Soda and your body weight / Diet drinks and your appetite / Artificial sweeteners and your risk of cancer

Posted on January 9, 2013

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This thing got out of control. I planned on this being a pretty short summary on the affect of diet drinks on weight-loss, and, well, I got a tad off track and just went off. For all the women who tell me I’m “emotionally unavailable” I now reply read my blogs! Apparently I have plenty of emotion when it comes to the written word. 

Because this got so long 1) I divvied it into a few different posts and 2) Put everything together in one long post (which would be the one you’re currently reading). Read it however you please. The different posts are: 

Is soda really that big of a deal when it comes to your body weight?

What’s up with diet drinks and appetite?

Are diet drinks safe? Do artificial sweeteners really cause cancer?

And here’s the full thing:

The devil does exist! Right?

The devil does exist! Right?

Diet drinks such as Diet Coke, 0 calorie Gatorade, 0 calorie Vitamin Water, etc. is another one of those areas only spoken about in the extreme.

In my experience, it’s typically in the vain of, “Don’t touch that shit. It gives you cancer. Water only. Anything else is for the weak.” If you’re Paleo or CrossFit then you can add blood to the list of allowable beverages.

I’m sure the fact I’m even going to argue against these notions has already made some people severely hate me. That’s ok, these people think Jillian Michaels is a viable source of inspiration, aka I hated those people first.

Tangent: Does anyone else wonder how a break up with Jillian Michaels would go?

Her girlfriend “How could you hurt me like this?”

Jillian “NO PAIN NO GAIN!!!”

Girlfriend “I can’t. It hurts too much.”

Jillian “Ok, ok. I’ll give you a Last Chance “work out.””

Just me? Moving on.

Bluntly, I vehemently disagree with such a negative position on diet drinks. I’m going to actually make a case for drinking them. As always, the proper context needs to be established. Getting there is going to take some time though.

So,

joker here we go

Couple words on soda and sugary (non-diet) drinks first

coca cola

Or maybe this is the real evil one?  I mean, this guy is more red.

Let me first be very clear, I am not at all advocating drinking soda or sugary drinks. I’m just going to go over the affect these things have on one’s weight; then we’ll go from there.

Much like diet drinks, soda has quite an alarmist stance too. Is this stance valid?

Since this is primarily mentioned in references to children and adolescents, let’s look there.

Sugar-sweetened beverages and body mass index in children and adolescents: a meta-analysis

This review looked at a bunch of different studies and tried to find the relationship between sugary beverages (SB) and body mass index (BMI).

The conclusion:

“The [review] found that the association between SB consumption and BMI was near zero, based on the current body of scientific evidence.”

Over and over again, there just wasn’t much, if any, affect from sugary beverages on BMI.

So, it seems issues with drinking soda are blown way out of proportion. When you step back, this shouldn’t be surprising. Everyone wants to hang their hat on one thing, but this rarely pans out. I can’t think of one person I’ve had who could say to me, “Yeah, once I took out X food or Y ingredient I lost all the weight I wanted.”

Rather than stop there though, let’s go into more detail by looking at one study from the review that seemed to find the biggest impact.

Effects of Decreasing Sugar-Sweetened Beverage Consumption on Body Weight in Adolescents: A Randomized, Controlled Pilot Study

This is probably the best study from the aforementioned review. The study compared a group who subsitituted non-sugary beverages for sugary beverages, then compared their BMI after about 6 months.

(Here’s the wikipedia for BMI if needed.)

The author’s primary conclusion:

“The net difference, -0.14 (BMI) was not significant overall.”

That is, the group that got rid of their sugary beverage consumption had a lower BMI than the sugary beverage group by .14. Considering most people’s BMI falls somewhere between 20 and 40, .14 is a pretty damn small difference.

This difference was much more noteworthy in children who started overweight / obese. Presumably because these are the types of kids who drink more soda. More on this later.

I want to take this further though. The authors for some reason seem to glance over this statement they made:

“Because each 360-mL (12-fl oz) serving of SSB contains 150 kcal, and total SSB consumption was reduced by 82% in the intervention group, we calculate that BMI decreased on average by 0.26 kg/m2 for every serving per day of SSB that was displaced”

Because the intervention group didn’t completely eliminate their SB consumption, the authors came up with (in my mind) a better indicator of the true BMI difference. For every serving per day of sugary beverages that was removed there was a change in BMI by .26.

