For decades, diet soda has been marketed as a guilt-free alternative to its sugar-laden counterpart. But beneath the allure of zero calories lies a complex web of potential health risks that are only now beginning to be understood. While switching from regular to diet soda may offer a short-term cut in calories, research suggests that the body reacts to certain nonnutritive foods, including the artificial sweeteners in diet soda, in ways that may actually harm health. This article delves into the latest scientific findings, exploring the potential dangers associated with diet soda consumption and offering insights into healthier alternatives.
A Sweet History: The Rise of Artificial Sweeteners
The quest for calorie-free sweetness began in 1879 with the synthesis of saccharin. Aspartame followed in 1965, paving the way for a new generation of artificial sweeteners like sucralose, acesulfame K, neotame, Stevia (rebaudioside A), and tagatose. Increased advertising and usage of artificial sweeteners are a consequence of rising concerns over the harmful health effects of sugar consumption during the past three decades. As concerns about sugar consumption grew, so did the popularity of diet soda. The global diet soda (DS) market is expected to grow at a compound annual growth rate of 3.2% from 2019 to 2025 to reach US$ 5.17 billion by 2025.
The Great Debate: ASBs vs. SSBs
Recent studies have uncovered that ASBs - much like SSBs - are linked to increased abdominal circumference, incident diabetes, and cardiovascular events. Recent research has challenged the notion that diet sodas are a healthy alternative, with some studies linking them to increased abdominal circumference, incident diabetes, and cardiovascular events. However, these findings have been controversial nevertheless, as other authors have not found the same metabolic associations. It has been determined by consensus that excess consumption of these drinks should be avoided because their impact on health beyond the metabolic aspects is unknown and is yet to be studied in depth. This has led researchers to question what other organs and systems could be affected by artificial sweeteners, and what other risks have been assessed.
Mental Health Implications
Mental health and its relationship with ASB consumption were studied by different authors. Studies have explored the link between diet soda consumption and mental well-being. Two of the studies focused on depression. One of them was cross-sectional, and the other one was a case-control study. 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. Two cross-sectional studies have suggested a correlation between diet soda consumption and eating disorders, with diet soda drinkers more likely to report binge eating and purging behaviors. 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. Individuals with eating disorders, particularly bulimia nervosa, consumed more DS than controls.
Impact on Child Neurodevelopment
A prospective cohort study done by Cohen et al. explored the relationship between ASB and child cognitive development. The potential impact of diet soda on child neurodevelopment has also been investigated. 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. The study found that maternal diet soda consumption during pregnancy may adversely impact child cognition, with children's cognitive scores inversely proportional to their mothers' consumption of both sugar-sweetened beverages (SSBs) and ASBs. Interventions and policies that promote healthier diets during pregnancy, including avoiding DS, may prevent adverse effects on childhood cognition.
Read also: Is Diet Soda Really Healthy?
Cardiovascular Concerns
While the link between diet soda and metabolic risks like obesity and diabetes has been debated, emerging evidence suggests potential cardiovascular consequences. Andersson et al., in their cross-sectional study, measured cardiac remodeling in SSB and DS consumers. 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. A cross-sectional study found that diet soda consumption was associated with higher left atrial dimension (LAD) and left ventricular mass (LVM), indicators of cardiac remodeling. 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. For individuals with diabetes, the common belief that diet soda is a harmless treat may be misguided. 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. A study found that diet soda consumption in diabetics was associated with higher glycosylated hemoglobin (HbA1c) levels and retinopathy, challenging the notion that it can be consumed without harm. 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.
Urogenital Implications
Associations between DS and the genitourinary system have been made by several authors. Several studies have explored the potential effects of diet soda on the urogenital system. Rebholz et al. studied the incidence of end-stage renal disease (ESRD) in consumers of the beverage. 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. A prospective cohort study found that higher diet soda consumption was associated with an increased risk of end-stage renal disease (ESRD). On the other hand, orange DS was believed to decrease urinary lithogenicity by increasing urine citrate excretion. A study was conducted in which participants consumed orange DS three times a day besides their regular diet to evaluate if lithogenicity changed with the consumption of this substance. They then served as their own controls. Diet orange soda increased urinary citrate excretion by 60 mg/day, which was not statistically significant. There was no significant change in pH from the control period to the study period. Another cohort study explored the effect that ASBs have on lower urinary tract symptoms (LUTS). 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. Another study found that caffeinated ASBs increased lower urinary tract symptoms (LUTS) in women, while citrus juice consumption diminished them in men.
Carcinogenic Potential
A prospective cohort study conducted with over 90,000 patients studied the possibility of carcinogenic properties of DS. The potential carcinogenic properties of diet soda have also been investigated. 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. One study found that men who consumed more than one daily serving of diet soda had an increased risk of non-Hodgkin's lymphoma and multiple myeloma.
Autoimmune Disease
Increased risk of different chronic inflammatory diseases, such as type 2 diabetes and CVDs, have been recurrently associated with ASBs; nevertheless, the relationship between ASB and rheumatoid arthritis (RA), the most common autoimmune inflammatory disease, remains uncertain. The relationship between diet soda consumption and autoimmune diseases, particularly rheumatoid arthritis (RA), remains unclear. Hu et al. conducted a prospective cohort study evaluating the tendency of soda consumption and risk of developing RA in women; 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. A study found a significant association between sugar-sweetened beverage consumption and an increased risk of RA in one cohort of women, but not in another, and no significant association between diet soda consumption and RA risk in either cohort.
Read also: Unwind with spa treatments and bar access
Bone Health
In a large cohort study conducted by Fung et al., 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. 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. 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.
Other Potential Health Impacts
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. Leung et al. examined, through a cross-sectional study, the associations between ASB and telomere length in a sample of 5,309 healthy adults. The effect of DS on the chemical loss of mineralized tooth substance was measured by a cross-sectional study that involved 2,368 male and female participants. The results revealed that high consumption of DS slightly increased the odds of dental erosion, although the relationship was not statistically significant. A randomized controlled trial, done on 20 participants and using two different moderate alcohol doses, 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.
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.
The Allure of Sweetness: Why Diet Soda Can Be Addictive
Soft drink companies have long pitched diet sodas as a healthy alternative to their full-sugar drinks, but that’s not medically accurate. Diet sodas are just as bad - but they’re just as bad in a slightly different way. They’re associated with weight gain, insulin confusion and may even change the way your brain responds to sweets in general. Quitting a habit is never easy, and soda of all types can be addictive. Although low in calories and sugar, diet soda has no nutritional value. It also contains artificial sweeteners that have been linked to adverse health effects, but research is mixed. 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.
Breaking the Habit: Strategies for Ditching Diet Soda
If your goal is better health, it’s time to kick your soda habit altogether. And that’s no small thing. Not only are many of these drinks caffeinated, but they also alter the sweet-sensing reward center of your brain. The stuff is addictive, just like sugar. If you’re ready to leave diet soda in your rearview mirror, here are a few things you can do to ease the transition:
Read also: Sweet and Savory Keto Cream Cheese
- Try alternatives to diet sodas: Flavor, caffeine, carbonation: Diet sodas bring a lot to the table. The good news is you can find all of those things in healthier beverages, too!
- 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!
- Add natural flavor to your drinks: If flavor is what made diet soda your drink of choice, try freezing raspberries, cucumber, mint, lemon or lime in ice cubes to add a hint of sweetness.
- 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.
- 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.
- 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.
- Start by slowly swapping it for other drinks in your diet: 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.
- 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.
- 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.