The trend of mixing alcohol with diet soda has gained traction among individuals seeking to reduce their caloric intake while still enjoying alcoholic beverages. However, emerging research suggests that this seemingly harmless combination may have unintended consequences on blood alcohol concentration (BrAC) and overall health. This article explores the potential health effects of drinking alcohol with diet soda, examining the impact on BrAC, liver health, and other associated risks.
Impact on Breath Alcohol Concentration (BrAC)
Studies indicate that alcohol consumed with an artificially sweetened mixer, such as diet soft drink, results in higher breath alcohol concentrations (BrACs) compared to the same amount of alcohol consumed with a similar beverage containing sugar.
Laboratory Studies
One laboratory study examined gastric emptying time and alcohol absorption for artificially sweetened versus regular mixers. Eight male subjects were administered vodka twice in randomized order, with the vodka being mixed with either a sucrose beverage or a diet mixer on each test session. Peak blood alcohol concentration was found to be greater following consumption of the diet alcoholic drink (0.053 g%) compared to the regular drink (0.034 g%). Gastric half-emptying time (using ultrasound) was recorded and found to be faster for the diet drink compared to the regular drink.
In a controlled experiment, sixteen participants (of equal gender) were recruited to participate in three sessions where they received 1.97 ml/kg vodka mixed with 3.94 ml/kg diet Squirt, 1.97 ml/kg vodka mixed with 3.94 ml/kg Squirt, and a placebo beverage in random order. BrACs were recorded, as were self-reported ratings of subjective intoxication, fatigue, impairment and willingness to drive. The results showed that BrACs were significantly higher in the alcohol + diet beverage condition compared with the alcohol + regular beverage condition. The mean peak BrAC was 0.091 g/210 L in the alcohol + diet condition compared to 0.077 g/210 L in the alcohol + regular condition. Cued go/no-go task performance indicated the greatest impairment for the alcohol + diet beverage condition. Subjective measures indicated that participants appeared unaware of any differences in the two alcohol conditions, given that no significant differences in subjective ratings were observed for the two alcohol conditions.
Field Studies
Supporting these findings, a field study conducted in bars revealed a significant association between BrAC and the number of diet cola-mixed drinks consumed. The greater the number of diet drinks mixed with alcohol, the greater the BrAC recorded. Rossheim and Thombs (2011) reported that the BrAC was significantly associated with the number of diet cola-mixed drinks.
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Mechanism
The mechanism behind this phenomenon may be related to how the presence or absence of sugar affects alcohol absorption and metabolism. The presence of food, or in this case, a sugar-sweetened beverage, delays stomach emptying, thus reducing BrAC. It appears that a regularly sweetened beverage might be treated by the stomach somewhat like food.
Potential Risks and Implications
Increased Risk of Impairment
The elevated BrAC levels resulting from mixing alcohol with diet soda may lead to greater behavioral impairment. Although individuals may not be aware of the differences in BrAC, higher BrAC levels are likely associated with increased impairment.
Underestimation of Intoxication
Studies have demonstrated that individuals have difficulty assessing their BrAC level. Underestimations of BrAC can be associated with an increased willingness to drive a car, which is a major safety concern.
Liver Health Concerns
Emerging research suggests that both sugar-sweetened and artificially sweetened beverages may pose risks to liver health. A study analyzing data from over 103,000 participants found that daily consumption of both types of beverages was associated with a significantly higher risk of MASLD (Metabolic Associated Steatohepatitis), formerly known as nonalcoholic fatty liver disease. Surprisingly, diet versions were tied to a greater risk of dying from liver-related causes.
Potential Impact on Women's Health
Women are more likely to be consumers of diet beverages. Women are also more likely to experience harms associated with alcohol consumption when compared to men. The combination of these factors raises concerns about the potential impact on women's health, especially in cases of unplanned pregnancies and the risk of Fetal Alcohol Syndrome (FAS).
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Considerations for Standard Drink Calculators
The findings of these studies need to be applied to standard drink calculators used by consumers to estimate BrAC. The differences of up to 25% higher BrAC levels may impact those consumers who think they are safe to drive when they are not.
Recommendations
Limit Consumption of Sugary and Diet Drinks
Experts recommend limiting both sugary and diet drinks and opting for water, coffee, or tea instead.
Be Aware of BrAC Levels
Individuals who choose to consume alcohol with diet soda should be aware of the potential for elevated BrAC levels and exercise caution.
Consider the Risks
Given the potential health risks associated with both sugary and diet drinks, it is important to consider the overall impact on health and make informed choices.
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