Sugar-Free but Not Healthy
You may have kicked your ‘regular’ coke-drinking habit to the curb only to replace it with a sugar-free version. I hate to say it, but you may not be doing yourself any favors. Often, the sugar-free formulations of these drinks contain many more harmful chemicals and bi-product than sugar itself. Although Americans have been using artificial sweeteners for decades, the safety of these chemicals remains questionable due to the growing number of studies reporting long-term health risks.
Most diet drinks contain the artificial sweeteners aspartame, saccharin, and sucralose.
Sweeteners such as NutraSweet, Splenda, Acesulfame, and Sweet N’ Low can actually disrupt the body’s ability to gauge calories and lead to overeating.
There have also been numerous reports of allergic reactions to known hazardous chemicals in these popular drinks, with severity of reactions governed by individual biochemistry. Since aspartame is much sweeter than sugar, the use of these sweeteners have actually been shown to promote a desire for sweeter foods. One study reported increased hunger and caloric intake when participants ingested diet soda containing aspartame (1).
Artificial sweeteners fall under the umbrella of food additives, and as such, are not subject to the same rigorous food safety trials that pharmaceuticals must undergo. Moreover, the safety testing is often funded by the very industry promoting their product.
Clearly, if a company has vested interests in the outcome of a study, then the idea of misleading claims should not be surprising.
Some claim that much of the research reporting harmful side effects have been conducted on rodents, and as such, cannot be fully extrapolated to humans. However, growing evidence points to an association of aspartame with metabolic disease, cardiovascular disease, insulin resistance, and cognitive impairment in humans.
Side Effects & Risks
In a 2007 study by the American Heart Association, researchers linked diet soda to the development of metabolic syndrome (2). Other studies have reported migraine headaches with aspartame and sucralose use (3-8). Another study with aspartame uncovered increased inflammation in blood vessels (9), while a study conducted on mice revealed that aspartame induced lung and liver cancers (10).
So what is the FDA doing about it? Well, in 2015, The Scientific Report of the 2015 Dietary Guidelines Advisory Committee (DGAC) included a short report regarding the safety of aspartame. The DGAC concluded that “aspartame in amounts commonly consumed is safe and poses minimal health risk for healthy individuals without phenylketonuria.” (11)
However, the Scientific Report also includes studies reporting a possible link between aspartame and risk of blood-borne cancers such as non-Hodgkin lymphoma and multiple myeloma in men, as well as the potential risk of preterm delivery (11). However, they conclude that the evidence is limited and inconsistent, and that further long-term studies in humans are warranted.
Upon analyzing two randomized controlled trials and two non-randomized controlled trials, the DGAC also concluded that no association was found linking aspartame to behavior and cognitive function impairments in children (11). However, the panel admits that these studies had several limitations, including small sample sizes, having been conducted over 20 to 30 years ago and over a short period of time (between 1 day to 3 weeks). These are highly significant limitations. The 2015-2020 Dietary Guidelines does not mention any of this and only briefly states that high-intensity sweeteners such as aspartame are “determined to be safe for the general population,” based on available scientific evidence (11; 12).
While the DGAC considers aspartame to be generally safe, I also found no mention of the possibility of a link between aspartame and metabolic syndrome or increased weight gain.
In a study conducted by Fowler, Williams, & Hazuda (2015), a positive dose-response relationship was observed with increasing diet soda intake and subsequent long-term elevation in waist circumference over a period of nearly a decade. This study was consistent with previous studies showing a positive association between artificial sweeteners and increased BMI, obesity, metabolic syndrome, diabetes, and cardiovascular events (13).
Now What?
Right about now you’re probably thinking, ‘ok, maybe I’ll just go back to my regular soda drinking days?’ While it’s one thing to have a soda every once in a while, but it’s another to drink one or more cans of soda every single day. If you are still under the assumption that sugar isn’t bad for heart disease, I strongly urge you to reconsider.
Harmful Effects of Sugar
In a JAMA-published study conducted on more than 40,000 people, Yang et al. (2014) demonstrated the harmful effects of sugar (not fat!) on insulin resistance, triglyceride levels, HDL and LDL cholesterol levels, as well as sugar’s significant contributory role in inflammation. These risk factors are all at the core of cardiovascular disease (14).
Researchers found that study participants with intakes greater than or equal to 10% of calories from added sugar (such as sweetened beverages) had a 30% elevated risk for cardiovascular disease mortality, whereas those with intakes of 25% or more calories from added sugar had almost triple the relative risk for CVD mortality (14).
According to the American Heart Association, Americans should keep their intake of added sugars to less than 10% of their total daily calories as part of a healthy diet. This translates to no more than 150 calories daily (36 grams or 9 teaspoons) for men, and 100 calories daily (25 grams or 6 teaspoons) for women (15).
