Approximately 20 to 25 percent of Americans will drink diet soda on any given day —according to CDC and Gallup polls
. All diet sodas contain some type of artificial sweetener.
While there are some conflicting studies on artificial sweeteners and human health, several recent studies give us pause and make us question the excess consumption of beverages and foods containing artificial sweetener.
According to research studies, the amount of artificial sweetener in as few as two cans of diet soda (or in, as some studies suggest, over 14 cans) could be detrimental to our health.
This doesn’t mean that the occasional consumption of artificial sweeteners or an occasional diet soda is bad.
There are no “good” or “bad” foods.
However, heavy consumption
of artificial sweeteners is likely to, at some point, affect your health. But how much is too much?
Artificial sweeteners and health
The health concerns over artificial sweeteners (known by many names such as aspartame, Equal®; saccharine, NutraSweet®, sucralose, Splenda®, Acesulfame K, Sunett®, etc.) begs us to ask if choosing them over sugar has any real benefit? Some experts may even contend that artificial sweeteners are a less desirable choice than more natural forms of sugar (maple syrup, honey, stevia, agave, etc.)
Overconsuming artificial sweeteners, which are synthetic chemicals, challenges nutritional common sense. Our bodies were simply not designed to digest and metabolize these foreign particles in excess over a long period of time. When people do so, it can be problematic to one’s health and well-being.
Research studies have found a number of potential negative health outcomes associated with artificial sweetener, including:
Should you cut back?
- Dental decay (outcomes are mixed) (Brand ’11; Namimi ‘11; Cochrane ’14; Bassiouny ‘13)
- Increased cravings for sweets (Nelson ‘16; Tietelbaum ’16; Anton ’10; Wang ‘16)
- Stimulating insulin release; resulting in lowering your blood sugar; making you hungrier and perhaps even craving sweets later in the day (Brown ’09, ‘10; Pepino ’13; De Koning ’11; Dus ’15; Frank ‘08) Note: This particular effect depends on whether one’s individual taste buds perceive the artificial sweetener to resemble sugar. Some individuals report artificial sweeteners having an unpleasant, metallic taste; these specific individuals would likely not experience this insulin response (Tey ’16; McQuillan ’05, ’09; Davidson ‘15)
- Binge eating on foods loaded with sugar and fat as compensation for the absence of calories in diet drinks (An ‘16)
- Taste buds getting used to sweetness and then requiring more and more to feel satisfied (Nelson ‘16; Tietelbaum ’16; Anton ‘10)
- Metabolic problems (insulin resistance, metabolic syndrome, high blood pressure, diabetes, heart disease) (Nelson ‘16; Tietelbaum ’16; Nettleton ’09; Fantino ‘13); A few studies find artificial sweeteners to be a healthy alternative at reducing diabetes (Calorie Council ’11; Catenacci. 2014; Rogers ’15; Phelan ‘09)
- Weight gain (or absence of weight loss) (Madjd ’16; Kuk ’16; Chen ’09; Gul ’16; Kaliannan ‘13); Some studies concluded that artificial sweeteners improved weight loss (Sørensen ’14; Blackburn ’97; Catenacci ’14; Peters ’14; Phelan ’09; Tate ’12); Other studies find artificially sweetened beverages (ASB) no more helpful for maintaining a healthy weight than their full-sugar versions (Borges ’17; Mattes ’09)
- Increased obesity and abdominal fat (Yang ’10; Fowler ‘05; ’08; ’15; Nettleton ’09; Nelson ’16; Hootman ‘17); One study found no increase in caloric intake or weight (Tey ’16)
- Reduction in friendly gut bacteria (Abou-Conia ’08; Gophna ’11; Suez ’14; Schiffman ‘13)
- Depression (Chen ’13; Guo ‘14)
- Alzheimer’s (Pase ’17; Gardener ’12; Duffey ‘12)
- Stroke (Pase ’17; Gardener ’12; Duffey ‘12)
- Kidney disease (Lin ‘09, ‘11)
- Alcohol intoxication (Stamates ‘15; Wu ’06; Rossheim ’11; Marczinski ‘13)
- Osteoporosis/hip fractures (Tucker ’06; Fung ’14; Teofilo ‘10)
- Problems with pregnancy, nursing, infants and children (Azad ’16; Sylvestsky ’11, 16; Brown ‘10); Studies examined the effect of artificial sweeteners on a child’s future taste preferences, weight and future metabolic problems; although limited controlled studies supported these conclusions.
