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Can diet soda ruin your diet?

Evidence is still quite mixed when it comes to diet soda effects on weight loss (or gain). Observational evidence often contradicts with trial evidence. This study adds to the body of evidence, specifically on those with type 2 diabetes.

Study under review: Beneficial effects of replacing diet beverages with water on type 2 diabetic obese women following a hypo-energetic diet: A randomized, 24-week clinical trial.

Introduction

When it comes to weight loss, eliminating sugar-sweetened beverages (SSBs) is low-hanging fruit. However, research isn’t clear on the impact of replacing these with diet beverages flavored with artificial sweeteners. As shown in Figure 1, these sweeteners interact with taste buds to produce a sweet sensation, yet they don’t provide substantial energy to the body like sugar would.

Figure 1: Sweetener and taste bud interactions

Adapted from: Fernstrom et al. J Nutr. 2012 Jun.

Artificial sweeteners, like aspartame, saccharin, and sucralose, have been the subject of nutrition debates for years. Trials that examine the effect of diet beverages versus water on weight regulation show mixed results, with at least one showing a benefit[1] for diet beverages, while another shows no difference[2]. Observational studies on artificial sweeteners, also called non-nutritive sweeteners or NNS, frequently show associations between NNS and obesity or diabetes[3].

So, other researchers have tried to determine why artificial sweeteners aren’t a surefire trick for easier weight loss. Some theorize that artificial sweeteners act on the brain and increase our desire[4] for sweeter foods. Others theorize that dieters reward themselves with more calorie-dense treats when they choose diet sodas rather than sugary treats. Recently, scientists have questioned whether artificial sweeteners affect the microbiome[5] and prevent weight loss by affecting gut bacteria.

But the varied scientific outcomes still leave questions unanswered. What’s the bottom line ... are diet drinks a poor choice for weight loss? And if they are, why? Like everything else, it may depend on the context.

In the study under review, researchers wanted to examine how diet soda may differentially affect the weight loss of adult women with diabetes. Researchers assigned one group of women to a diet that included diet soda and a second group that did not. Weight loss, metabolic markers, and other surrogate health markers were examined.

In a previous study[6], researchers found a slight beneficial effect of replacing diet beverages with water in obese women without diabetes on a low calorie diet plan. In the current study, researchers wanted to examine whether they would see the same effects in women with obesity and type II diabetes.

Artificial sweeteners, and diet beverages in general, remain controversial in the nutrition community, despite the low calorie count. Observational studies show correlations between diet soda intake, weight gain, and metabolic syndrome that could prevent health professionals from recommending them. A previous study by the same authors found that obese women who replaced diet beverages with water had improved weight loss. The current study examines whether the addition of diet soda or water has an effect on women with diabetes enrolled in a weight loss study.

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