Diet soda is very popular, as it is perceived to be the healthier alternative to sugar-containing sodas – although this has been challenged by many studies. A new study[i], recently published, says that increasing diet soda intake is directly linked to greater abdominal obesity in adults 65 years of age and older. This is especially worrisome, for this type of fat distribution is the most likely to lead to diabetes and cardiovascular disease.

For the study, University of Texas researchers enrolled a large number of volunteers who were aged 65 and older at the outset. Diet soda intake, waist circumference, height, and weight were measured, and at three follow-ups for over 9 years.

Findings indicated that the increase in waist circumference among diet soda drinkers, per follow-up interval, was almost triple that among non-users: 2.11 cm versus 0.77 cm, respectively. After adjustment for multiple potential confounders, they found that waist circumference increases of 2.04 cm for non-users, 4.67 cm for occasional users, and 8.06 cm for daily users over the total 9.4-year follow-up period.

Does this information really portend a greater risk for heart disease? Unfortunately, it probably does: As reported—at least in women—in a recent national cardiology meeting, as compared with non-drinkers, those who drank at least two diet drinks daily had a 1.3X higher risk of cardiovascular disease with a similar increase in overall mortality.

Although this type of information does not prove that diet drinks are directly responsible for such bad outcomes, at least it places a severe warning to those consuming such drinks. It also places a burden on the makers of such beverages to prove that they are not unsafe. In the meantime, I recommend that all individuals who drink diet soda daily should try to eliminate their consumption of artificially sweetened drinks in favor of plain old water, or perhaps unsweetened tea.


[i] Fowler SPG, Williams K, and Hazuda HP. 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; Published Online: March 17, 2015 (DOI: 10.1111/jgs.13376)




     Because of the widespread availability and use of artificial, non-caloric, sweeteners we must examine this subject from the standpoint of their impact—if any—on health.

At present there are six such sweeteners on the market, all cleared as being safe by the FDA. The following discussion centers on the three most prevalent, which are aspartame, saccarin, and sucralose .

First, let’s look in more detail about each of these substances:

Aspartame (EqualR ,NutrasweetR) is a combination of 2 amino acids, aspartic acid and phenylalanine. It is about 220 times sweeter than sugar and leaves little aftertaste when consumed. One rare exception to its excellent safety record is that people who have phenylketonuria (PKU) cannot eat aspartame. This is because their bodies cannot metabolize, phenylalanine, one of its amino acids. Fortunately PKU is a rare, genetically inherited condition that is routinely screened for in early infancy, and this regularly allows for those individuals to avoid such substances in their diets. Otherwise, aspartame is one of the most researched sugar substitutes available in the United States, with more than 200 studies establishing its safety, and no adverse health consequences have been identified. Although there has been a lot of misinformation about aspartame since it came onto the market in 1981, studies have concluded that it specifically does not cause headaches, seizures, Alzheimer’s disease, Parkinson’s disease, lupus or multiple sclerosis.

Saccharin (Sweet ‘N LowR and Sweet TwinR) is the oldest sugar substitute, first discovered in 1879. It is 200 to 700 times sweeter than sugar, depending on how it is used. Saccharin leaves an aftertaste some people can detect. Earlier, safety was of some concern, and it used to carry a warning label indicating that it was known to cause cancer in laboratory animals. After extensive research on the safety of saccharin, however, the United States government passed a bill in 2000 confirming its safety and removed the warning label from food and drinks made with saccharin.

Sucralose (SplendaR) is another no-calorie sugar substitute that tastes like sugar but is 600 times sweeter. It leaves no aftertaste when consumed. It was approved for use in the United States in 1998, and also has been subjected to many studies on its safety, all of which have indicated that it is safe for people to consume in customary amounts used for sweetening.

How effective are these products? Since we have recognized their excellent safety record, another important question centers on whether they are helpful:

Although substitution of artificial sweeteners in food and drinks offers promise of better weight control,  I note that leading medical organizations have weighed in on this issue[1]: According to the joint scientific statement from the American Heart Association and American Diabetes Association. “At this time, there are insufficient data to determine conclusively whether the use of such sweeteners to displace caloric sweeteners in beverages and foods reduces added sugars or carbohydrate intake, or benefits appetite, energy balance, body weight, or cardiometabolic risk factors.”

As suggested, research results are mixed about this issue, for some studies show that individuals consuming artificial sweeteners often compensate by consuming more high caloric foods in response to the non-caloric sweeteners, thus nullifying any efforts at weight control. Although this is a complicated issue, from personal experience I have found virtually nothing to suggest that those individuals consuming such products actually do lose weight. One counter argument, however, is to say that these same individuals—had they consumed sugary beverages—would have actually gained weight, but, unfortunately, they probably would have done so either way. Accumulating evidence[2] demonstrates that frequent consumers of sugar substitutes are also at increased risk of excessive weight gain. This may result because consuming sweet-tasting but non-caloric or reduced-calorie food and beverages interferes with learned responses that normally constrain sugar and energy consumption. As a result of this interference, frequent consumption of high-intensity sweeteners may have the counterintuitive effect of inducing metabolic or brain responses that actually induce the individual to eat more calories. Some experimental studies in animals have also supported this contention.

Not only has research failed to confirm the idea that artificial sweeteners are beneficial in reducing overall caloric sugar intake, there are some preliminary data suggesting that they may be actually harmful, increasing one’s propensity to develop cardiovascular disease, i.e., the same malady that we wish to prevent! These newer data show an association between daily consumption of dietary beverages and cardiovascular disease (CVD) outcomes (including mortality) in postmenopausal women. The findings were based on an analysis of dietary beverage intake and cardiovascular risk factors in 59,614 women who did not have cardiovascular disease at the time they enrolled in the study. Results were reported in March, 2014, at a large national medical meeting. At an average follow-up of 8.7 years, they found that women who drank at least two diet drinks on a daily basis had a higher risk of cardiovascular disease (CVD) events compared to the zero-to-three drinks per month group.

The researchers warned, however, that data on the link between diet beverages and CVD outcomes have been limited and emphasized that more research was needed to verify the findings. This type of research, although showing clear links between artificial sugar intake and CVD, does not conclusively establish a causal role for such beverages, because other, heretofore unrecognized factors may cast such a conclusion in doubt.

Regardless of the eventual resolution of this issue, however, simply substituting all sweetened/caloric beverages with simple unadulterated water is the best—and cheapest—solution to this problem. If you cannot tolerate plain old water, seltzer or unsweetened tea may be an acceptable alternative. In the absence of conclusive data, children and pregnant women are advised to avoid any of these products.