
Low-Calorie Sweetener Use and Risk of Abdominal Obesity Among Older Adults - notadoc
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167241
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nostromo
This seems incredibly weak because they haven't shown causation -- or, in
particular, disproved reverse causation. (That people struggling with weight
gain are more likely to use sugar substitutes.)

This is more of a "huh, someone should do additional research" paper than
anything conclusive.

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ineedasername
Came here to make exactly this point. It seems like the people already slim
and petite are less likely to be drawn to such artificial additives, whereas
many/most overweight people would at least be trying some "bare minimum"
weight management through them.

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lucas_membrane
Yes, this shows how hard science can be. Studies have shown both that people
who consume artificial sweeteners tend to gain a little weight (like this
study) and that people who lose a lot of weight tend to be above-average
consumers of artificial sweeteners. Best hope is that chemistry can untangle
the mess.

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killjoywashere
Not only all the above, but where's the head-to-head comparison with sucrose
(layman's 'sugar')-sweetened beverages?

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RandomInteger4
Unless you can show that low calories sweeteners are directly responsible for
weight gain; i.e. somehow the sweeteners affect how food is metabolized, fat
is stored, etc., then these studies don't really say much other than people
who are unable to control their appetites are unable to control their
appetites.

Low calorie sweeteners are still a better option than sucrose with respect to
flavoring.

In terms of annecdata, I've been trying to control my father's eating habits
for years now (due to his numerous heart attacks and double bypass), and while
I've not been completely successful, everything about my father's health has
improved since he switched to diet pepsi from regular pepsi and since I got
him to stop buying sugar for his coffee, convincing him to go with Stevia
instead.

He still sneaks junk food, but that's not something that has changed. His
blood sugar has decreased and his joint pains have improved.

