Many people are drinking fewer sugary soft drinks than in the past. Given the well-known hazards of sugar-sweetened beverages, this is a huge triumph for public health. However, over time, the consumption of diet soft drinks has increased. In fact, it is so high that these compounds are now commonly found in wastewater. So, what do studies indicate about how drinking them regularly affects your health over time?

‘Are diet soft drinks really a healthier alternative? While sugar-free, they can pose risks like metabolic diseases and dental erosion. Moderation is key! #health #nutrition #medindia’
      

What is the Sweetener Used in Diet Soft Drinks?

The World Health Organization (WHO) recommends that adults “limit their daily intake of free sugars to less than 10% of their total energy intake.” A further reduction to less than 5%, or approximately 25 grams (six teaspoons) per day, might bring significant health benefits (1).

However, most normal soft drinks include a lot of sugar. A standard 335 milliliter can of original Coca-Cola includes at least seven teaspoons of added sugar. Diet soft drinks are made to taste like conventional soft drinks but without the sugar. Diet soft drinks contain artificial or natural sweeteners rather than sugar (2).

Artificial Sweeteners vs. Natural Sweeteners

Artificial sweeteners include aspartame, saccharin, and sucralose. Natural sweeteners include stevia and monk fruit extract, both derived from plants (3). Many artificial sweeteners are far sweeter than sugar, thus less is required to achieve the same level of sweetness.

Diet soft drinks are marketed as healthier alternatives to ordinary soft drinks, especially for those looking to limit their sugar intake or control their weight. However, while surveys of Australian adults and adolescents demonstrate that most individuals recognize the benefits of limiting sugar consumption, they are often unaware of how diet drinks may affect overall health.

Is Aspartame a Healthy Sugar Substitute?

Food agencies worldwide, including the United States and Australia, believe artificial sweeteners in soft drinks to be safe to consume. However, some academics are concerned about the long-term effects of use (4).

People who drink diet soft drinks daily are more prone to develop certain metabolic diseases (such as diabetes and heart disease) than those who do not use them. The association was discovered even after accounting for other dietary and lifestyle factors (such as physical activity) (5).

In 2023, the WHO announced that aspartame, the primary sweetener used in diet soft beverages, was “possibly carcinogenic to humans” (carcinogenic meaning cancer-causing). Importantly, the report stated that there is insufficient current scientific data to be confident that aspartame increases the risk of cancer, although it is safe to ingest on occasion (6).

Do Diet Soft Drinks Help with Weight Loss?

Despite the word “diet” in the name, diet soft drinks have little association with weight management. In 2022, the WHO did a systematic review (a process in which researchers examine all available information on a topic) to determine whether the use of artificial sweeteners is effective for weight management. Overall, the randomised controlled trials they reviewed indicated that persons who used artificial sweeteners lost slightly more weight. Still, it does not help in the long term (7).

However, observational studies (in which no intervention is provided and participants are tracked over time) discovered that those who drink large amounts of artificial sweeteners have a higher chance of having a higher BMI and a 76% increased likelihood of being obese (8). In other words, artificial sweeteners may not directly contribute to long-term weight management. As a result, the World Health Organization advised against using artificial sweeteners to manage weight.

Animal studies have shown that consuming high quantities of artificial sweeteners might signal to the brain that it is starving for fuel, leading to overeating. However, the evidence for this happening in humans remains questionable.

Do Artificial Sweeteners Cause Inflammation and Dental Issues?

There is preliminary evidence that artificial sweeteners may irritate the digestive system’s lining, causing inflammation and increasing the chance of diarrhea, constipation, bloating, and other symptoms commonly associated with irritable bowel syndrome. However, this study concluded that more research is needed. High consumption of diet soft drinks has also been associated with inflammation-related liver damage (9).

The intake of diet soft drinks has also been linked to dental deterioration. Many soft drinks include phosphoric and citric acids, which can harm tooth enamel and contribute to dental erosion (10).

Moderation is the Key

Diet soft drinks, like many other areas of nutrition, should be used in moderation.

References:

1. WHO calls on countries to reduce sugars intake among adults and children
   (https://www.who.int/news/item/04-03-2015-who-calls-on-countries-to-reduce-sugars-intake-among-adults-and-children)




2. An In-Depth Exploration of Knowledge and Beliefs Associated with Soda and Diet Soda Consumption
   (Miller C, Ettridge K, Wakefield M, et al. An In-Depth Exploration of Knowledge and Beliefs Associated with Soda and Diet Soda Consumption. Nutrients. 2020;12(9):2841. Published 2020 Sep 17. doi:10.3390/nu12092841)




3. Artificial sweeteners as a sugar substitute: Are they really safe?
   (Sharma A, Amarnath S, Thulasimani M, Ramaswamy S. Artificial sweeteners as a sugar substitute: Are they really safe?. Indian J Pharmacol. 2016;48(3):237-240. doi:10.4103/0253-7613.182888)




4. The Impact of Artificial Sweeteners on Human Health and Cancer Association: A Comprehensive Clinical Review
   (Ghusn W, Naik R, Yibirin M. The Impact of Artificial Sweeteners on Human Health and Cancer Association: A Comprehensive Clinical Review. Cureus. 2023;15(12):e51299. Published 2023 Dec 29. doi:10.7759/cureus.51299)




5. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)
   (Nettleton JA, Lutsey PL, Wang Y, Lima JA, Michos ED, Jacobs DR Jr. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2009;32(4):688-694. doi:10.2337/dc08-1799)




6. Aspartame and Other Sweeteners in Food
   (https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food#:~:text=The%20FDA%20is%20aware%20of,is%20actually%20linked%20to%20cancer.)




7. WHO advises not to use non-sugar sweeteners for weight control in newly released guideline
   (https://www.who.int/news/item/15-05-2023-who-advises-not-to-use-non-sugar-sweeteners-for-weight-control-in-newly-released-guideline)




8. The Impact of Artificial Sweeteners on Body Weight Control and Glucose Homeostasis
   (Pang MD, Goossens GH, Blaak EE. The Impact of Artificial Sweeteners on Body Weight Control and Glucose Homeostasis. Front Nutr. 2021;7:598340. Published 2021 Jan 7. doi:10.3389/fnut.2020.598340)




9. Association between diet soft drink consumption and metabolic dysfunction-associated steatotic liver disease: findings from the NHANES
   (Wu Y, Tan Z, Zhen J, Liu C, Zhang J, Liao F, Dong W. Association between diet soft drink consumption and metabolic dysfunction-associated steatotic liver disease: findings from the NHANES. BMC Public Health. 2023 Nov 20;23(1):2286. doi: 10.1186/s12889-023-17223-0. PMID: 37985986; PMCID: PMC10658943.)




10. Damage from Carbonated Soft Drinks on Enamel: A Systematic Review
    (Inchingolo AM, Malcangi G, Ferrante L, et al. Damage from Carbonated Soft Drinks on Enamel: A Systematic Review. Nutrients. 2023;15(7):1785. Published 2023 Apr 6. doi:10.3390/nu15071785)

Source-Medindia