Diet soda, particularly Diet Coke, has long been marketed as a guilt-free alternative to sugary soft drinks, appealing to health-conscious individuals, athletes, and those looking to manage their weight or diabetes. However, a growing body of research suggests that diet soda may not be as harmless as it seems. While it offers a short-term cut in calories, the long-term effects on health are complex and warrant a closer look. This article delves into the potential health effects of diet coke, examining the latest research and expert opinions to provide a comprehensive overview.
The Appeal of Diet Soda
Soft drinks are known by different names in different parts of the country: soda, cola, pop, and the generic “coke,” are the most common. Diet soda has been marketed as an alternative free of sugar and calories - and the guilt and health risks that come with them. It’s often targeted at people who are health-conscious, athletes, and for those who have diabetes, or want to lose weight.
Diet soda's popularity stems from its promise of providing the satisfying sweetness and carbonation of regular soda without the calories and sugar. This has made it a go-to beverage for individuals seeking to reduce their sugar intake, manage their weight, or control blood sugar levels. However, the science behind diet soda's health effects is far from clear-cut.
The Not-So-Sweet Truth: Potential Health Risks
While diet soda avoids the high sugar content of regular soda, it introduces a new set of concerns related to artificial sweeteners and other ingredients. Here are some of the potential health effects associated with diet coke consumption:
Type 2 Diabetes Risk
New research found that knocking back just one artificially sweetened soft drink a day may increase your risk of developing type 2 diabetes. Professor Barbora de Courten said that the findings signal a need to rethink current public health strategies. Professor de Courten said the findings challenge the common belief that artificially sweetened drinks are a better option. Type 2 diabetes is a chronic condition where the body either can’t properly use insulin or doesn’t produce enough of it, causing blood sugar levels to rise.
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Two large studies found people who drank regular or diet soda had higher risks of type 2 diabetes and metabolic syndrome, which includes health conditions like high blood pressure, high blood sugar and abnormal cholesterol.
Gut Microbiome Disruption
The artificial sweeteners found in diet soda might negatively affect your gut microbiome, which is the community of beneficial bacteria in your digestive tract. According to researchers, the gut microbiome plays a key role in many aspects of health, including immune function, nutrient absorption, heart health, and more. Aspartame is one of the most common nonnutritive sweeteners in diet soda. One in vitro study of 13 individuals found that aspartame decreased production of Isobutyric acid, a type of short-chain fatty acid. Short-chain fatty acids play a role in preventing inflammatory diseases and regulating body weight. However, more studies are needed to understand how artificial sweeteners and diet soda may affect gut health in humans.
Some studies suggest that artificial sweeteners may disturb the balance of bacteria in the digestive tract, called the gut microbiome. Saccharin and sucralose in particular have been shown to dramatically alter healthy bacteria levels in the gut and may affect blood sugar control. Changes in the microbiome caused by artificial sweeteners may also inhibit some aspects of the immune system’s ability to respond to infections.
Dental Health Concerns
Although diet soda doesn’t contain sugar like regular soda, it’s still highly acidic. adults, but further research is needed. However, damage to dental enamel from acidity is not the same thing as an increased risk of cavities due to sugar content. A 2020 study found that diet soda did not promote dental cavities among children.
Diet sodas often contain phosphoric and citric acids which can erode tooth enamel. Weakened tooth enamel can lead to tooth sensitivity, pitting of the tooth’s surface and changes to the color of the teeth, giving them a chalky appearance.
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Headaches
For some people, drinking multiple servings of diet soda per day could cause headaches. This may be due to certain artificial sweeteners found in diet soda, such as aspartame. One review noted that aspartame caused symptoms like headaches and migraines in those who took aspartame pills, particularly in those with neurological or psychiatric conditions. However, the review notes that some of the studies used aspartame pills, which release more aspartame into the body than you would get from drinking it in liquid form. Some studies have also found that caffeine, which is present in some diet sodas, could cause headaches for a small percentage of people.
People who are prone to migraines may be more likely to get headaches after consuming artificial sweeteners, such as those found in diet soda.
