"Does Diet Soda Increase Stroke Risk as Much as Regular Soda?"
Recommendations to limit sugar consumption
vary around the globe, with guidelines ranging from
“Limit sweet desserts to one every other day” to
“Keep sugar consumption to 4 or less occasions per day.”
In the U.S. the American Heart Association
is leading the charge, proposing dramatic reductions
in the consumption of soft drinks and other sweetened products.
They recommend sticking to under about 5% of calories a day
from added sugars,
which may not even allow a single can of soda.
Why the American Heart Association?
Because the overconsumption of added sugars
has long been associated with an increased risk
of cardiovascular disease,
meaning heart disease and strokes.
We used to think that added sugars was just
a marker for an unhealthy diet.
At fast food restaurants people are probably more likely
to order a cheeseburger with their super-sized soda
than a salad.
But the new thinking is that "NO",
the added sugars in processed foods and drinks
may be an independent risk factor in and of itself
worse than just empty calories
but actively disease- promoting calories
based on data like this.
This is how much sugar the American public is eating.
Only about 1% meet the American Heart Association recommendation
to push added sugar consumption to 5 or 6% of your daily caloric intake.
Most people are up around 15%,
and that’s where cardiovascular disease risk
starts to take off,
with a doubling of risk at about 25% of calories,
and a quadrupling of risk
for those getting a third of their daily caloric intake
from added sugar.
We went from eating 7 pounds of sugar every year
200 years ago,
to 50 pounds
to now over 100 pounds of sugar.
We’re hardwired to like sweet foods
because we evolved surrounded by fruit,
not fruit loops.
But this adaptation is terribly misused and abused today,
hijacked by the food industry for our pleasure and their profits.
Why are we consuming so much sugar
despite knowing how much it can harm us?
Yes, it may have an addictive quality.
Yes, there’s that hard-wiring,
but the processed food industry isn’t helping.
75% of packaged food products in the United States
contain added sweeteners,
mostly coming from sugar sweetened beverages like soda,
thought responsible for more than 100,000 deaths
worldwide and millions of years of healthy life lost.
No problem, why not just switch to diet?
By choosing diet soda can’t we get the sweet taste
we crave without the downsides?
Unfortunately, routine consumption
of diet soft drinks is associated with increases
in the same risks that many seek to avoid
by using artificial sweeteners.
Here’s what studies have found for the increased risk
of cardiovascular disease associated with regular soda
and here’s the cardiovascular risks associated with diet soda.
In other words, the belief that switching to diet soda
will reduce long-term health risks
is not well supported by scientific evidence,
and instead may contribute to the very health risks
people were seeking to avoid in the first place.
But why?
It makes sense why drinking all that sugar
might increase stroke risk,
with the extra inflammation and triglycerides,
but why, in this pair of Harvard studies,
did a can of diet soda appear to increase
stroke risk the same amount?
Yes, maybe the caramel coloring in brown sodas
like cola’s may play a role,
but another possibility is that artificial sweeteners
may increase the desire for sugar-sweetened,
energy-dense beverages and foods.
See, the problem with artificial sweeteners
is that there's a disconnect that ultimately develops
between the amount of sweetness the brain tastes
and how much blood sugar ends up coming up to the brain.
The brain feels cheated and figures you have to eat
more and more and more sweetness
in order to get any calories out of it.
As a consequence, at the end of the day,
your brain says, 'OK, at some point I need some blood sugar here'.
And then you eat an entire cake,
because no one can hold out in the end.
If you give people Sprite, Sprite Zero, or unsweetened carbonated lemon-lime water
and you don’t tell them what is what
or what the study’s about
and then later on you offer them a choice.
Then can have M&M’s, spring water, or sugar-free gum.
Guess who picks the M&M’s?
Those that drank the artificially sweetened soda
were nearly 3 times more likely to take the candy
than either those that consumed either
the sugar-sweetened drinks or the unsweetened drinks.
So, it wasn’t a matter of sweet versus nonsweet
and it wasn’t a matter of calories versus no calories.
There’s something about noncaloric sweeteners that tricks the brain.
Then they did another study in which everyone was given oreos
and they asked people how satisfied
the cookies made them feel.
And again, those that drank the Sprite Zero,
the artificailly sweetened Sprite
reported feeling less satisfied
then either the normal Sprite or the sparkling water.
These results are consistent with recent brain imaging studies
demonstrating that regular consumption
of artificial sweeteners can alter the neural pathways
responsible for the pleasure response to food.
The only way to really prevent this problem -
to break the addiction -
is to go completely cold turkey and go off all sweeteners -
artificial as well as table sugar
and high fructose corn syrup.
Eventually the brain resets itself
and you don’t crave it as much.
We’ve always assumed that consumption
of both sugar and artificial sweeteners
may be changing our palates
or taste preferences over time,
increasing our desire for sweet foods.
Unfortunately, the data on this are lacking...
...until now.
Twenty folks agreed to cut out all added sugars
and artificial sweeteners for 2 weeks
and afterwards, 95% found that sweet foods and drinks
tasted sweeter or too sweet
and said moving forward they would use less
or even no sugar at all.
And most stopped craving sugar
within the first week–6 days.
This suggests a 2-week sugar challenge,
or even 1-week challenge
may help to reset taste preferences
and make consuming less or no sugar easier.
And so maybe we should be recommending it to our patients.
Eating fewer processed foods
and choosing more real, whole, and plant- based foods
make it easy to consume less sugar.