For those of you that opt for artificial sweeteners as a way to cut calories or reduce the amount of sugary foods you eat, it could be helpful to at least reconsider the consequences of this consumption.
When you drink diet soda and your brain detects sweetness — but your body receives no calories (fuel/energy) — the brain sends a message to overcompensate. This may mean that sweets will be even more desirable to you later in the day.
Here’s why: The artificially-sweetened beverage sufficed and successfully tricked your brain, but, later, you may be more likely to binge on sweets
— and that late-night binge could be stored as fat.
The reason that this happens is that our brains need glucose (sugar) from foods to supply much-needed fuel to function. When we are hungry and reach for diet soda instead of a nutritious snack, the brain says, “You’ve tricked me! That tasted sweet but provided me no fuel! Now I will make you crave the very thing you were trying to avoid!
” As a result, we may be driven to overeat later in the day after drinking diet soda.
Reducing diet soda consumption
You may read this and think, “Dr. Carson, I really like to have a diet soda or two each day. I like the taste and the caffeine buzz and it helps me get my work done!”
My response is what you might expect, “OK, then, just have them in moderation.”
If you want to have one or two diet sodas a day, you’re probably going to be OK. But, if you’d like to take steps to reduce your consumption of artificial sweetener, here are a few suggestions
- Look at your habits when dining out - Most people who order sodas at restaurants tend to overdo it. Restaurant workers are trained to continually offer you free refills. You may end up consuming three or more servings of diet soda at one meal — without even realizing it. Opt for water instead or simply be mindful and stop after drinking 16 ounces or less.
- Identify why you drink diet soda – Is it the caffeine you crave? Are you trying to cut calories? Do you feel like you are addicted to your diet soda habit? If you are having more than two diet sodas a day, ask yourself: Why? And if you regularly choose diet soda instead of having a regular (sugary) small soda, ask yourself: Why?
- Choose water instead – Instead of diet soda, why not just drink water? Do you not like the taste of water? If it’s the fizziness you crave, try sparkling water. Add a splash of cranberry juice, lemon or lime to sparkling water or try one of the many flavored sparkling water drinks on the market that do not contain artificial sweetener.
- Stop buying artificial sweetener and diet soda — If controlling the intake of diet sodas is a problem, don’t buy them; don’t keep them in the house and encourage family members to keep them out of the house as well.
- Set goals or limits — For instance, you can decide to only have diet soda when hanging out with friends. Or, set a weekly limit and once you have reached it cease further intake until next week.
Another strategy is to not get in the habit of drinking diet soda with meals. Instead, have it as a thirst quencher or pleasurable addition to your day.
Diet soda and weight loss
For those who drink soda regularly, the decision to drink fewer sugary sodas — or replacing sugary soda with diet soda — could result in weight loss. Likewise, reducing diet soda consumption and choosing water instead may also result in weight loss.
Studies have found that people who consume just three diet sodas per week are more than 40 percent more likely to be obese (Fowler ‘05; ‘08). The risk of becoming overweight or obese increased with each diet soda consumed per day. However, it’s important to note that this study is not necessarily implying a cause and effect relationship. In other words, this is an observation and it does not prove that diet sodas cause weight gain or assume that people of higher weight drink diet sodas.
Many people choose diet sodas thinking that they are a smart alternative to sugary drinks. One may choose diet soda instead of sugary soda as a way to reduce health problems, mitigate cravings and lose weight.
Unfortunately, this is not necessarily the case: beverages that contain artificial sweeteners are not as healthy for us as some people like to believe. Artificial sweeteners do not nourish the body.
On the other hand, artificial sweetener — in the amounts that most people consume it — is not life threatening or so dangerous that we should completely omit it from our diets. If we find diet soda to be refreshing and enjoyable, an occasional drink is fine. This is why moderation is so important.
In my professional opinion, when we choose sweets (or any foods/drinks for that matter), the source of the sweets should resemble something that is as close to nature as possible. Each day, we have a choice to make as to what we will consume. And, as Yogi Berra was famously quoted as saying, “When you come to a fork in the road, take it.”
Ralph Carson, RD, PhD, is a nutritionist and exercise physiologist with over 40 years of experience. He is currently Vice President of Science and Innovation for Eating Recovery Centers (ERC). Dr. Carson is an active member on the board of the International Association of Eating Disorder Professionals (iaedp) and author of The Brain Fix: What’s the Matter with Your Gray Matter.
