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MSN,RN,CDE
Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised
Section:  General Diabetes

 Waist circumference is often used as a measure of visceral adiposity , which is known to be a major risk factor for diabetes, cancer, heart disease and other chronic conditions.

 At the  ADA`s 71st Scientific Sessions held in San Diego 24 to 28 June, two new studies have suggested that taking diet sodas as healthy alternatives to control weight gain might be a self-defeating behavior.
 

People who said they drank two or more diet sodas a day experienced waist size increases that were  500 percent greater  than those who didn't drink diet soda, according to researchers from the University of Texas Health Science Center at San Antonio.

A second study found that the sweetener aspartame raised blood sugar levels in diabetes-prone mice

"Data from this and other prospective studies suggest that the promotion of diet sodas and artificial sweeteners as healthy alternatives may be ill-advised," said Helen P. Hazuda, Ph.D., professor and chief of the Division of Clinical Epidemiology in the School of Medicine. "They may be free of calories but not of consequences."

Bottom line?  "...The results suggest that, amidst the national drive to reduce consumption of sugar-sweetened drinks, policies that would promote the consumption of diet soft drinks may have unintended deleterious effects," the authors wrote.

Source- http://www.sciencedaily.com/releases/2011/06/110627183944.htm

                      Water, taken in moderation, cannot hurt anybody~ Mark Twain

                                                      Thoughts?

                                      Thank you. Isabella Wiznitzer RN/CDE

MEMBER COMMENTS
Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised
Hi Isabella
I did see the study report, and I can't help but think there is an ulterior motive behind it.  Personally I find that it is best to advise patients to use the diet drinks in moderation. Diet drinks are helpful as a meal accompaniment or as an accompaniment to a high protein low carb snack bar. It helps with the feeling of satiety.

The FDA has established an “acceptable daily intake” (ADI) for each sweetener. This is the maximum amount considered safe to consume each day over a lifetime.

Artificial Sweetener

ADI*

Aspartame (NutraSweet, Equal)

50 milligrams (mg) per kilogram

Saccharin (Sweet’N Low, SugarTwin)

5 mg per kg

Acesulfame K (Sunett, Sweet One)

15 mg per kg

Sucralose (Splenda)

5 mg per kg

Neotame

18 mg a day

 
There are several websites with more in depth information about artificial sweeteners. There is even some evidence (yet to be proved) that some artificial sweeteners have specific health benefits.  One health benefit that I know to be true is that it does help some people stick to a weight loss diet when used in moderation.
 
It will be interesting to see what our other colleagues have to say
Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised

I think it's an oxymoron to say "healthy" diet sodas!  There's nothing healthy about the chemicals, the bone draining phosphoric acid, and such. 

 

With new products out like Zevia and Virgil ZERO sodas, sweetened with stevia or erythritol, there's no reason to have patients drink typical diet pops.  Another study published this week again showed typical diet drinks increased weight gain in folks who drink them.  Not sure if that happens with the Zevia or Virgil Zero sodas, but still want folks to drink those instead.  Also, people can make lemonade with water, lemons and stevia.  Sun tea with herbal teas (my favorite--Tazo Passion tea).  There are so many other options than diet drinks.

Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised

Hi Mona

Thank you for your input. You always have such fabulous ideas,
Except for lemonade with water, lemons and stevia,I have never heard of the drinks that you suggest. I will try to find them , and if I do, I will surely try them.

Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised

Hello, Patricia,

 

Thanks!

 

Zevia comes in many flavors such as "cola", black cherry, orange, ginger ale, etc.  It's in cans.

 

Virgil ZERO soda (I find them at Whole Foods here in Mesa, AZ) is bottled and is seriously good root beer or vanilla creme soda. 

 

If we give patients other ideas (although half their body weight in water should of course be the first focus of beverage intake a day), they welcome them.


Oh! Another great idea is buying a home carbonator unit such as from Sodastream usa. I have one of these.  You then self-carbonate your own 1 liter of water and then can add drops from Sweetleaf Stevia, which comes in many flavors, and make your own "diet pop".  Or you can add lemon, cucumber, or orange slices, or lime, or I like to just drink it plain. 

 

Mona

Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised

Patricia and Dr Morstein, thank you for your comments.

Dr Morstein, I am with you re: intake of diet sodas. We have much healthier drinks to quench our thirst with and take in as part of our meals.. There is nothing wrong with various teas such as mint or green, lemonade, infused water, ice water, certain vegetable juices(such as low-sal/low carbt tomato or V-8), kefir and good old milk- the last four/ in small amounts . Thank you. Isabella Wiznitzer, RN/CDE

Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised

Hi Mona
Very interesting ideas.
I just went to the soda stream website, and found there are many models.  Which model do you have? How long does the carbonator cartridge last?

Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised

I heard about this presentation at the ADA meeting and plan to watch the replay.  I am interested to hear what they have to say.  I think moderation in all things is the best medicine.  

Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised

Micki, unfortunalety many people don't understand the concept of moderation. People rationalize they can eat more (a lot more) because they are drinking a diet drink . Thank you. Isabella

Re: Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised
Quote:

Micki, unfortunalety many people don't understand the concept of moderation. People rationalize they can eat more (a lot more) because they are drinking a diet drink . Thank you. Isabella


So true.  And that my be why these studies show that people who drink diet soda have higher rates of wt gain, obesity, and in-turn disease.  They may not be the cause, but a contributing factor in a round about way.  

Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised

 Micki, a colleague of mine(a neurologist) had the following to say about the content of this post:

"There is mounting evidence to suggest these sweeteners act on the satiety center producing CBH cravings,- thus weight gain indirectly". So according to his statement there is a cause and effect relationship here. I do agree, however, that diet sodas and artificial sweeteners are significant contributors to people's ballooning calories and waists as well.  Also,  this was a large population-based study with an average follow-up time of 9.5 years. We can't exactly ignore the statistics either .Thank you. Isabella

Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised

Everyone's comments are valid.

 I think the most important thing to do is assess the patients who come to us for assistance. There are always some who do not understand what moderation is; we can help them understand exactly what moderation would mean by assessing what their usual eating and drinking habits are...and making recommendations to moderate the use of artificial sweeteners if they do not want to stop them all together.

  Then there are those patients who do understand what moderation is. I always start my recommendations to patients by asking them what they want to work on first, then second, etc.  Nobody is going to change all their habits overnight. That is why consultation as needed along the continuum of a patient's life is so important.  If a patient never drinks diet soda, I certainly do not encourage them to start. If they enjoy 2 or 3 glasses a day, the goal of changing to drinking something else can be a future one while they concentrate on a more urgent goal needed to achieve glycemic control.

Re: Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised
Quote:

 Micki, a colleague of mine(a neurologist) had the following to say about the content of this post:

"There is mounting evidence to suggest these sweeteners act on the satiety center producing CBH cravings,- thus weight gain indirectly". So according to his statement there is a cause and effect relationship here. I do agree, however, that diet sodas and artificial sweeteners are significant contributors to people's ballooning calories and waists as well.  Also,  this was a large population-based study with an average follow-up time of 9.5 years. We can't exactly ignore the statistics either .Thank you. Isabella


I would never ignore evidence.  In addition, I am not going to hang a cause and effect relationship on the statements of professionals.  I am content to watch the evidence as it develops.  I agree there must be 'something' going on with artificial sweeteners because they keep showing up in the literature and media.  But I'm not exactly sure what that 'something' is yet.  

Patricia, thanks for your comments about focusing on urgency first.  If I have a patient who was drinking regular soda who has now switched to diet soda and is not ready to switch to no soda then I am content to work on a topic of interest to them at the time.  

I choose to 'pick my battles' and not lose the patients interest by pushing too much change too quickly upon them.  

Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised

 Wow, this is turning into quite a discussion!
 Thank you for the thought-provoking statements and suggestions. At the end of the day it's all about patient empowerment and having people with diabetis own their condition and manage it successfully....with or without diet soda and artificial sweeteners as part of their daily meal plan.

Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised

I am very hesitant to believe these studies as very accurrate becuase I don't think you can say it is the diet soda that makes the waist circumference increase.  Because, as I see it, you drink diet soda most likely either becasue #1 you are already overweight or #2 you know someone close to you who is diabetic (ie a family member).  Either way, the study is biased from the start because these are people who are prone to increase their weight circumference.

They would have to control what the people eat aside from the diet sodas to truly establish anything in my mind.  I have to read/look at the mice study to fully evaluate that.  But, I have great suspicion of these studies because they obviously go into them knowing the answer they want to find out.  I am a type 2 diabetic who has managed to keep my weight at 144 for a 5"8 height drinking diet sodas well out of moderation.  I endeavour more to decrease my consumption out of concern for caffiene than any thing else.

OK on to other suggested drinks in this discussion (other than water of course!):

Stevia sweetened drinks: my daughter and I have tried almost every one on the market and have found none that have a good taste or at least don't have a very strong aftertaste.  (our personal opinion of course, but it gets expensive if you have to buy a 6 pack.)

Lemonade made with lemons:  lemons still have quite a bit of sugar< they only taste bitter because of other chemicals that are present.

Kefir and Milk:  (especially if using low fat) very high in sugar.  we can use low fat milk to raise our BG in a pinch.

Vegetable juices:  again very high in sugar.  eeven if juicing yourself.  I just had one person who had started juicing and who got to a point where she had difficulty walking.  She went in, only to find out that her HBA1C had gone up and when she stopped juicing, the symptoms went away.

So actually, other than water or straight alcohol, I don't see any other safe alternatives.

Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised

Carole, thank you for your comment. I agree that only modest amounts of milk, kefir and lower carb/salt tomato juice or V8 should be taken in...preferably as a part of one's meal and not as a thirst quencher. Water is a winner indeed!

Re: Promotion of Diet Sodas and Artificial Sweeteners as Healthy Alternatives may be Ill-advised

I'll be really interested to see where the research goes on the topic of sugar substitutes and body weight - including sugar substitutes that are made from stevia. I always describe nutrition as a continuum, not an absolute, to my clients. For example, water is on one end of the continuum, and sugar-sweetened beverages are at the other end. Inbetween are a whole bunch of different choices. I encourage my clients to move from the negative end toward the positive end - they don't have to jump all the way to the positive side in one moment, and instead can make gradual progress. They also may decide that they've reached their tolerance/acceptance someplace in the middle. People seem to get this description, and it empowers them to make choices - which is exactly my goal.

Sometimes people tell me they've switched from regular to diet soda - and I see that as a positive step. Others may decide to decrease the amount of diet soda they drink in favor of more water - again, a positive step. I honestly think there's room for a whole bunch of different choices and options, and that there is a lot of individual variability involved.