Here’s how this works out. The equation for BMI is weight (in kilograms) / (height (in meters) ^2). Or kg / m^2

So, a person who weighs 91kg with a height of 1.94 meters:

91 kg / (1.94^2) = BMI of 24.2

Over the course of roughly 6 months (the length of the study), if you added a serving per day of say, a soda, the BMI would increase to 24.46. Meaning the person’s body weight would be (stay with me, algebra haters),

24.46 = weight (?) / (1.94^2) =>

24.46 * (1.94^2) = 92.1 kg = the person’s weight

Start at 91kg; end at 92.1 kg (if everything else is equal)

Thus, over the course of about 6 months the soda netted a difference of about 2.2 pounds. (92.1 kg – 91 kg.) We’ll say over a year this might equate to 4 or 5 pounds. (Note I’m making an assumption that may be false.)

While this difference certainly isn’t going to prevent childhood obesity, I think it’s a bit more important than the authors let on. Also, if you only look at the fattest kids, this difference becomes a little over 6 pounds. Over a year, maybe 12 pounds. (Again, the reasoning being the most overweight kids tend to consume to most amount of soda to begin with.) This is starting to become more of a factor.

Over the course of an entire childhood this could certainly add up. However, I’m speculating these numbers would hold up. Which brings me to this next study:

A randomized trial of sugar sweetened beverages and adolescent body weight

First, this study basically did the same thing as the last study I just mentioned -substituting non-sugared beverages for sugared ones- but looked at overweight and obese adolescents only. In essence, a lot of the fattest kids of the previous study. The participants where things like decreased soda consumption would have the biggest impact.

Second, this study looked at things for 2 years instead of 6 months.

Next, for all the people who bitch “these studies aren’t recent enough,” well, here’s your recent one. Unfortunately, because it’s so recent, I can’t get the full text. That’s ok though, I only want to bring up one line from the abstract:

“The primary outcome, the change in mean body-mass index (BMI) at 2 years, did not differ significantly between the two groups. At 1 year, however, there were significant between-group differences for changes in BMI (-.57) weight (-1.9kg).”

At one year the difference of about 5 pounds holds up pretty nicely with the projected 5 -12 pound difference I just mentioned in the study before this. It seems whatever difference there is after 6 months might just be maintained to the one year mark. HOWEVER, while there was an initial difference after 1 year in BMI by changing sugar beverage consumption, this effect lessened over time, because there is no difference at two years!

This is really bizarre. I don’t want to spend too much time theorizing on why this happened. My initial reaction is the body is amazing at adjusting things, -often unconsciously- in its intent to maintain bodyweight. Perhaps people unconsciously (or consciously?) eventually started consuming more of other items where the difference became negligible. I don’t know.

What’s important here is saying anything resembling “Soda is the cause for childhood obesity” or  “Just eliminate soda to help obese kids” is patently false. I certainly am not saying soda or sugary drinks aren’t factors, but to single them out is futile.

Rant mode, on

I came across this site when I was researching this: KickTheCan [link no longer exists].

This site lists one of the above studies I just went over as a reason (I assume) to disuade people from drinking soda. The site actually quotes the abstract here, going (bolding mine):

“Among overweight and obese adolescents, the increase in BMI was smaller in the experimental group than in the control group after a 1-year intervention designed to reduce consumption of sugar-sweetened beverages, but not at the 2-year follow-up.”

Apparently they don’t even realize on their website, their website which is designed to disuade soda drinking,  they’ve posted a study contradicting their mission statement. They posted a study saying those who drank soda were no fatter after two years than those who did not. 

(I’m guessing someone was too lazy to read more than a couple of sentences.)

The site quotes another study here saying,

“In a recent (2010) study, it was found that children’s median intake is two sodas per week,”

I don’t even want to look at what study they’re referencing, but two sodas per week? Maybe 300 calories per week is what you’re singling out to turn around the obesity problem? There is another term for worrying about 300 calories per week; it’s called masturbation. You know, you’re throwing your hands around but you’re never really getting anywhere.

