Diet soda has long been marketed as a healthier alternative to regular, sugar-laden soft drinks. Promising the same fizzy refreshment without the calories, it has become a staple for many seeking to manage their weight or reduce sugar intake. However, emerging research suggests that diet soda may not be as harmless as it seems. While it may offer a short-term cut in calories, studies have linked its consumption to a range of potential adverse health effects. This article delves into the possible side effects of diet soda, examines the science behind these claims, and offers practical advice on how to reduce your intake.
The Sweet Deception: What's Really in Diet Soda?
Although low in calories and sugar, diet soda has no nutritional value. The primary concern surrounding diet soda lies in its artificial sweeteners. These nonnutritive sweeteners, such as aspartame, saccharin, and sucralose, provide the sweet taste without the calories of sugar. While approved for use by regulatory agencies, their impact on the body is a subject of ongoing research and debate.
Potential Health Risks Associated with Diet Soda
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. 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. Changes in the microbiome caused by artificial sweeteners may also inhibit some aspects of the immune system’s ability to respond to infections. However, more studies are needed to understand how artificial sweeteners and diet soda may affect gut health in humans. Saccharin and sucralose in particular have been shown to dramatically alter healthy bacteria levels in the gut and may affect blood sugar control.
Dental Health Concerns
Although diet soda doesn’t contain sugar like regular soda, it’s still highly acidic. 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. A 2020 study found that diet soda did not promote dental cavities among children. However, damage to dental enamel from acidity is not the same thing as an increased risk of cavities due to sugar content.
Headaches
For some people, drinking multiple servings of diet soda per day could cause headaches. People who are prone to migraines may be more likely to get headaches after consuming artificial sweeteners, such as those found in diet soda. 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.
Read also: The Truth About Diet Soda and Autism
Bone Health
Diet soda contains several compounds that may negatively affect bone health and lead to bone loss. Diet soda contains phosphorus, which may decrease bone density and increase the risk of osteoporosis, especially in older adults. 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.
Cardiovascular Complications and Metabolic Syndrome
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 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. 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. 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 have shown a link between diet soda and an increased risk for metabolic syndrome, a cluster of symptoms that may include low levels of HDL (good) cholesterol, high blood sugar, increased belly fat, high triglycerides and high blood pressure.
Increased Hunger and Sugar Cravings
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. 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. Nevertheless, research on this topic is mixed. Additional studies on diet soda and sugar cravings are needed.
Weight Gain
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.
Stroke and Dementia
The consumption of artificial sweeteners like aspartame, has been linked to an increased risk of neurological problems like stroke and dementia.
Read also: Is Diet Mountain Dew Healthy?
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.
Nonalcoholic Fatty Liver Disease (NFLD)
Research has established a strong correlation between diet soda and NFLD, which affects up to half of people.
Thyroid Function Issues
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.
Mental Health Implications
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.
Read also: Flavorful Diet Soda Review
Impact on 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.
Carcinogenic Properties
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.
Rheumatoid Arthritis
Increased risk of different chronic inflammatory diseases, such as type 2 diabetes and CVDs, have been recurrently associated with ASBs [24]; nevertheless, the relationship between ASB and rheumatoid arthritis (RA), the most common autoimmune inflammatory disease, remains uncertain. Hu et al. conducted a prospective cohort study evaluating the tendency of soda consumption and risk of developing RA in women [24]; following 79,570 women between 1980 and 2008, and 107,330 women between 1991 and 2009. Follow-up was made every four years, obtaining information from a validated food-frequency questionnaire, and finally, incident RA cases were validated by medical record review. The results showed a significant association between SSB consumption and increased risk of RA in the first cohort, but not in the second cohort; on the other hand, neither of the two cohorts showed a remarkable association between DS consumption and risk of RA.
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.
Impact on Fecundability
A prospective cohort study was done among 3,828 women planning pregnancy and 1,045 of their male partners, evaluating the association of ASB intake with fecundability; following enrolled participants for up to 12 menstrual cycles or up to pregnancy [23].
Telomere Length
Leung et al. examined, through a cross-sectional study, the associations between ASB and telomere length in a sample of 5,309 healthy adults [33].
Breath Alcohol Concentrations
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: Tips for Reducing Diet Soda Intake
There are plenty of simple steps you can take to decrease your intake of diet soda. Even though drinking a moderate amount of diet soda isn’t likely to hurt you, it has no nutritional value and offers no benefit to human consumption. If you choose to occasionally indulge in soda, it’s better to choose one made with real sugar instead of diet versions with all the chemicals and additives.
Find healthier alternatives: Start by slowly swapping it for other drinks in your diet.
- Flavored water
- Herbal tea
- Coconut water
- Seltzer water
- Kombucha
Look for versions of these drinks that either are unsweetened or have a lower sugar content. You can also try adding a splash of juice to water or seltzer. You can make flavored water by adding cucumber slices, fresh or frozen fruit, herbs like basil and mint, or citrus fruits like lime or lemon to plain or sparkling water for a hint of flavor without added sugar. Carbonation is key. Many diet soda drinkers relish the carbonation of soda even more than the sweetness. If that’s you, try putting fruit in seltzer or sparkling water to recreate soda’s bubbly appeal. There are also many flavored seltzers and sparkling waters on the market that work well as a diet soda alternative.
Stock up on healthy alternatives: It may also help to buy less soda when you go grocery shopping and stock up on healthy alternatives instead. This will make it much easier to reach for a different drink in place of diet soda when you feel thirsty. Try new things. There are a lot of alternative beverages out there. Have you tried kombucha? Coconut water? You can even get carbonated apple cider vinegar drinks these days! Just make sure you review the ingredients before you raise a toast to your new, soda-free life.
Gradual reduction: Finally, it may be easier to gradually decrease your diet soda consumption instead of cutting it out all at once. Reducing the amount of diet soda that you drink each week to make long-lasting, sustainable changes may be easier to stick with over time.
Get your caffeine somewhere else: If you crave caffeine (in moderation), you’re likely better off with plain coffee or tea. Just don’t load them up with cream and sugar!
Lifestyle changes can help: 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.
Distract yourself: If you’re suddenly struck with the urge to grab a soda, respond by doing something that isn’t drinking soda. Drink a glass of water: It’s possible you’re just thirsty. Take a 10-minute walk. Call that friend you keep meaning to catch up with. Chances are, that craving’s going to drift to the back of your mind, and eventually disappear.
Plan accordingly: Make sure you bring a soda alternative with you to the neighborhood barbecue. Have cold water or iced tea waiting for you in the fridge, so it’s easier to make a healthy choice at the end of a busy day. Anticipating cravings and planning ahead can make confronting them less taxing.