
Two or more diet beverages a day linked to high risk of stroke, heart attacks - koolba
https://www-m.cnn.com/2019/02/14/health/diet-soda-women-stroke-heart-attack/index.html
======
floathub
It is entirely unclear how any controls were implemented. They say "after
controlling for lifestyle factors" but do not say which factors nor how they
controlled for them. It is entirely possible, perhaps even likely, that diet
beverages are simply a proxy for some other factor. Maybe even just weight. To
wit:

    
    
        "This association may also be contributed 
        to by rising blood pressure and sugars 
        that were not yet diagnosed as hypertension 
        or diabetes but warranted weight loss," 
        thus leading the women in the study to take 
        up diet beverages, said Dr. Keri Peterson, 
        medical advisor for the Calorie Research Council, an
        international association representing the low- and
        reduced-calorie food and beverage industry.
    

This possibility makes the implication that there is some causal relationship
pretty tenuous. This question:

    
    
        "What is it about these diet drinks?" asked 
         lead study author Yasmin Mossavar-Rahmani ...
    

might well be answered with, "nothing at all actually".

(edited for quotes because I keep forgetting this is not markdown)

~~~
toasterlovin
Welcome to all of nutrition science. As a field it is characterized by a
dearth of studies which are actually capable of demonstrating causation.
Almost every study is simply a measurement of correlation. And then you get
these moronic interpretations of the studies, sometimes by the study authors
themselves.

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jillesvangurp
I concluded a some time ago that soda drinks weren't adding a lot of value for
me at all. And I heard some people claim that the artificial sugars actually
are not that great for you. 1) they teach your body that sweet stuff has no
nutrition, which then becomes a problem when you actually eat sweet stuff 2)
sweeteners like aspartame build up in your liver and fat deposits, which may
or may not have long term impact. 3) artificial sweeteners can cause issues
with your gut bacteria/cause some irritation. All of that may or may not be
true and I never really experienced any of that.

I used to just order a cola light/zero/diet in restaurants but it was more of
a habit than something I actually particularly enjoyed. These days I usually
go for water, tea, or coffee. Small change, probably a lot healthier, and I
actually enjoy drinking it.

~~~
drankula3
On 2 and 3: aspartame metabolizes into the amino acid phenylalanine, a
precursor to dopamine and epinephrine[0]. In normal people, breakdown of the
upstream neurotransmitters increase when phenylalanine increases, meaning
there are no negative effects from it's consumption. It does not store in the
liver.

There are some diseases that involve a malfunction in phenylalanine
processing, like phenylketonuria[1] and hyperphenylalaninemia[2]. It would not
surprise me a bit if people with subclinical forms of hyperphenylalaninemia
self-medicate with diet soda to feel better, particularly energy drinks that
come with other things that aid in dopamine synthesis. Disfunction in dopamine
synthesis often affects other things like NO synthesis, affecting blood
pressure and inflammation.

[0]
[https://en.wikipedia.org/wiki/Aspartame?wprov=sfla1](https://en.wikipedia.org/wiki/Aspartame?wprov=sfla1)

[1]
[https://en.wikipedia.org/wiki/Phenylketonuria?wprov=sfla1](https://en.wikipedia.org/wiki/Phenylketonuria?wprov=sfla1)

[2]
[https://en.wikipedia.org/wiki/Hyperphenylalaninemia?wprov=sf...](https://en.wikipedia.org/wiki/Hyperphenylalaninemia?wprov=sfla1)

Edit: changed serotonin to epinephrine, as phenylalanine is not a precursor to
serotonin.

~~~
cagenut
thank you! as someone who replaced ~100g/day of hfcs with ~450mg of aspartame
by switching from coke to dietcoke I'm alway interested in what I should be
specifically watching for as the downside of this tradeoff. thanks to your
links i now know _an_ answer to that is "phe >120 <360, 600+ is a real
problem".

by any chance is that number a standard part of a yearly blood test, or do you
have to ask for it?

~~~
aesclepius
Phenylalanine is not part of your yearly blood test (Complete Blood Count,
Complete Metabolic Panel) and generally isn't tested unless you specifically
ask for it, or if a pediatric concern for phenylketonuria is manifested. At
least, this is in general N. American, adult primary practice. (I'm interested
if any other providers regularly test, as i've not done it at all)

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bluedino
I’ve never seen a skinny person regularly drink Diet Coke/Pepsi

Diet carbonated drinks just make me gassy. I’d rather have the sugar from a
regular Coke and just not drink one every day, or multiple ones per day. I
have co-workers that drink 6-8 per day.

I find the “tiny” cans which are only 7.5 are about the perfect size. 3-4
drinks, only 80 cslories, a small bump of sugar...if I drink a 20oz bottle I
usually can’t finish it as it’s way too sweet. Turns out the original size of
a bottle of Coke was 6.5 ounces.

~~~
zzzcpan
> I’d rather have the sugar from a regular Coke

I guess this is what the article tries to achieve. Just PR to steer you to
more unhealthy consumption.

Safe choice here was always to simply avoid sweet beverages altogether, and
not just Coke, all the juices too.

~~~
vorpalhex
There's nothing wrong with having something sweet.. occasionally.

I made this mistake for a long time, trying to fudge my diet with faux-healthy
snacks that were still basically just packaged fake sugar.

If you want a bit of chocolate, have a bit of chocolate. If you want a soda,
have a bit of soda (the small cans are about the right size it seems). Just
don't have 8 sodas a day, or eat an entire cake to yourself. Calorie count.
Make sure most of your diet consists of things other than empty carbs. Eat
your veggies, etc.