Continuing one of the quotes from above (emphasis mine),

“”In a recent (2010) study, it was found that children’s median intake is two sodas per week, with a mean of six per week.”

AH! Now we’re getting somewhere. For the non-statistically inclined, means (averages) and medians have a very subtle, but very important, difference.

A mean is susceptible to outliers -those who stand way out of the pack-  medians are not. For example, take 10 people and look at their mean income. If Warren Buffett is part of these 10, the mean is going to be very, very high. Take the median though and Warren Buffett has no greater impact on the data than the other 9. Medians are almost always more accurate of a population.

Bringing me back to my long-winded point: Your median person (or adolescent in this instance) does not have much of an issue with soda or sugary drinks. Abolishing these things is unlikely to have much of an impact on your everyday person or kid. However, if the person is someone who consumes a lot of soda, then we’re likely to see an impact.

That last sentence should read as “No shit.” Yet how many people do you know decrying soda is bad for everyone? Are you sure you’ve never been one of those people yourself? How many weight-loss coaches or dietitians immediately tell people no more soda, ever? Maybe now you understand why your diet of just eliminating soda has failed, over and over again.

Said another way: Your kid consuming too much soda is likely not why he or she (or you) is overweight or obese. It might be part of the equation, but only a part.

Another quote from this “wonderful” website:

“When it comes to childhood obesity, parents certainly have a big role to play. But parents also face the biggest challenge, because sodas are available everywhere and the industry spends more than one million dollars every day marketing their sugar water to kids. Parents don’t stock the shelves in the corner store their kids visit on the way home from school. And parents can’t monitor every website or text message soda companies send to their kid’s phones. Soda companies must stop undermining parents with their aggressive marketing.”

Actually, many parents do stock the corner store. Unless every person of every corner / grocery / food store is not a parent.

And who are the people doing the marketing? The kids?

“Well, they have to make a living” you say. Exactly.

I’m sure parents don’t give their kids the money to buy anything at the corner store either. Oh, wait…This is America and 8 year olds aren’t in sweat shops.

One of the studies stated 50% of sugared beverages were consumed at home.

Home.

You know, that place the parents live. Where they bring in the groceries. The groceries the parents bought. 

When you’re blaming 8 year olds for their own health issues you’ve hit the ceiling of ignorance.

And really, Coca Cola is sending text messages to kid’s phones trying to get them to drink soda??? Does this seriously happen? If it does happen, who at Coca Cola is sending the messages? More 8 year olds?

Or how about websites? Because social media has proven to be a terrible way to get people to drink soda. (An interesting aside: I have 13 friends who like Coca Cola on facebook; 8 of them are skinny.)

No, children’s free will isn’t the reason they’re overweight. Coca Cola isn’t the reason either.

The reason they’re overweight is due to all the shit you put in their mouth. You, the parent(s). THE SHIT THEY’RE EATING RIGHT WITH YOUR OVERWEIGHT ASS!

(This is not meant to criticize those who are overweight; this is meant to criticize self-delusion.)

Rant over.

With all that said, what if soda IS a problem for you?

What’s up with diet drinks? Do diet drinks increase appetite?

Diet drinks get chastised all over the place. I’m going to go over some of the more prevalent reasons, at least from what I’ve seen.

One of the main arguments against diet drinks is they increase appetite. The main tenet of this argument seems to be artificial sweeteners are sweet, so they cause sweet cravings.

I’m going to ignore the fact I’ve never heard someone go, “Yeah, you know, whenever I’m craving chocolate I’ll eat chocolate, and then my craving gets worse. Next thing I know the only thing I’m eating is chocolate 24/7.”

Or “Yeah, I was just chomping at the bit for a cheeseburger so I entered one of those pound burgers challenges and you know what? All it did was make me go and order more burgers!”

Five pound burger

Five pound burger from Fuddruckers, which is the best burger place. All those who disagree are wrong.

I’m pretty sure people typically eat a particular food to mitigate a craving; not exacerbate it, but let’s throw silly logic aside for now.

