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Are diet drinks really a sweet deal?

Diet drinks using low-energy sweeteners are supposed to help with weight loss. But some research has suggested that they could actually stimulate appetite and food intake. This study explores the issue.

Study under review: Beverages containing low energy sweeteners do not differ from water in their effects on appetite, energy intake and food choices in healthy, non-obese French adults

Introduction

A high intake of sugar[1], and sugar-sweetened drinks in particular, is associated with a higher calorie intake and weight gain. Therefore, low-energy sweeteners[2] (LES) such as aspartame, acesulfame-K, neotame, saccharin, sucralose, and stevia are used to reduce the sugar and calorie content of various food and drinks, while maintaining sweetness. These products are often sold as ‘diet’ or ‘low calorie’ options. This is becoming increasingly common[3] due to worldwide efforts to tackle public health concerns such as obesity and excess sugar intake.

On the other hand, there are concerns[4] that using LES may cause weight gain by interfering with metabolism, taste receptors, hormone secretion, gut bacteria, and thought patterns related to rewards and taste. There have also been suggestions that LES may increase appetite[5] by stimulating a sweet taste without providing the same amount of energy as sugar. However, much of this research is observational. For example, a study from Texas[6] found that adults who consumed more than 21 artificially sweetened drinks per week had almost twice the risk of being overweight or obese as compared with adults who didn’t consume these drinks. Although many factors, including dieting, were adjusted for in this study, there is still a risk that observational studies such as this are affected by outside factors, aside from LES themselves.

To date, there is no strong evidence[7] in human studies that LES stimulate appetite. For example, one randomized trial[8], in which sugar-sweetened beverages were substituted with either water or diet drinks (sweetened with LES), found that there was no significant difference in calorie reduction between the groups. Furthermore, a recent systematic review[9] of animal and human studies found that replacing sugar with LES leads to reduced energy intake and bodyweight in children and adults. You can see the shorter and longer term effects of LES vs. water found in this review in Figure 1. Some studies in the review also found that diet drinks containing LES had the same effect as water on energy intake and bodyweight. However, this was less clear than the evidence which compared diet drinks to sugary drinks.

Therefore, the study under review looked at whether there was any difference when a diet drink containing LES was consumed at mealtimes, as compared with water. Researchers examined whether this affected appetite, energy intake or food intake (including preferences for sweet or savoury foods) by the end of the study.

Low energy sweeteners (LES) are used in diet drinks to reduce the amount of sugar and energy. It is thought that this is a helpful way of reducing overall energy intake and promoting a healthy weight, but there is some disagreement about this. This study compared the intake of diet drinks, which contained LES, with water, to determine whether this would affect appetite, energy intake, or food intake.

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