Abou-Conia MB et al Splenda alters gut microflora and increases intestinal p-glycoprotein and cytochrome p-450 in male rats Toxicol Environ Health A (2008) 71: 1415 – 29
An R et al Beverage Consumption in Relation to Discretionary Food Intake and Diet Quality among U.S. Adults, 2003-2012. Journal of the Academy of Nutrition and Dietetics (2016) 116(1):28-37
Azad MB et al Association Between Artificially Sweetened Beverage Consumption During Pregnancy and Infant Body Mass Index. JAMA Pediatrics (2016) 170(7):662-70
Bassiouny MA et al Dental erosion due to abuse of illicit drugs and acidic carbonated beverages Gen Dent (2013) 61L 38 -44
Blackburn GL et al. "The effect of aspartame as part of a multidisciplinary weight-control program on short-and long-term control of body weight. The American journal of clinical nutrition (1997): 65: 409-418
Borges MC et al Artificially Sweetened Beverages and the Response to the Global Obesity Crisis. PLOS Medicine (2017) 14(1):e1002195
Brand HS et al Summary of: Are sugar-free confections really beneficial for dental health? Br Dent J (2011) 211: 324 – 5
Brown RJ et al Ingestion of diet soda before a glucose load augments glucagon-like peptide-1 secretion Diabetes Care (2009) 32: 2184 – 6
Brown RJ et al Artificial sweeteners: a systematic review of metabolic effects in youth. Int J Pediatr Obes. (2010) 5(4):305-12.
Calorie Control Council Diet Calorie Control Council Sucralose facts: A safe food ingredient (2011) http://www.sucralose.org/facts/default.asp
Catenacci VA et al. "Low/No calorie sweetened beverage consumption in the National Weight Control Registry Obesity (2014) 22: 2244-2251.
Chen H Sweetened beverages, coffee, and tea in relation to depression among older U.S. adults presented at the American Academy of Neurology 65th Annual Meeting in March 2013
Cochrane NJ et al Food acid content and erosive potential of sugar-free confections. Unpublished research report (2014)
De Koning L et al Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men AJCN (2011) 93: 1321 – 7
Duffey KJ et al Dietary patterns matter: diet beverages and cardiometabolic risks in the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) Study AJCN (2012) 95: 909 - 915
Dus M et al. Nutrient Sensor in the Brain Directs the Action of the Brain-Gut Axis in Drosophila. Neuron, (2015) 87(1):139-51
Fantino M et al Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes: methodologic concern about a recent epidemiological study AJCN (2013) 98: 251- 2
Fowler SP et al Diet soft drink consumption is associated with increased incidence of overweight and obesity in the San Antonio Heart Study (2005) ADA Conference abstract 1058-P
Fowler SP et al Fueling the Obesity Epidemic? Artificially Sweetened Beverage Use and Long-term Weight Gain Obesity (2008) 16: 1894 - 1900
Fowler SPG et al Diet Soda Intake Is Associated with Long-Term Increases in Waist Circumference in a Biethnic Cohort of Older Adults: The San Antonio Longitudinal Study of Aging. Journal of the American Geriatrics Society, (2015)
Frank GK et al. Sucrose activates human taste pathways differently from artificial sweetener. Neuroimage. (2008);39(4):1559-69
Fung TT et al Soda consumption and risk of hip fractures in postmenopausal women in the Nurses' Health Study AJCN (2014) 100: 953 – 8
Gardener H et al Diet Soft Drink Consumption is Associated with an Increased Risk of Vascular Events in the Northern Manhattan Study J Gen Intern Med (2012) 27(9):1120-6
Gardner C et al. Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. (2012) 35(8):1798-808
Gophna U Microbiology. The guts of dietary habits Science (2011) 334: 45 – 6
Gul SS et al Inhibition of the gut enzyme intestinal alkaline phosphatase may explain how aspartame promotes glucose intolerance and obesity in mice. Applied Physiology, Nutrition, and Metabolism, (2016) 42(1):77-83
Guo X et a; Sweetened beverages, coffee, and tea and depression risk among older US adults PLoS One (2014) 9: e94815
Hootman KC et al Erythritol is a pentose-phosphate pathway metabolite and associated with adiposity gain in young adults. Proceedings of the National Academy of Sciences (2017) 114(21):E4233-E4240
Kaliannan K et al Intestinal alkaline phosphatase prevents metabolic syndrome in mice PNAS (2013) 110: 7003 – 8
Kuk JL and Brown RE Aspartame intake is associated with greater glucose intolerance in individuals with obesity. Applied Physiology, Nutrition, and Metabolism, (2016) 41(7):795-8.