Bone Health
Diet soda contains several compounds that may negatively affect bone health and lead to bone loss. One study found that excessive caffeine intake can negatively affect bone health. Another study found that excessive phosphoric acid consumption could lead to the same thing. Changes in Bone Density. Diet soda contains phosphorus, which may decrease bone density and increase the risk of osteoporosis, especially in older adults.
Cardiovascular Risks
One 2021 study found that regularly consuming artificial alternative sweeteners, which are present in diet soda, is associated with a risk of developing cardiovascular complications. This includes glucose intolerance and type 2 diabetes. Another study found that consumption of these sweeteners is associated with an increased risk of metabolic syndrome. Metabolic syndrome is a group of factors that, if left untreated, may increase the likelihood of developing heart disease.
Studies show that drinking just one diet soda per day may increase the risk of cardiovascular problems including AFib (irregular heartbeat) and high blood pressure.
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Increased Cravings and Weight Gain
Some research suggests that the artificial sweeteners found in diet soda may have the same effect on the food reward pathway in the brain as regular sugar. One study found that it can make food more palatable. This could lead to increased hunger and food intake. Additionally, because artificial sweeteners are significantly sweeter than regular sugar, researchers have suggested they might increase sugar cravings and dependence, making it much harder to reduce your intake. Nevertheless, research on this topic is mixed. Additional studies on diet soda and sugar cravings are needed.
Scientists have found mixed results on whether drinking diet soda is associated with weight gain. One study found that habitual, long-term diet soda consumption was linked to increased body fat, including visceral fat.
The artificial sweeteners in diet soda trigger the same response in the brain as real sugar. The moment "sweetness” is detected, it signals the body to release hormones to process the sugar. And because diet soda is hyper-sweetened, it can trigger cravings for more sweet, high-calorie foods leading to weight gain and belly fat in particular.
Stroke and Dementia
The consumption of artificial sweeteners like aspartame, has been linked to an increased risk of neurological problems like stroke and dementia.
Kidney Problems
Excessive soda consumption, diet or regular, may increase the risk of chronic kidney disease and the formation of kidney stones. Rebholz et al. studied the incidence of end-stage renal disease (ESRD) in consumers of the beverage [28]. They designed a prospective cohort study, in which participants were asked about DS consumption habits and were followed over time. Over a median follow-up of 23 years, 357 incident ESRD cases were observed. Relative to one glass/week of DS, consuming one to four glasses/week, five to seven glasses/week, and seven glasses/week, respectively, was associated with 1.08-times, 1.33-times, and 1.83-times higher risk of ESRD after adjusting multiple variables. The results were statistically significant.
Liver Issues
Research has established a strong correlation between diet soda and NFLD, which affects up to half of people.
Thyroid Function
Some studies have found that drinking diet soda can cause the thyroid gland to work less efficiently, potentially leading to increased fat storage and weight gain.
Joint Pain
The artificial sweeteners in diet soda can trigger an inflammatory response in the body and may worsen joint pain.
Cancer Risks
Food and Drug Association, has been suspected of causing health concerns, including cancer. A prospective cohort study conducted with over 90,000 patients studied the possibility of carcinogenic properties of DS [30]. In men, > one daily serving of DS increased risks of non-Hodgkin's lymphoma and multiple myeloma in comparison with men who did not consume DS.
Mental Health
Mental health and its relationship with ASB consumption were studied by different authors [20,32,36,38]. Two of the studies focused on depression (36,38). One of them was cross-sectional [36], and the other one was a case-control study [38]. Both studies consisted of large groups of patients, with more than 18,000 participants. In both studies, the majority of the patients involved were women, and the design was based on a survey evaluating coffee consumption, ASBs consumption, and major depression. They found a statistically significant association between depression and consumption of ASB, which was more apparent among women than men. Another approach evaluated the consumption of these substances in the setting of eating disorders [20,32]. They were also both cross-sectional studies. DS drinkers were more likely to report binge eating and purging than regular soda drinkers, who were more likely to report these behaviors than non-soda drinkers [32]. Individuals with eating disorders, particularly bulimia nervosa, consumed more DS than controls.
