass index.
Several recent studies have pointed to the disturbing possibility that diet soft drinks may just be a marketing strategy to keep people who know soft drinks are bad for them drinking soft drinks.
Diet Soft Drinks & Diabetes
Another reason for choosing diet soft drinks is that people think they are better for managing blood sugar. But research shows that drinking commonly used artificial sweeteners leads to the development of glucose intolerance, possibly by negatively affecting intestinal bacteria. That means that the artificial sweeteners in diet soft drinks, instead of helping to prevent diabetes, may actually be promote it by leading to the development of glucose intolerance in healthy people (Nature 2014;514:181-6).
Diet Soft Drinks & Kidney Disease
And when researchers discovered that drinking two or more colas a day doubled the risk of chronic kidney disease, they also discovered that it made no difference if the soft drink was regularly or artificially sweetened (Epidemiology 2007;18:501-6): no benefit there either.
Diet Soft Drinks & Osteoporosis
It is well known that soft drinks cause osteoporosis. What is less well known is that research that found that women who drink soft drinks on a daily basis have significantly lower bone mineral density also found that the results were no better for women who chose diet soft drinks (Am J Clin Nutr 2006;84:936-42).
Diet Soft Drinks & Heart Disease
Research has also demonstrated that people who drink diet soft drinks on a daily basis have a significant 43% greater risk of a cardiovascular event, like stroke or heart attack. Strangely, this study found the risk only for diet soft drinks: there was no association between regular soft drinks and cardiovascular events (J Gen Intern Med 2012;27(9):1120-6). A second study, though, found the increased risk for both. This massive study found that drinking one or more soft drinks a day--whether they were sweetened with sugar or artificial sweeteners--increased the risk of stroke by a significant 16% (Am J Clin Nutr 2012;95:1190-99).
A systematic review and meta-analysis of seventeen observational studies discovered an 8% increased risk of suffering a stroke with artificially sweetened drinks. When the people who drank the most were compared to the people who drank the least, they had a 14% increase in the risk of stroke and a 44% increase in the risk of vascular events (Int J Clin Pract 2016;70(10):791-805).
So, maybe diet soft drinks really are just a marketing trick to keep making money at the expense of the health of people who are trying to be healthy.
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