Back to the original argument: While you may get rid of the calories from say, a Coke, by drinking a 0 calorie Diet Coke, you’re still not going to get anywhere. You may actually go backwards due to the diet drink increasing your appetite.

First, and I can’t believe I even have to address this, but there are people who go “Aritificial sweetener use has increased in the last 40 years and so has obesity. Thus, increased artificial sweetener use leads to eating more, which leads to obesity.” When attempting to describe the rage instilled in me upon hearing things like this the only words that come to mind are, “Dexter.”

Let’s take a look at some research.

Satiety scores and satiety hormone response after sucrose-sweetened soft drink compared with isocaloric semi-skimmed milk and with non-caloric soft drink: a controlled trial.

In this study a few different drinks and their affect on hunger were looked at. How much people ate after they had each drink was looked at too. The drinks were a regular soda, skim milk, aspartame (artificial sweetener found in things like Coca Cola) drink, and water.

Soda increased hunger the most, milk was second, and then water and artificial sweetener were tied for the least.

Summarizing from the author in an interview with NPR,

“We found if you’re drinking soft drinks without calories it behaves [on the appetite] exactly like drinking water”

And then from the actual study:

“Furthermore, there were no indications [diet soda] increased appetite or energy intake compared with water.”

Another study finding no evidence is The Use of Low-Calorie Sweeteners by Adults: Impact on Weight Management

One quote from that paper:

“Although reported consumption of carbonated soft drinks and fruit juice, 2 of the most frequently consumed food categories, has declined over the past decade”

For all those who love correlation, there you go. According to this, in the last 10 years people have gotten fatter, but soft drink consumption has gone down. Riddle me that, Ms. Kick The Can.

There’s also this from Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms 

“Overall, only 15.1% of all Americans indicated that they consumed any food or beverage with NNS added in 2003–2004”

66% of people are overweight / obese, but only 15% consume artificial sweeteners. Only adding to the case for artificial sweeteners not having much, if any, impact on people being overweight.

Sucrose compared with artificial sweetener – different effects on ad libitum food intake and body weight after 10 weeks of supplementation in overweight subjects

In this study a group of overweight people, primarily women, were given one of two supplements. One essentially a sugar drink; the other an artificially sweetened drink. Basically one sweet drink with calories and one sweet drink without calories.

The result:

“Records of ad libitum [unrestricted] food intake (including supplements) showed that total energy intake increased significantly in the sucrose group (by 1.5 MJ/d) but remained constant in the sweetener group compared with habitual energy intake (Week 0.) “

Other than carbohydrates and sugar, nutrient consumption stayed pretty much the same between groups.

The most noteworthy thing from this study is the group who was given more sugar to drink consumed…more sugar (and carbs). Thus, they gained weight. In comparison to the artificial sweetener group which actually lost some weight.

“Body weight and fat mass increased in the sucrose group and decreased in the sweetener group during the 10-wk intervention. For the sucrose group, the total weight gain at week 10 averaged 1.6 kg, of which 1.3 kg was a gain in fat mass. For the sweetener group, the total weight loss at week 10 averaged 1.0 kg, of which 0.7 kg was fat-free-mass and 0.3 kg was fat mass. “

The artificial sweetener group improved in just about everything. Likely due to the fact they lost weight as opposed to the sweetener doing anything physiologically.

Sweetener versus sucrose chart

(Click to enlarge.)

Another anecdote: In the group given the sugar supplement, while there overall sugar and carbohydrate consumption increased, they decreased their original consumption of sugar. For example, say a person consumed 100 grams of carbs a day from three different foods before the intervention. After the intervention they may have decreased their consumption to 50 grams a day from those three foods, but overall increased the consumption to 150 grams due to the supplementation scheme.

This makes sense. The body is trying to make some adjustments and not just increase everything.

What’s interesting here is this: The artificial sweetener group ALSO decreased their sugar and carbohydrate consumption. As if the artificial sweetener acted in the brain just like the sugar supplement did. So, if the artificial sweetener isn’t doing anything physiologically, it could very well be doing something psychologically. (Although, maybe you can’t really separate the two.) The significance being the artificial sweetener has much less, if any calories associated with it. Hence, sweetener group loses weight; sugar group gains weight.

