Does Diet Soda Increase Stroke Risk as Much as Regular Soda?

Does Diet Soda Increase Stroke Risk as Much as Regular Soda?
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Sugar is no longer considered just empty calories, but an independent risk factor for cardiovascular disease. So what happens if you switch to artificial sweeteners?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Recommendations to limit sugar consumption vary around the globe, with guidelines ranging from “Limit sweet desserts to one every other day” to “Keep sugar consumption to 4 or less occasions per day.” In the U.S., the American Heart Association is leading the charge, “proposing dramatic reductions in the consumption of soft drinks and other sweetened products.” They recommend sticking to under about 5% of calories a day from added sugars, which may not even allow a single can of soda.

Why the American Heart Association? Because the “[o]verconsumption of added sugars has long been associated with an increased risk of cardiovascular disease”— meaning heart disease and strokes. We used to think that added sugars were just “a marker for [an] unhealthy diet.” At fast food restaurants, people are probably more likely to order a cheeseburger with their super-sized soda than a salad.

But the new thinking is that no, the added sugars in processed foods and drinks may be “an independent risk factor” in and of themselves—worse than just empty calories, but actively disease-promoting calories, based on data like these.

This is how much sugar the American public is eating. Only about 1% meet the American Heart Association recommendation to push added sugar consumption to 5 or 6% of your daily caloric intake. Most people are up around 15%, and that’s where cardiovascular disease risk starts to take off, with a doubling of risk at 25% of calories, and a quadrupling of risk for those getting a third of their daily caloric intake from added sugar.

We went from eating seven pounds of sugar every year 200 years ago, to 50 pounds, to now over 100 pounds of sugar. We’re hardwired to like sweet foods, because we evolved surrounded by fruit—not Fruit Loops. But, this adaptation is “terribly misused and abused” today, hijacked by the food industry for our pleasure, and their profits.

“Why Are We Consuming So Much Sugar Despite Knowing [How] Much [it] Can Harm Us?” Well, yes, it may have an addictive quality. Yes, there’s that hard-wiring. But, the processed food industry isn’t helping.

75% of packaged food products in the United States contain added sweeteners, mostly coming from sugar-sweetened beverages, like soda, thought responsible for more than a hundred thousand deaths worldwide, and millions of years of healthy life lost.

No problem, why not just switch to diet? By choosing diet soda, can’t we get the sweet taste we crave, without the downsides? Unfortunately, “[r]outine consumption of diet soft drinks is [associated with] increases in the same risks that many seek to avoid by using artificial sweeteners.”

Here’s what studies have found for the increased risk of cardiovascular disease associated with regular soda, and here’s the cardiovascular risks associated with diet soda. “In other words, the belief that [switching to diet soda will] reduce long-term health risks is not [well] supported by scientific evidence, and instead…may contribute to the very health risks people [were] seeking to avoid” in the first place.

But why? I mean, it makes sense why drinking all that sugar might increase stroke risk, with the extra inflammation and triglycerides. But why, in this pair of Harvard studies, did a can of diet soda appear to increase stroke risk the same amount? Yes, maybe the caramel coloring in brown sodas, like colas, may play a role. But, another possibility is that “artificial sweeteners may increase the desire for sugar-sweetened, energy-dense beverages/[and] foods.”

See, the problem with artificial sweeteners “is that [there’s] a disconnect [that] ultimately develops between the amount of sweetness the brain tastes and how much [blood sugar] ends up coming [up] to the brain.” The brain feels cheated, and “figures you have to eat more and more and more sweetness in order to get any calories out of it. As a consequence, at the end of the day, your brain says, ‘OK, at some point I need some [blood sugar] here.’ And then, you eat an entire cake, because [nobody] can hold out in the end.”

