It is widely known that sugar-sweetened beverages promote weight gain and type 2 diabetes.1-3 However, artificially sweetened beverages are regarded by many as safe alternatives that will satisfy sweet cravings while preventing the dangerous surge in blood glucose from their sugar-sweetened counterparts, thereby circumventing the weight gain and associated increase in diabetes risk.
Are people who drink diet soda less likely to end up with diabetes?
The newest research says no. A recent French study following 66,118 women for 14 years uncovered strong trends of increased diabetes risk in women who consumed greater amounts of either sugar-sweetened or artificially sweetened beverages; for each type of beverage, as consumption increased, risk increased. The authors note that this effect was only partly dependent on body mass index (BMI); that means that it wasn’t just that overweight people were the ones drinking the diet soda and getting diabetes. Women who drank at least one 20-ounce diet soda per week had a risk more than double (a 121% increase in risk) that of women who did not consume any sweetened beverages. High consumers of sugar-sweetened beverages, who drank 12 ounces per week or more, had a 34% increase in diabetes risk.4
Artificial sweeteners, weight gain and diabetes
Since a major purpose of artificial sweeteners is to avoid calorie load, it seems counterintuitive, but artificial sweeteners have been associated with weight gain in several (though not all) observational studies.5,6 In the Multi-Ethnic Study of Atherosclerosis (MESA), drinking diet soda at least once daily was associated with high waist circumference and a 67% greater risk of type 2 diabetes seven years later.7 Similarly, saccharin use (during the 1970s) was associated with weight gain during the following eight years in the Nurses’ Health Study.8 In the San Antonio Heart Study, normal weight subjects who consumed 21 or more artificially sweetened beverages per week almost doubled (93% increase) their risk of overweight or obesity eight years later.9
How might artificial sweeteners promote weight gain?
Artificial sweeteners mimic the sweet taste of sugar, but do not provide the high calorie load – but it seems that it’s not that simple. What happens in the body when we consume a diet soda? Just because diet sodas do not contain calories doesn’t mean they don’t have any physiological effects.
First, simply because they taste sweet, artificial sweeteners promote desire for and dependence on excessively sweet tastes. These excessively sweet tastes are unnatural, hundreds or thousands of times sweeter than table sugar, which in itself is unnaturally sweet. Throughout human history, the body has been accustomed to the more subtle, naturally sweet tastes in fruits and starchy vegetables. Someone who consistently consumes artificially sweetened foods or beverages is training their taste buds to prefer excessive sweetness. Therefore, artificial sweeteners are counterproductive in that they keep the body craving excessively sweet flavors rather than naturally sweet flavors. Some research has suggested that increased use of artificial sweeteners indeed increases appetite or sweet cravings.10 There is also evidence that consuming artificially sweetened beverages between meals (in the absence of calories) increases appetite and food consumption during the next meal.11 Sweet tastes also produce reward signals in the brain, and there is some evidence that artificial sweeteners produce “incomplete” reward signals, leading to incomplete satisfaction and cravings for more food.10
Another potential explanation is the concept of “informed overcompensation.” For example, perceiving that she has “saved” calories by drinking a diet soda with her dinner, a woman decides to order dessert. Interestingly, it has been shown that knowingly (but not unknowingly) consuming artificially sweetened foods led to overcompensation with increased caloric intake.11,12
Another interesting explanation is a possible dysregulation of hunger and satiety signals in the body. This may occur due to an inconsistent relationship between sweetness and amount of calories supplied. The body uses information from the sweetness and calorie load of previous meals in order to predict calorie load from the level of sweetness in future meals. Artificially sweeteners may “uncouple” sweetness and calories, impairing normal physiologic mechanisms that regulate energy balance. There is evidence for this impaired energy balance with several artificial sweeteners. Rats regularly exposed to artificially-sweetened food (or drink) were less able to regulate their calorie intake when given sugar-sweetened, calorie-dense meals, and they gain excess weight.6,13
Steer clear of artificial sweeteners, and prevent diabetes naturally
The safety of many of these artificial sweeteners has been questioned; most are relatively new compounds, and their long-term health effects are still uncertain.14 These are not natural, whole foods, so it is wise to avoid them. The evidence suggests that they are not helpful for weight loss, and certainly not the solution to obesity and diabetes epidemics. However, you can protect yourself against type 2 diabetes, or reverse type 2 diabetes if you already have it, by simply following a health-promoting eating style and exercising frequently. The dietary program described in my book The End of Diabetesis a vegetable-based eating style, including naturally sweet foods like fresh fruits and squashes, designed to maximize nutrient content per calorie. For type 2 diabetes, this approach results in complete reversal of diabetes for the majority of patients. For type 1 diabetes, it eliminates the excessive highs and lows and prevents dangerous complications. Both type 1 and type 2 diabetics can maintain excellent health and quality of life into old age with natural foods and exercise.
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