Since sweeteners are known to be passed on in small amounts via the placenta and breast milk, we asked whether...
Kimber L. Stanhope, Ph.D., M.S., R.D.
Research Nutritional Biologist
Department of Molecular Biosciences: SVM
University of California, Davis
MedicalResearch.com:? What are the main findings of this study?
Response: Sugar-sweetened beverages increase risk factors for cardiometabolic disease compared with calorically-equal amounts of starch.
We are not the first group of experts to reach this conclusion. The Nutrition and Chronic Diseases Expert Group reached a similar conclusion last year (Micha, 2017). Yet very different conclusions/opinions are being still being published by other researchers. (Latest example: Archer E., In Defense of Sugar: A Critique of Diet-Centrism. Progress in Cardiovascular Disease, May 1, 2018).
These conflicting conclusions confuse the public and undermine the implementation of public health policies, such as soda taxes and warning labels, that could help to slow the epidemics of obesity and cardiometabolic disease. We hope that the careful review of the evidence and the discussion of issues that can lead to conflicting opinions in nutrition research in this paper will help to clarify this issue.
Consumption of polyunsaturated (n-6) fats, such as those found in some vegetable oils, seeds, and nuts, lowers disease risk when compared with equal amounts of saturated fats.
It is important to note however, that the effects of saturated fat can vary depending on the type of food. Dairy foods such as cheese and yogurts, which can be high in saturated fats, have been associated with reduced cardiometabolic risk.
The non-caloric sweetener aspartame does not promote weight gain in adults.
Aspartame is the most extensively studied of the non-caloric sweeteners. None of the dietary intervention studies that have investigated the effects of aspartame consumption have shown it promotes body weight gain.
This includes studies in which the adult research participants consumed aspartame for 6 months, 1 year or 3 years.
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MedicalResearch.com Interview with:
Dr Nita Forouhi, MRCP, PhD, FFPHM
MRC Programme Leader and Consultant Public Health Physician
MRC Epidemiology Unit
University of Cambridge School of Clinical Medicine
Cambridge Biomedical Campus
Cambridge UK
Medical Research: What is the background for this study? What are the main findings?
Dr. Forouhi: Consumption of soft drinks is known to cause obesity and may contribute to the development of type 2 diabetes. We had previously published findings from the EPIC-InterAct study in 8 European countries that habitual consumption of sugar sweetened beverages increases the risk of developing type 2 diabetes, and we now wanted to probe deeper to understand more about this relationship between sweet beverages and diabetes.
We conducted research in the large EPIC-Norfolk study which included more than 25,000 men and women aged 40–79 years living in Norfolk, UK. Study participants recorded everything that they ate and drank for 7 consecutive days covering weekdays and weekend days, with particular attention to type, amount and frequency of consumption, and whether sugar was added by the participants. During approximately 11 years of follow-up, 847 study participants were diagnosed with new-onset type 2 diabetes.
By using this detailed information on diet, we were able to study several different types of sugary beverages, including sugar-sweetened soft drinks, sweetened tea or coffee and sweetened milk drinks as well as artificially sweetened beverages (ASB) - such as diet soft drinks - and fruit juice, and to examine what would happen if plain water, unsweetened tea or coffee or artificially sweetened beverages were substituted for sugary drinks.
Our study provided three main findings:
First, there was an approximately 22% increased relative risk of developing type 2 diabetes per extra serving per day habitually of each of soft drinks, sweetened milk beverages and ASB consumed, even after accounting for a range of important factors including other lifestyle and social factors and for total energy intake. However, after further accounting for body mass index and waist girth as markers of obesity, there remained a higher risk of diabetes associated with consumption of both soft drinks and sweetened milk drinks, but the link with ASB consumption no longer remained, possibly because artificially sweetened beverages was likely to be consumed by those who were already overweight or obese.
Second, when we estimated the likely effects of replacing a habitual serving of soft drinks with a serving of water or unsweetened tea or coffee, we found that the risk of diabetes could have been cut by 14%; and by replacing a habitual serving of sweetened milk beverage with water or unsweetened tea or coffee, that reduction could have been 20%–25%. However, consuming ASB instead of any sugar-sweetened drink was not likely to reduce the risk of diabetes, when accounting for baseline obesity and total energy intake.
Third, we found that each 5% of higher intake of energy (as a proportion of total daily energy intake) from total sweet beverages (soft drinks, sweetened tea or coffee, sweetened milk beverages, fruit juice) was associated with a 18% higher risk of diabetes. We estimated that if study participants had reduced the energy they obtained from sweet beverages to below 10%, 5% or 2% of total daily energy, 3%, 7% or 15% respectively of new-onset type 2 diabetes cases could have been potentially avoided.
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MedicalResearch.com Interview with:
Susan E. Swithers PhD
Professor, Behavioral Neuroscience
Department of Psychological Sciences and Ingestive Behavior Research Center
Purdue University, 703 Third Street
West Lafayette, IN 47907, USA
MedicalResearch.com: What are the main findings of the study?
Dr. Swithers: The paper examined the last 5 years of studies that looked at risks associated with consuming artificially sweetened beverages like diet soda. These studies indicated that those who consume diet soda were at significantly greater risk for a variety of negative health outcomes like type 2 diabetes, coronary heart disease, hypertension and stroke, along with being more likely to gain excess weight. These effects might be due to a disruption of basic learned response. The idea is that normally things when things that taste sweet are consumed, the body receives calories and sugar. Our bodies can learn to prepare to deal with these calories and this sugar by starting up our digestive processes as soon as the sweet taste hits our mouth, for example by releasing hormones that not only help us regulate blood sugar, but also can contribute to feelings of fullness. When we consume diet sodas, the mouth gets the sweet taste, but the body doesn't get the calories or the sugar. The body may then learn that a sweet taste in the mouth doesn't always predict sugar and calories, so it makes adjustments in how many hormones it releases. So when we actually consume real sugar, the body doesn't produce the same kinds of physiological responses, which can lead to overeating, higher blood sugar, and over the long term could contribute to diseases like diabetes and stroke.
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