To put things into perspective, a 12oz can of coke contains 39g of sugar; a 16oz bottle contains 52g of sugar; and a 20oz drink contains a whopping 65g of sugar!
Bottom Line
Cardiovascular disease is the number one killer worldwide. Moreover, there has been a steady rise in chronic diseases such as diabetes, autoimmune disorders, and cancer. Alas, I think it would certainly be wise to adopt a “guilty until proven innocent” approach as opposed to the alternative when weighing the evidence for the safety of artificial sweeteners.
References:
(1) Lavin, J. H., French, S. J., Read, N. W. (1997). The effect of sucrose- and aspartame-sweetened drinks on energy intake, hunger and food choice of female, moderately restrained eaters. Int J Obes Relat Metab Disord, 21, 37–42. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/9023599/
(2) Lutsey, P. L., Steffen, L. M., & Stevens, J. (2008). Dietary intake and the development of the metabolic syndrome: the Atherosclerosis Risk in Communities study. Circulation, 117(6), 754-761. doi:10.1161/CIRCULATIONAHA.107.716159 Retrieved from: http://circ.ahajournals.org/content/117/6/754.long
(3) Newman, L. C., & Lipton, R. B. (2001). Migraine MLT-down: an unusual presentation of migraine in patients with aspartame-triggered headaches. Headache, 41(9), 899-901. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1526-4610.2001.01164.x
(4) Lipton, R. B., Newman, L. C., Cohen, J. S., & Solomon, S. (1989). Aspartame as a dietary trigger of headache. Headache, 29(2), 90-92. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/2708042
(5) Van den Eeden, S. K., Koepsell, T. D., Longstreth, W. J., van Belle, G., Daling, J. R., & McKnight, B. (1994). Aspartame ingestion and headaches: a randomized crossover trial. Neurology, 44(10), 1787-1793. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/7936222
(6) Butchko, H. H. (1994). “Adverse reactions to aspartame: double-blind challenge in patients from a vulnerable population” by Walton et al. Biological Psychiatry, 36(3), 206-208. Retrieved from: https://www.biologicalpsychiatryjournal.com/article/0006-3223(94)91228-9/pdf
(7) Patel, R. M., Sarma, R., Grimsley, E. (2006). Popular sweetener sucralose as a migraine trigger. Headache, 46(8):1303-4. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1526-4610.2006.00543_1.x
(8) Bigal, M. E., Krymchantowski, A. V. (2006). Migraine triggered by sucralose–a case report. Headache, 46(3):515-7. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1526-4610.2006.00386_1.x
(9) Alleva, R., Borghi, B., Santarelli, L., Strafella, E., Carbonari, D., Bracci, M., & Tomasetti, M. (2011). In vitro effect of aspartame in angiogenesis induction. Toxicology In Vitro: An International Journal Published In Association With BIBRA, 25(1), 286-293. doi:10.1016/j.tiv.2010.09.002 Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/20837131
(10) Soffritti, M., Belpoggi, F., Manservigi, M., Tibaldi, E., Lauriola, M., Falcioni, L., & Bua, L. (2010). Aspartame administered in feed, beginning prenatally through life span, induces cancers of the liver and lung in male Swiss mice. American Journal Of Industrial Medicine, 53(12), 1197-1206. doi:10.1002/ajim.20896 Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/20886530
(11) DGAC (2015). Scientific Report of the 2015 Dietary Guidelines Advisory Committee. 7(1), 202-204. doi:10.3945/an.115.011684. Retrieved from: https://webcampus.uws.edu/pluginfile.php/189634/mod_resource/content/2/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee-CLEAN.pdf
(12) USDA (2015). Dietary Guidelines for Americans 2015-2020. Eighth Edition. Retrieved from: https://webcampus.uws.edu/pluginfile.php/189635/mod_resource/content/1/2015-2020_Dietary_Guidelines-1.pdf.
(13) Fowler, S. P., Williams, K., & Hazuda, H. P. (2015). Diet soda intake is associated with long-term increases in waist circumference in a bi-ethnic cohort of older adults: The San Antonio Longitudinal Study of Aging. Journal of the American Geriatrics Society, 63(4), 708–715. http://doi.org.uws.idm.oclc.org/10.1111/jgs.13376 Retrieved from: https://www-ncbi-nlm-nih-gov.uws.idm.oclc.org/pmc/articles/PMC4498394/
(14) Yang, Q., Zhang, Z., Gregg, E. W., Flanders, W. D., Merritt R., Hu, F. B. (2014). Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults. JAMA Internal Medicine, 174(4), 516–524. http://www.doi:10.1001/jamainternmed.2013.13563 Retrieved from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1819573
(15) American Heart Association. (2017). Added Sugars. Retrieved from: http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Added-Sugars_UCM_305858_Article.jsp#.Wx2bglMvyHo