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The Skinny on Diet Sodas + Poll

Patients often ask me how they can lose weight. As we discuss the balance between their caloric expenditure versus their caloric intake, the subject of beverages inevitably arises.

For now, let’s skip the whole caffeine subject. I won’t even focus on the regular calorie soft drinks sweetened with high fructose corn syrup. (That one’s really a no-brainer.)
Let’s just consider the commonly misunderstood topic of diet sodas.

I was taught in medical school not to “drink” your calories. High-calorie drinks are too quickly absorbed, don’t have enough fiber, raise blood sugar, spike insulin, and then cause reactive hypoglycemia. How, then, does the low calorie or no calorie artificially sweetened drink fit into all this? It’s confusing.

Here in the United States the Food and Drug Administration (FDA) has approved the use of six different artificial sweeteners: stevia, aspartame, sucralose, neotame, acesulfame potassium, and saccharin. Each one is many times sweeter than sugar and can be used in small doses to sweeten products, making their caloric contribution negligible. Each is used in various foods based on the chemical’s innate characteristics, such as stability to heat, aftertaste, texture, etc.

These products have been the source of intensive controversy regarding their potential health risks. Artificial sweeteners have been blamed for causing everything from impotency to cancer. Hundreds of toxicological, clinical, and post marketing studies have been performed and reviewed in detail trying to establish a link to any of these adverse side effects. Here’s what the literature shows: when used in accordance with established FDA guidelines, these products are considered safe for consumption as long as the volume is kept within the recommended acceptable daily intake (ADI). Each ADI varies based on which artificial sweetener is used. There are over 100 regulatory agencies from numerous countries around the world that concur with the safety of these additives.

Diet sodas are okay then, right? Not quite. Now, I know what you’re thinking, “Dr. Boud—don’t mess with this one. It’s the one vice I’m allowed.”

I agree that there are worse things to get hooked on. But the reality is that several studies show that drinking diet sodas doesn’t really help with weight loss. There are several theories on why this occurs. One is based on the brain’s response to the sweetness in diet sodas, which triggers a craving of more calories and more sugar. This perpetuates itself, and you keep on eating and drinking until your intake of calories exceeds your expenditure of calories.

It becomes very easy to lose track of the amount you drink during the day. Do you really have any idea how much volume you are putting down the hatch? Recently a patient told me it’s cheaper for her to fill up a 64-ounce jug of soda every morning at the gas station than to buy a smaller 12-ounce can—and she gets to just sip it throughout the work day. Besides it keeps her awake.

I’ll let you guess what health problem she was in to talk to me about.

Despite not having many calories, diet sodas still have a known association with increased weight, diabetes, hypertension, and, most recently, stroke risk. One theory for this is the body’s reactive release of the hormone insulin when it recognizes the sweet taste in artificially sweetened products. Insulin is a storage hormone and will put circulating glucose into storage (a.k.a. fat cells) causing a paradoxical drop in blood sugar. This then can stimulate appetite, promote further carbohydrate cravings, and cause you to seek out high calorie snacks for quick energy. Either way, diet or non-diet, you end up having an insulin surge with a resulting hypoglycemic crash, leaving you feeling tired and grumpy, with increased difficulty concentrating. The only way to avoid this roller coaster ride is to constantly keep your blood sugar up—which just leads to more empty calories, higher circulating insulin levels, and presto—you’re a typical overweight American.

So what do we do? I like the principle of moderation. It’s good for us to cut back on our regular full-calorie beverages. It’s even better to limit our consumption of diet sodas. I believe it’s best to focus on good old H2O. Let that be our drink of choice.

Now let’s get healthy!

—Dr Boud

Thomas J. Boud, MD, is board certified in family medicine and practices in Salt Lake Valley. He is also a volunteer physician for the Church’s Missionary Medical Department and cares for the health care of many of the local fulltime missionaries. He is an avid runner, having completed more than 50 full marathons. He is married to a very patient wife and has six beautiful children, two of which are currently serving full-time missions.

How often do you drink diet soda?

Never
Rarely
Occasionally
Often
Every day
Several times a day—I'm addicted!

Do you think diet soda is healthier than regular soda?

Yes
No
I'm not sure

If you had the choice, which would you drink?

Diet soda
Regular soda
Water
Juice
Other