Below I summarize the health effects of low-calorie sweetened beverages as viewed by governmental and leading health organizations. Future areas of research are needed.
In the United States, 32% of beverages consumed by adults and 19% of beverages consumed by children in 2007 to 2010 contained low-calorie sweeteners (LCSs). The term LCS includes the 6 high-intensity sweeteners currently approved by the US Food and Drug Administration and 2 additional high-intensity sweeteners for which the US Food and Drug Administration has issued no objection letters. Because of a lack of data on specific LCSs, this advisory does not distinguish between these LCSs. Furthermore, the advisory does not address foods sweetened with LCSs. This advisory reviews evidence from observational studies and clinical trials assessing the cardiac and health outcomes of LCS beverages. It summarizes the positions of governmental agencies and other health organizations on LCS beverages and identifies research needs on the effects of LCS beverages on energy balance and overall health. The use of LCS beverages may be an effective strategy to help control energy intake and promote weight loss. Nonetheless, there is a dearth of evidence on the potential adverse effects of LCS beverages relative to these potential benefits.
On the basis of the available evidence, the advisory committee concluded that, at this time, it is prudent to discourage prolonged consumption of LCS beverages by children. Although water is the optimal beverage choice, children with diabetes who consume a balanced diet and closely monitor their blood sugar levels may be able to prevent excessive sugar fluctuations by substituting LCS beverages for sugar-sweetened beverages [SSBs] when needed.
For adults who are habitually high consumers of SSBs, the committee concluded that LCS beverages may be a useful replacement strategy to reduce intake of SSBs. This approach may be particularly helpful for people who are habituated to a sweet-tasting beverage and for whom water, at least initially, is an undesirable option. Encouragingly, self-reported consumption of both SSBs and LCS beverages has been declining in the United States, suggesting that it is feasible to reduce SSB intake without necessarily substituting LCS beverages for SSBs. Thus, the use of other alternatives to SSBs, with a focus on water (plain, carbonated, and unsweetened flavored), should be encouraged.
Many people think of diet sodas as healthy, low-calorie alternatives to sugary drinks. Yet a small but growing body of evidence suggests that diet sodas may have health downsides and may not even provide the benefits some people turn to them for weight loss. Excess sugar intake is a problem in Western society because it contributes to obesity, diabetes, and other conditions. We know that diet beverages are becoming more popular, but we don’t have a lot of research into the effects of diet beverages on different aspects of health.
According to a 2016 study published in the Journal of the Academy of Nutrition and Dietetics, nearly half of adults and a quarter of children in the U.S. consume artificial sweeteners—and the majority do so on a daily basis. Diet drinks make up the bulk of their intake. So here is what we know so far about diet sodas and their role in health, and what you can you do to make smart beverage choices in the meantime.
Not So Heart Smart?
The strongest evidence so far links regular diet soda intake with cardiovascular conditions, such as stroke and heart attack, as well as type 2 diabetes and obesity (which are also risk factors for cardiovascular disease). For example, a recent study of about 4,400 people ages 45 and older found that those who drank one or more diet sodas every day were three times more likely to have a stroke than those who didn’t. This study, however, had several limitations and didn’t prove that diet sodas themselves caused people to have strokes. Although it could be that people who drink diet sodas are in poorer health than people who don’t, these findings are consistent with previous research and thus strike a note of caution. For example, three large studies published between 2007 and 2009 found that people who drank diet sodas regularly were more likely to develop type 2 diabetes and had between 30 and 55 percent higher risk of metabolic syndrome (a constellation of health problems that could increase the risk of type 2 diabetes, heart disease, and stroke) than those who didn’t. Two other studies from 2012 further bolstered these results: In one study of about 2,600 people, researchers linked daily diet soda consumption to about a 45 percent higher risk of heart attack, stroke, and early death.
A Cautious Interpretation
The studies linking diet sodas and cardiovascular risk are intriguing, but they still need to be repeated in more rigorous settings. For example, all of these studies relied on participants self-reporting their dietary habits, which can introduce errors because people don’t always remember what they ate. Additionally, those who drink diet sodas may already be at increased risk of conditions such as diabetes or obesity because they are unhealthy to begin with. For example, someone who is overweight may have switched from regular soda to diet soda to help control an already burgeoning waistline.
And not every study has shown that diet sodas negatively affect health. For example, in 2012 researchers from the Harvard School of Public Health analyzed the drinking habits of almost 43,000 men and found that those who drank sugary drinks had a higher risk of coronary heart disease, but those who drank diet sodas did not.
Another reason scientists hesitate to say definitively that diet sodas are bad for your health is that they aren’t sure how they increase disease risk. It’s possible that artificial sweeteners may damage blood vessels—possibly explaining their link to diseases such as diabetes and stroke. It’s also possible that the artificial sweeteners commonly used in diet sodas may “trick” the brain into craving rich, high-calorie foods, leading to weight gain. They may also cause changes in hormone levels or intestinal bacteria, both of which play a role in weight and insulin management. For example, a study published in the journal Nature in 2014 found that artificial sweeteners altered intestinal bacteria in people and mice, increasing their risk of sugar intolerance, a condition often preceding diabetes. However, these various ideas warrant larger, more rigorous studies.
What to Do
In general, your best bet is to avoid regular and diet sodas altogether. They offer little nutritional benefit, and in some cases, diet sodas may even cause headaches. For example, shortly after the artificial sweetener aspartame came onto the market in the late 1990s, one of the biggest complaints the Food and Drug Administration received about the sweetener was headaches. No scientific studies have proved that aspartame or diet sodas in general cause headaches, but a review of evidence published in The Clinical Journal of Pain in 2009 suggested that large amounts of sweeteners—such as contained in five or more diet soda drinks—could trigger or make headaches worse in people who are already susceptible to migraines.
In the end, an occasional soda—with sugar or artificial sweeteners—is probably OK. But your best bet is to stick with water, plain or sparkling, as much as possible. If you find unflavored water boring, add a splash of bitters with a slice of lemon or lime. Unsweetened tea is also a great choice.
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