Lin, Julie presented at the annual meeting of the American Society of Nephrology in San Diego (Nov. 2, 2009)
Lin J and Curhan GC Associations of sugar and artificially sweetened soda with albuminuria and kidney function decline in women Clin J Am Soc Nephrol (2011) 6: 160 - 6
Madjd A et al Beneficial effects of replacing diet beverages with water on type 2 diabetic obese women following a hypo-energetic diet: A randomized, 24-week clinical trial. Diabetes, Obesity and Metabolism, (2016) 19(1):125-132
Marczinski CA and Stamates AL Artificial sweeteners versus regular mixers increase breath alcohol concentrations in male and female social drinkers Alcohol Clin Esp Res (2013) 37: 696 – 702
Mattes RD, Popkin BM. Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. Am J Clin Nutr. (2009) 89(1):1-14
Namimi H et al Are sugar-free confections really beneficial for dental health? Br Dent J (2011) 211:E15
Nelson M Soda Politics: Taking on Big Soda (And Winning) Oxford University Press (2015)
Nettleton JA et al Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA) Diabetes Care (2009) 32: 688- 94
Pase MP et al Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia: A Prospective Cohort Study Stroke (2017) 48: 1139 – 1146
Pepino MY et al Sucralose affects glycemic and hormonal responses to an oral glucose load Diabetes Care (2013) 36: 2530 – 5
Peters JC et al. "The effects of water and non‐nutritive sweetened beverages on weight loss during a 12‐week weight loss treatment program Obesity (2014) 22: 1415-1421.
Phelan S et al Use of artificial sweeteners and fat-modified foods in weight loss maintainers and always-normal weight individuals International Journal of Obesity (2009) (33) 1183-1190
Rogers PJ et al Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. International Journal of Obesity, (2015) 40 (3): 381
Rossheim ME Thombs DL Artificial sweeteners, caffeine, and alcohol intoxication in bar patrons Alcohol Clin Exp Res (2011) 35: 191 – 6
Schiffman SS and Rother KI Sucralose, a synthetic organochlorine sweetener: overview of biological issues J Toxicol Environ Health B Crit Rev (2013) 16: 399 – 451
Sørensen LB et al. Sucrose compared with artificial sweeteners: a clinical intervention study of effects on energy intake, appetite, and energy expenditure after 10 wk of supplementation in overweight subjects The American journal of clinical nutrition (2014) 100(1):36-45.
Stamates AL et al Effects of artificial sweeteners on breath alcohol concentrations in male and female social drinkers Drug Alcohol Depend (2015) 157: 197 – 9
Suez J et al Artificial sweeteners induce glucose intolerance by altering the gut microbiota Nature (2014) 514: 181 – 186
Sylvetsky A et al Artificial sweetener use among children: epidemiology, recommendations, metabolic outcomes, and future directions Ped Clin North Am (2011) 58: 1467 - 80
Sylvetsky AC et al Plasma concentrations of sucralose in children and adults. Toxicological & Environmental Chemistry, (2016) 99: 535-542
Tate DF et al Replacing caloric beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial The American journal of clinical nutrition (2012) 95: 555-563
Teitelbaum J Complete Guide to Beating Sugar Addiction Fair Winds Press (2015)
Teofilo JM et al Cola beverage consumption delays alveolar bone healing: a histometric study in rats Braz Oral Rex (2010) 24 (2)
Tucker KL et al Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study Am J Clin Nutr (2006) 84: 936 – 42
Wang Q-P Sucralose Promotes Food Intake through NPY and a Neuronal Fasting Response. Cell Metabolism, (2016) 24 (1): 75
Wu KL et al Artificially sweetened versus regular mixers increase gastric emptying and alcohol absorption Am J Med (2006) 24: 75
Yang Q. Gain weight by “going diet?” Artificial sweeteners and the neurobiology of sugar cravings: Neuroscience (2010). Yale J Biol Med. (2010) 83(2):101-8