“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.