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orzig
Positive: The article links to a study

Positive: The study is open access!

Negative: The study is, to the best of my few minutes of ToC reading and Ctrl-
F-ing, _entirely_ unrelated to soft drinks or sweeteners

Am I missing something? In either event, 2 out of 3 ain't bad, I suppose

~~~
lucozade
I think they linked to the wrong study. I believe it's here:

[https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023100](https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023100)

Unfortunately, it's locked. So I'm going to go for 0.5 out of 3 on this one.

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lolc
I wonder whether even if there is a causal link, the diet version will still
be healthier (for low values of healthy) than the sugary version. I tend to
think so.

I would assume the people most likely to drink diet beverages do so to wean
themselves off of sugary drinks. That's one of the first steps in getting
towards a healthier lifestyle. The article notes this too.

A mystery to me is why they haven't asked about consumption of sugary drinks
at the same time. That would have allowed to get much more interesting
correlations.

~~~
zzzcpan
> A mystery to me is why they haven't asked about consumption of sugary drinks
> at the same time.

Obviously because sugary drinks manufacturers are paying for the article and
the "study".

~~~
swah
But Coke sells Coke, Diet Coke, juices and bottled water. What difference does
it make to them?

~~~
Matticus_Rex
They're more dominant in cola than they are in orange juice.

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Waterluvian
"...16% more likely to die from any cause than women who drank diet beverages
less than once a week or not at all."

Doesn't this suggest that they actually failed to control for lifestyle
effects?

~~~
mattkrause
All-cause mortality is a pretty common way to look at “side-effects”,
especially when it is not clear exactly what they might be.

These do need to be interpreted carefully though, lest you end up concluding
that a drug increases your odds of getting into a car crash or something.
There _could_ be a causal link—maybe the drug causes drowsiness or affects
vision—but it could also be noise....5% of the time happens 5% of the time,
after all!

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rcdmd
The linked CNN article is a very poor summary. It doesn't even include a
proper citation, and the link to the study isn't directing to the one being
discussed!? Come on, CNN.

I recommend reading the editorial in Stroke instead:
[https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.119.02...](https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.119.024456)

And you can get the article here if you have access to Stroke:
[https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023100](https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023100)

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S_A_P
The problem is that diet sodas are seen as a cheat that allows a person to eat
more calories than they should. This usually is linked to people with poor
nutrition habits. Those same people are probably more likely to stroke out or
have a heart attack.

~~~
lucozade
That's unlikely to be the basis for this result as they controlled for weight.

In fact, of their cohort, if the person was obese _and_ drank high quantities
of diet drinks, their risk of strokes shot up even further.

~~~
bitexploder
I would still guess it has little to do with the diet soda itself and
everything about the persons habits, which led them to drink diet soda twice
or more per day. It seems unlikely artificial sweetener can have this impact.
If it can, that is definitely interesting and the mechanism should be
discovered.

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njitram
The article states that the research was done only for women above 50, and
that it is observational, does not show cause and effect, so not sure how to
interpret this.

~~~
shhehebehdh
You should interpret it the same way you interpret any other study that
demonstrates only correlation and fails to control for obvious confounders.

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C1sc0cat
Coke and similar drinks are q problem for patients with renal failure its the
phosphor.

You normally take phosphor binders (Renagel) as well as giving up coke - god
only knows what costs in the states it cost the nhs about £1000 for 2 months
supply for me.

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dilap
I dunno, 1.23 increase in risk is tiny; seems likely that it's just lifestyle
stuff (which you can try to control for a bit, but you can't know every single
choice a diet soda drinker is making -- quite likely an overall less healthy
lifestyle).

Compare this to e.g. 20x lung cancer incidence for smokers, where even w/
observational data, you can be pretty sure there's a causal relationship.

Maybe do some RCTs giving diet soda to animals or something and see what
happens. And look into the chemistry to see what the mechanism might be...

(That said, probably prudent not to go too crazy with diet soda, or any other
novel ingredients.)

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twistedanimator
I didn't RTFA, but I'm going to chime in anyways.

I think if you're drinking 2 or more diet beverages a day, you probably have a
"fuck it" attitude when it comes to your health. And that attitude probably
pervades the rest of your decisions you make in your life.

Even the people I know who couldn't care less about their health all talk
about not wanting to get cancer from drinking diet sodas, especially those
containing aspartame.

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franky_g
Ill just have one then....

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lowken10
I think I'll go grab a diet coke.

~~~
lolc
Why not get the one with the sugar? The data on that one are clear. No
worrying about whether it's bad for you.

~~~
joebluemoon
Because natural is uncool. The most "educated" ones promote artificial
(because they created it, duh!) and the hippies and ludites promote "natural".
See how human psychology works? If you want to be cool on the internet, you DO
NOT go against science. (Except of course, when the science is disproving
science). It's that simple. Carefully observe this for a while on similar
subjects and make yor own conclusion abput what im saying. Good luck! Im gonna
go take mud bath now.

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joebluemoon
Why do westerners treat everything as a cause and effect machine? Its such an
amateur view. This is a great illustratin of "intellect" vs "intelligence".
The entire western societies are based on "intellect". Also, don't consume
fake anything ;)

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joebluemoon
I noticed a pattern on sites where the userbase is more "science savvy" types,
concencus os always to discredit anything against manmade like gmo and now
this. Also, the entire perception on food in the west is so upside down its
like the darkages here in that regard. Its fascinating to witness.