To a certain extent, studies like this that make recommendations against
recommendations seem irresponsible.

~~~
ineedasername
Yes. The failure to even mention, much less account for the selection bias
that may come in to play here means the correlation may be used to recommend
precisely the opposite of the healthy choice.

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btilly
I see this as, "What we thought was true actually is, and we still have no
real idea why."

The fact that this is a longitudinal study lets us say that not only is
heavier use of low calorie sweeteners tied to being fat, it is correlated with
getting fatter faster. That's an important point that only longitudinal
studies can verify.

However without being able to control people's diet, we don't know which way
causation goes. Do low calorie sweeteners cause people to gain weight faster?
Or does having a tendency towards gaining weight cause people to use low
calorie sweeteners? And if it is a cause, why that would be.

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darawk
> However without being able to control people's diet, we don't know which way
> causation goes. Do low calorie sweeteners cause people to gain weight
> faster? Or does having a tendency towards gaining weight cause people to use
> low calorie sweeteners? And if it is a cause, why that would be.

It seems overwhelmingly likely that the causality goes the other way, though.

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RobLach
“Using artificial sweeteners” vs “not using artificial sweeteners” doesn’t
really tell you much. I mean it makes sense that people who use artificial
sweeteners would have more excess mass since people who are dealing with that
would seek artificial sweeteners in the first place. If you’re feeling fine
about your weight you won’t bother with artificial sweeteners.

What would be interesting is if people who replaced the calories they ate that
came from sugar with artificial sweeteners that are effectively no calorie and
still had a greater increase in stored mass.

That said; the chance of a properly controlled food study is astronomical as
you’d have to control people’s diets in near totality, for a large enough
sample size, across years, which no one would agree to unless you planned to
cover or subsidize their food costs over that time.

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impostervt
2.6 cm larger waist doesn't seem very convincing. I probably go up/down 2.6cm
on any given day.

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oculusthrift
Wouldn’t fatter people naturally try to switch over to low calorie sweetener
in order to lose weight? whereas non fat people might just enjoy sugar
instead?

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chineseGoogle
I have numerous fat friends that use the calories saved by diet foods as a
green light to recover equivalent calories elsewhere.

The fatalist claim being: well, one would've just eaten that much anyway, so
what's the difference?

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RandomInteger4
The difference is that one choice of sweetener is inherently bad for those
trying to lose weight, while the other choice of sweetener puts the burden of
fault for weight gain on a lack of self control.

We're humans. Not wanting to eat bitter food all the time is natural and
should not be faulted. Losing weight shouldn't have to be a strenuous ascetic
chore, so choosing to consume something sweet isn't the mental failing; the
mental failing is choosing to choose something calorically and macro-
nutritionally incorrect for one's body recomposition goals.

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jddj
When someone puts sugar in my tea or coffee it genuinely ruins it for me, but
I eat sweet things faily rarely and so haven't developed the tolerance and/or
addiction to that flavour.

Could it be that not eating sugar isn't so much of a strenuous ascetic chore,
but rather it's the reduction in sugar intake which is particularly (albeit
temporarily) awkward?

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RandomInteger4
My comment wasn't against not eating / drinking sweet thing things. My comment
was anti-anti-sweet things (which is not the same as pro-sweet things in
certain systems of logic)

One doesn't need to have an addiction to sweet things to want to enjoy sweet
things every once in a while, though I admit that "addictions" to sweet things
exist (namely my father, whom I have a hard time breaking him away from that
addiction).

The point was mainly that there is a certain brand of health and fitness that
says one must suffer / become a stoic ascetic in order to make progress, and
it's this brand of health and fitness that is counter productive. Yes, maybe
it works for many people, but it doesn't work for everyone.

I'm perfectly happy living a rather Spartan life; my 70 year old father is not
and it's very difficult to change his stubborn mind.

Another way of putting it is that if you say that the only way to health and
fitness is to climb over this 50 ft. wall, then you're going to get far fewer
people actually putting in the effort to do so. Artificial Sweeteners are the
large hand holds on the climbing wall, before they're ready to switch over.

And yes, if your goal is body recomposition, then macronutrition and caloric
intake is far more important than this "artificial sweeteners make you fatter"
voodoo magic nonsense.

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blakesterz
Interesting reading:

These data suggest that low-calorie sweetener consumption may deleteriously
affect visceral fat deposition, a strong risk factor for cardiovascular
disease and mortality.

Mechanisms for the association between low-calorie sweetener use and
progressively rising prevalence of abdominal obesity remain unknown. One
potential explanation derives from the physiology of the brain food reward
system.

Therefore, individuals who consume low-calorie sweeteners may compensate by
over-eating in order to experience the expected satiety. Another possible
mechanism may involve the gut microbiome.

~~~
btilly
Interesting, but unoriginal. I've known about both potential explanations for
years, as well as the fact that switching to low calorie sweeteners does not
seem to be a good way to lose weight.

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dyoo1979
Can anyone tell _which_ low calorie sweeteners the study is talking about?
Certain artificial sweeteners elicit a large insulin response even if they are
"low-calorie". Did they use any of the sweeteners listed in
[https://www.hsph.harvard.edu/nutritionsource/healthy-
drinks/...](https://www.hsph.harvard.edu/nutritionsource/healthy-
drinks/artificial-sweeteners/)?

~~~
masonic
It says (aspartame, saccharin, acesulfame potassium, or sucralose).

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xiphias2
I was looking for Erythritol in the study, as it seems to be the safest sugar
replacement so far (I'm using it all the time, still trying not to overuse it
of course). It's strange that the study didn't take it into account.

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qwerty456127
Fat people should probably try lactulose - a zero-calory (indigestible) sweet
syrup (somewhat similar to maple syrup) with prebiotic and laxative
properties. Besides being tasty it can actually make their guts healthier so
their ghrelin (hunger hormone) secretion can decrease and their leptin
(fullness hormone) secretion can increase.

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comicjk
Laxative artificial sweeteners have the problem that people don't dose food as
carefully as medicine. I'm reminded of the famous Haribo maltitol gummy bears,
which when eaten more than about 20 at a time would cause a...powerful
laxative effect.

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qwerty456127
Worth (and fun) mentioning but as for me I don't feel like it's a problem as
long as there is a toilet nearby. Lactulose laxative effect is faster to act
but not nearly as powerful as e.g. that of bisacodyl. According to my
experience (needless to say it may differ in others so be careful) it will
hardly cause any serious inconvenience or discomfort any soon after you
defecate (a couple of times in a row perhaps) or make you need a toilet really
often, especially after you get used to it and your colon adapts and gets
generally cleaner and healthier. What I find the most valuable property of
lactulose is its prebiotic effect (somewhat similar to that of inulin[1]), it
really feels and seems like it makes an amazing difference in the gut ecology.

[1]
[https://www.startpage.com/do/dsearch?query=lactulose+inulin+...](https://www.startpage.com/do/dsearch?query=lactulose+inulin+prebiotic&cat=web&pl=opensearch&language=english)

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maxxxxx
I use a quite a bit of Stevia. I wonder where that fits in.