If you give people Sprite, Sprite Zero, or unsweetened carbonated lemon-lime water, and you don’t tell them what is what, and what the study’s about, and then, later on, you offer them a choice; they can have M&Ms, spring water, or sugar-free gum. Guess who picks the M&Ms? Those that drank the artificially-sweetened soda were nearly three times more likely to take the candy than either those that consumed the sugar-sweetened drinks or the unsweetened drinks. So, it wasn’t a matter of sweet versus non-sweet, and it wasn’t a matter of calories versus no calories. There’s something about noncaloric sweeteners that tricks the brain.

Then, they did another study in which everyone was given Oreos, and they asked people how satisfied the cookies made them feel. And again, those that drank the Sprite Zero (the artificially-sweetened Sprite) reported feeling less satisfied than either the normal Sprite or the sparkling water. “These results are consistent with recent [brain imaging] studies demonstrating that regular consumption of [artificial sweeteners] can alter the neural pathways responsible for the [pleasure] response to food. The only way [to] really prevent this problem – to break the addiction – is to go completely cold turkey and go off all sweeteners” – artificial, as well as [table sugar, and high fructose corn syrup]. Eventually, the brain resets itself, and you don’t crave it as much.”

We’ve always assumed that “[c]onsumption of both sugar and artificial sweeteners may be changing our palates or taste preferences over time, increasing our desire for sweet foods. Unfortunately, the data on this [were] lacking”—until now.

Twenty folks “agreed to cut out all added sugars and artificial sweeteners for 2 weeks,” and afterwards, “95%…found that sweet foods and drinks tasted sweeter or too sweet, and…said moving forward they would use less or even no sugar” at all. And most “stopped craving sugar” within the first week; “6 days.”

This suggests a two-week sugar challenge, or even one week, may “help to reset taste preferences, and make consuming less or no sugar easier.” And so, maybe we should be recommending it to our patients. 

“Eating fewer processed foods and choosing more real, whole, [and] plant-based foods make it easy to consume less sugar.”

Please consider volunteering to help out on the site.

Image credit: SimonQ via flickr. Images have been modified.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Recommendations to limit sugar consumption vary around the globe, with guidelines ranging from “Limit sweet desserts to one every other day” to “Keep sugar consumption to 4 or less occasions per day.” In the U.S., the American Heart Association is leading the charge, “proposing dramatic reductions in the consumption of soft drinks and other sweetened products.” They recommend sticking to under about 5% of calories a day from added sugars, which may not even allow a single can of soda.

Why the American Heart Association? Because the “[o]verconsumption of added sugars has long been associated with an increased risk of cardiovascular disease”— meaning heart disease and strokes. We used to think that added sugars were just “a marker for [an] unhealthy diet.” At fast food restaurants, people are probably more likely to order a cheeseburger with their super-sized soda than a salad.

But the new thinking is that no, the added sugars in processed foods and drinks may be “an independent risk factor” in and of themselves—worse than just empty calories, but actively disease-promoting calories, based on data like these.

This is how much sugar the American public is eating. Only about 1% meet the American Heart Association recommendation to push added sugar consumption to 5 or 6% of your daily caloric intake. Most people are up around 15%, and that’s where cardiovascular disease risk starts to take off, with a doubling of risk at 25% of calories, and a quadrupling of risk for those getting a third of their daily caloric intake from added sugar.

We went from eating seven pounds of sugar every year 200 years ago, to 50 pounds, to now over 100 pounds of sugar. We’re hardwired to like sweet foods, because we evolved surrounded by fruit—not Fruit Loops. But, this adaptation is “terribly misused and abused” today, hijacked by the food industry for our pleasure, and their profits.

“Why Are We Consuming So Much Sugar Despite Knowing [How] Much [it] Can Harm Us?” Well, yes, it may have an addictive quality. Yes, there’s that hard-wiring. But, the processed food industry isn’t helping.

75% of packaged food products in the United States contain added sweeteners, mostly coming from sugar-sweetened beverages, like soda, thought responsible for more than a hundred thousand deaths worldwide, and millions of years of healthy life lost.