(Remember, in this study people didn’t know what they were consuming.)

Lastly, again, the artificial sweetener group suffered no negative influences on their appetite. If anything, they received a benefit.

Oh, and just to throw it out there. The sweetener group, again the group that lost weight, consumed more alcohol than the group that gained weight. No surprise there. 

Summarizing appetite effects

Overall, it appears diet drinks or artificial sweeteners really have no impact on appetite. Anyone who quotes a study saying they do can easily be refuted by a study saying they don’t. Hell, some studies say they decrease hunger.

I also want to bring up for the studies that do find an increase in hunger, the reasoning seems to be this: Whenever an artificial sweetener increases hunger it seems to be when it is consumed by itself, in a form similar to regular eating (like drinking a diet drink). However, consume the diet drink with other food, and this effect, if it was even there to begin with, goes away.

There are even studies out there where people were given the sweetener in pill form and this result of increased hunger goes away. Further indicating it’s not the sweetener but the act of drinking that may be bringing on the hunger.

This is discussed nicely in Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms.

This is a good time to apply all this research to the real world. And in reality hunger is an extremely complicated area. Another quote from one of the above studies (bolding mine):

“It is clear that low energy sweeteners can be as satisfying as sugars during a meal, particularly when subjects are unaware of the caloric manipulation.”  

When they are unaware.

Here’s a big issue with this body of research: In the majority of research a double blinded study is ideal. However, in reality, people know what they’re eating. They know if they switched to diet, or a low-fat alternative. And because they know, they can consciously or unconsciously compensate.

A similarity would be exercise: People know they exercised on a particular day; because of this some are likely to go to McDonald’s as a “reward” where others are going to want to eat very “clean” that day to not mess up their great workout. Psychology is profound in influencing appetite.

For instance, if you’re someone who only has a can of diet coke when eating lunch, it’s easily conceivable drinking a diet soda is going to trigger hunger as your body is used to the association of soda = meal time.

Or here’s a quick blurb how the color of a cup of hot chocolate affects satisfaction: http://www.businessinsider.com/color-of-containers-affect-taste-2013-1

Or the fact often times people switch to a “diet” or “low-fat” food but then immediately compensate by eating more calories from the low-fat option than they would have eaten of the original. In my post on Mindless Eating (here and here) I talk about how those given a “low-fat” granola bar end up eating more overall than the “regular” granola bar group. The theory being people subconsciously go, “Well, I had a low-fat snack, now I can eat more of other things.”

At this juncture, a bunch of people are thinking, “Ok, but what about the health concerns of artificially sweeteners themselves? I get they can help me lose weight, but won’t they cause cancer in the process? I’d rather be fat without cancer than skinny with tumors.”

Health concerns (or how to get famous by unnecessarily scaring the shit out of people)

This is covered pretty extensively elsewhere so I’m not going to go into as much detail as the previous sections.

First, I’ve heard / read often “Artificial sweeteners are toxins, thus they are bad.” Well, alcohol is toxic, and it’s been found to be quite healthythere goes that logic.

Second, and this is how this section really boils down: Artificial sweeteners have been found to cause cancer under two conditions, 1) In studies using rats and 2) Using extremely high dosages in those rats.

Of course, people like Dr. Mercola, aka Dr. Lunatic, completely gloss over these factors. I’m going to go into detail on one study to illustrate and leave it at that.

First Experimental Demonstration of the Multipotential Carcinogenic Effects of Aspartame Administered in the Feed to Sprague-Dawley Rats

Notice the word “Rats” in the title.

A quote:

“Through dietary surveys performed in the United States among aspartame (APM) consumers during the period 1984–1992, the average APM daily intake in the general population has been shown to range from 2 to 3 mg/kg body weight”

(Yes, I’m well aware this data is old. The recency of the data is irrelevant to my following point.)

So, I’m 90 kg, then,

Between 2 and 3 mg / kg * 90 kg = Between 180 and 270 mg of aspartame

There are 180 mg of aspartame in a Diet Coke,

Between 180 and 270 / 180 = Between 1 and 1.5 can(s) of Diet Coke per day. This is the average intake of aspartame per day. 