Child Neurodevelopment
A prospective cohort study done by Cohen et al. explored the relationship between ASB and child cognitive development [21]. They followed 1,234 mothers’ diets during their pregnancies and years later monitored their children’s neurodevelopment. They found that maternal DS consumption during pregnancy may adversely impact child cognition, as children's cognitive scores were inversely proportional to mothers' SSB and ASB consumption. The results were statistically significant. Interventions and policies that promote healthier diets during pregnancy, including avoiding DS, may prevent adverse effects on childhood cognition.
Cardiac Remodeling
Andersson et al., in their cross-sectional study, measured cardiac remodeling in SSB and DS consumers [19]. Despite having identified the high body weight of soda drinkers as a confounder, they found that soda consumption, especially DS, was associated with higher left atrial dimension (LAD) and left ventricular mass (LVM), compared to no soda consumption [19]. These studies allowed two conclusions to be made: DS consumption in high quantities might increase not only metabolic risks but also cardiovascular risks, which should prompt clinicians to educate patients on the regulation of ASBs.
Diabetic Retinopathy
One article was found that studied the relationship between the consumption of DS and diabetic retinopathy in the diabetic population [34]. It found statistically significant results and determined that, in diabetics, DS consumption was associated with higher glycosylated hemoglobin (HbA1c) and retinopathy, while non-caloric flavor consumption was associated with obesity. This challenges the common myth that diabetics can consume DS without harm, and questions the fact that a healthy diet in this population is based solely on the glycemic charge of meals.
Lower Urinary Tract Symptoms
Another cohort study explored the effect that ASBs have on lower urinary tract symptoms (LUTS) [26]. With statistically significant results, they found that caffeinated ASBs increased LUTS in the women’s cohort, and that citrus juice consumption diminished them in the men’s cohort. Findings support recommendations to limit caffeinated beverage intake for LUTS, and in men, they suggest the benefits of citrus juice consumption.
Hip Fractures
In a large cohort study conducted by Fung et al., [22], with a total of 73,572 female patients, it was determined that, after repeatedly assessing patients every four years for DS consumption and incident risk fractures, increased soda consumption of all types may be associated with increased risk of hip fracture in postmenopausal women. The risk was significantly elevated in consumers of both regular soda (RR: 1.19; 95% CI: 1.02, 1.38) and DS (RR: 1.12; 95% CI: 1.03, 1.21) and also did not significantly differ between colas and non-colas or sodas with or without caffeine.
Increased Breath Alcohol Concentration
A randomized controlled trial, done on 20 participants and using two different moderate alcohol doses [39], confirmed the premise that mixing alcohol with diet beverages can result in higher breath alcohol concentrations (BrAC) when compared with mixing the same amount of alcohol with sweetened beverages.
Breaking the Habit: Strategies for Reducing Diet Soda Intake
Quitting a habit is never easy, and soda of all types can be addictive. If you're looking to reduce or eliminate diet soda from your diet, here are some practical strategies:
Gradual Reduction: Instead of quitting cold turkey, gradually decrease your diet soda consumption each week. This can make the transition more manageable and sustainable.
Find Healthier Alternatives:
- Flavored Water: Add slices of cucumber, fresh or frozen fruit, herbs, or citrus fruits to plain or sparkling water for a hint of flavor without added sugar.
- Herbal Tea: Explore a variety of herbal teas, which offer different flavors and potential health benefits.
- Coconut Water: A natural source of electrolytes, coconut water can be a refreshing and hydrating alternative.
- Seltzer Water: Plain seltzer water provides the carbonation you might crave, and you can add a splash of juice for flavor.
- Kombucha: This fermented tea beverage offers a unique flavor and potential probiotic benefits.
Address Cravings:
- Stay Hydrated: Sometimes, thirst can be mistaken for cravings. Drink a glass of water when you feel the urge to reach for a diet soda.
- Distract Yourself: Engage in activities that take your mind off the craving, such as going for a walk, calling a friend, or reading a book.
Plan Ahead:
- Bring Alternatives: When you're going to be in situations where diet soda is readily available, bring your own healthy alternatives.
- Stock Up: Keep a supply of healthy drinks at home and work so you can easily make a better choice.
Avoid getting too hungry. Are you the type to skip breakfast? Do you stick to three square meals a day? That’s not setting you up for success because it makes you more likely to crave something sweet during the day.