No problem, why not just switch to diet? By choosing diet soda, can’t we get the sweet taste we crave, without the downsides? Unfortunately, “[r]outine consumption of diet soft drinks is [associated with] increases in the same risks that many seek to avoid by using artificial sweeteners.”

Here’s what studies have found for the increased risk of cardiovascular disease associated with regular soda, and here’s the cardiovascular risks associated with diet soda. “In other words, the belief that [switching to diet soda will] reduce long-term health risks is not [well] supported by scientific evidence, and instead…may contribute to the very health risks people [were] seeking to avoid” in the first place.

But why? I mean, it makes sense why drinking all that sugar might increase stroke risk, with the extra inflammation and triglycerides. But why, in this pair of Harvard studies, did a can of diet soda appear to increase stroke risk the same amount? Yes, maybe the caramel coloring in brown sodas, like colas, may play a role. But, another possibility is that “artificial sweeteners may increase the desire for sugar-sweetened, energy-dense beverages/[and] foods.”

See, the problem with artificial sweeteners “is that [there’s] a disconnect [that] ultimately develops between the amount of sweetness the brain tastes and how much [blood sugar] ends up coming [up] to the brain.” The brain feels cheated, and “figures you have to eat more and more and more sweetness in order to get any calories out of it. As a consequence, at the end of the day, your brain says, ‘OK, at some point I need some [blood sugar] here.’ And then, you eat an entire cake, because [nobody] can hold out in the end.”

If you give people Sprite, Sprite Zero, or unsweetened carbonated lemon-lime water, and you don’t tell them what is what, and what the study’s about, and then, later on, you offer them a choice; they can have M&Ms, spring water, or sugar-free gum. Guess who picks the M&Ms? Those that drank the artificially-sweetened soda were nearly three times more likely to take the candy than either those that consumed the sugar-sweetened drinks or the unsweetened drinks. So, it wasn’t a matter of sweet versus non-sweet, and it wasn’t a matter of calories versus no calories. There’s something about noncaloric sweeteners that tricks the brain.

Then, they did another study in which everyone was given Oreos, and they asked people how satisfied the cookies made them feel. And again, those that drank the Sprite Zero (the artificially-sweetened Sprite) reported feeling less satisfied than either the normal Sprite or the sparkling water. “These results are consistent with recent [brain imaging] studies demonstrating that regular consumption of [artificial sweeteners] can alter the neural pathways responsible for the [pleasure] response to food. The only way [to] really prevent this problem – to break the addiction – is to go completely cold turkey and go off all sweeteners” – artificial, as well as [table sugar, and high fructose corn syrup]. Eventually, the brain resets itself, and you don’t crave it as much.”

We’ve always assumed that “[c]onsumption of both sugar and artificial sweeteners may be changing our palates or taste preferences over time, increasing our desire for sweet foods. Unfortunately, the data on this [were] lacking”—until now.

Twenty folks “agreed to cut out all added sugars and artificial sweeteners for 2 weeks,” and afterwards, “95%…found that sweet foods and drinks tasted sweeter or too sweet, and…said moving forward they would use less or even no sugar” at all. And most “stopped craving sugar” within the first week; “6 days.”

This suggests a two-week sugar challenge, or even one week, may “help to reset taste preferences, and make consuming less or no sugar easier.” And so, maybe we should be recommending it to our patients. 

“Eating fewer processed foods and choosing more real, whole, [and] plant-based foods make it easy to consume less sugar.”

Please consider volunteering to help out on the site.

Image credit: SimonQ via flickr. Images have been modified.

Doctor's Note

Speaking of stroke, did you see the last video? Chocolate & Stroke Risk

This is part of an extended video series on added sugars. Check out a few of the others:

I’ve previously touched on artificial and low-calorie sweeteners if you’re interested:

In 2020, I did a new video on added sugar: The Recommended Added Daily Sugar Intake

If you haven’t yet, you can subscribe to my videos for free by clicking here.

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