~~~
jgrowl
I use stevia and monk fruit a lot and would be curious too. I've never felt
bad after using it though, unlike stuff like aspartame which seems to make me
feel a bit funny.

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newnewpdro
I thought it was already established that anything sweet-tasting stimulates an
insulin response, which is an energy storage (fattening) hormone.

~~~
Baeocystin
If sweet-tasting things stimulated a significant insulin response without
providing the actual sugar to justify it, we'd die from insulin shock. Not
hyperbole. This is the mechanism behind Xylitol toxicity in dogs, for example.

[https://vcahospitals.com/know-your-pet/xylitol-toxicity-
in-d...](https://vcahospitals.com/know-your-pet/xylitol-toxicity-in-dogs)

~~~
newnewpdro
There are plenty of results if you search google for "artificial sweetener
insulin", some from quite reputable sources.

It doesn't take much of a response to accumulate significant fat over the
years, when you're constantly consuming the stuff.

~~~
jgrowl
Not all artificial sweeteners are the same though. Xylitol, stevia, and monk
fruit for example all taste super sweet and do not have a significant insulin
response.

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jpatokal
Totally unscientific theory: sweeteners are to sugar what methadone is to
heroin. If you're using them, you're still craving/addicted to sugar and your
palate remains out of whack, so you're probably also drawn to sugary foods
that don't use sweeteners (eg. most commercial pasta sauce, ketchup, fruit
juice, many breads).

~~~
eckza
In my lived, anecdotal experience:

I grew up eating “normal” foods and drinking non-diet soda.

I am an average-sized guy. I fell in love with a sweetheart of a woman that
was around 300lbs. I married her. She’s now less than half that.

I eat what she eats. Diet, sugar-free everything. After a few years of
tolerating it, I prefer it. Normal soda tastes like cough syrup, to me. Cake
and donuts make me nauseated. I don’t crave sugar, at all.

Also, ketchup has a shit ton of sugar in it, for the record. (I know this,
because we use sugar-free ketchup.)

Do with this anecdotal informaton what you will; but as someone who has fully
transitioned to artificial sweeteners - I can’t say that my lived experience
lines up with your claims.

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BadassFractal
I pretty much live on this stuff. Huh, wonder if I should be dropping it
altogether.

~~~
BigJono
Mehhhhh in for a penny, in for a pound. If it turns out this stuff kills you
I'm probably already done for anyway.

------
seandougall
[2016]

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RandomInteger4
This is an important note. Thank you for pointing this out. It seems like a
lot of people here are arguing that this study reaffirms prior studies, when
in reality I think they were thinking of this study as the one being re-
affirmed without realizing it.

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mrsteveman1
`

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protonfish
I am frustrated by the dismissal of this study in the comments. I think the
burden of proof clearly lays on the claim that using artificial sweeteners is
a healthier alternative to sugar. It seems fairly certain that is not the
case.

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edtechdev
That's not what this study is about. There are already plenty of studies
showing weight loss or reduced weight gain when consuming low calorie
sweeteners vs sugar. And there are no ill health effects such as causing
cancer, which a lot of people still believe.
[https://www.hsph.harvard.edu/nutritionsource/healthy-
drinks/...](https://www.hsph.harvard.edu/nutritionsource/healthy-
drinks/artificial-sweeteners/)

~~~
protonfish
Here's a quote from the link you sent:

> The health effects of LCS are inconclusive, with research showing mixed
> findings.