We’ll come back to this.

Results of the study (bolding mine):

a) an increased incidence of malignant-tumor–bearing animals with a positive significant trend in males and in females, particularly in the females treated at 50,000 ppmb) a statistically significant dose-related increase of the incidence of lymphomas/leukemias in females treated at the doses of 100,000, 50,000, 10,000, 2,000, or 400 ppm and a positive significant trend in both males and females; c) in females, dysplastic lesions and carcinomas of the renal pelvis and ureter combined show a significant positive trend and a statistically significant increase in those treated at 100,000, 50,000, 10,000, 2,000, or 400 ppm

In this study ppm (parts per million) correlated to mg / kg in the following ways:

100,000 ppm = 5,000 mg / kg

50,000 ppm = 2,500 mg / kg

10,000 ppm = 500 mg / kg

2,000 ppm = 100 mg / kg

400 ppm = 20 mg / kg

80 ppm = 4 mg / kg

Remember the average intake from above? 2-3 mg/kg? Notice how the lowest dosage in this study is still above the average person’s consumption???

Next, I am 90 kg, so:

5,000 mg / kg * 90 kg = 450,000 mg of aspartame

2,500 mg / kg * 90 kg = 225,000 mg of aspartame

500 mg / kg * 90 kg = 45,000 mg of aspartame

100 mg / kg * 90 kg = 9,000 mg of aspartame

20 mg / kg *90 kg = 1,800 mg of aspartame

4 mg / kg * 90 kg = 360 mg of aspartame

Next, there are 180 mg of aspartame in a Diet Coke, so,

450,000 / 180 = 2,500 cans of Diet Coke

225,000 / 180 =1,250 cans of Diet Coke

45,000/ 180 = 250 cans of Diet Coke

9,000 / 180 =50 cans of Diet Coke

1,800 / 180 =10 cans of Diet Coke

360 / 180 =2 cans of Diet Coke

This is amount of Diet Cokes PER DAY. Most of these dosages are impossible for a person to consume. You think the cinnamon challenge is tough? Please, that shit is weak. Try a 1,000 cans of diet soda per day.

cinnamon challenge

Lightweight

Study’s conclusion:

“Our study shows that aspartame is a multi-potential carcinogenic compound whose carcinogenic effects are evident even at a daily dose of 20 mg/kg bw”

In layman’s terms, “Drinking more than 10 cans of Diet Coke a day, everyday, for your entire life, which is 10 times the average amount, may be bad for you.”

I’ve never come across someone who drinks that much of anything except for alcohol or coffee. If you’re out there, then “Hey, 10 cans a day is bad.” Which I’m sure you really needed someone to tell you.

The authors make a fair point this recommendation is lower than current FDA standards, but again, if you need someone to tell you 10 cans of diet soda a day isn’t a good idea you probably have a lot of other issues needing resolution too.

And again, this was done on rats. Don’t forget that. We’re still just guessing for humans.

One of my favorite defenses of studies like this is, “Well, it would be unethical to try and cause cancer in humans, so we have to do these things on rats. It doesn’t mean they aren’t carcinogenic though.”

To which I reply, “Yes, trying to cause cancer in humans is unethical. You know what else force feeding a human 20 cans of soda a day is called? Fucking stupid. I don’t need a study to tell me my stomach feeling like it’s bleeding isn’t good.”

Summarizing everything (finally)

If you don’t have issues with soda / sugary beverages, there is no reason to start consuming artificially sweetened beverages. I suppose you could make the argument if you’re someone who gets sugar / sweet cravings artificially flavored drinks could possibly curb these cravings, although I tend to go with other modalities. (Eating fruit for a sugar craving for example.)

Next, if you’re someone who has issues with soda then switching to diet options is a more than reasonable alternative. Just don’t go out of your mind. The biggest caveat here is to understand when switching to a diet option to be hyperaware you don’t make up for this change by eating more of other foods.

Finally, if you’re someone who has issues with drinking too much sugar and artificially sweetened drinks keeps this in check, thus helping you to lose weight, it’s pretty damn easy to make the argument for you, in your particular situation, consuming artificial sweeteners is actually healthy. And something you should probably do.

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