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Two or more diet beverages a day linked to high risk of stroke, heart attacks (cnn.com)
60 points by koolba 69 days ago | hide | past | web | favorite | 63 comments

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)

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.

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.

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

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

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

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

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?

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)

This may well be the most interesting hypothesis for why I rely so heavily on these I've ever seen.

Are you aware of any research on this idea?

I am not aware of any research, I've only connected the dots from my experience. I was super pale growing up, had orthostatic hypotension, dry skin, sweated insanely during puberty, and felt like I got progressively stupider as I got into my early 20s. I developed hypertension, and I drank lots of diet energy drinks from 16-20 and felt better when I did.

At some point, I got genetic testing done through 23andme, ran that info through software that revealed health info, and it showed I had a genoset that heavily affects phenylalanine processing. I started taking a stimulant and tyrosine, and I've felt better ever since.

My genetic oddity also affects NO synthesis, and will probably lead to my death through heart attack or stroke. It's gs224 if you're interested in the specifics.

Damn... my wife and I are doing our 23 and me for the holiday today, I'll have to check it out. I've been investigating a ton of stuff related to my Tourette's (hence the ticviking handle) and now I'm curious how that dopamine path and my tics might be related...

In the UK, most carbonated beverages now contain a blend of sugar and artificial sweeteners, in order to stay under the 5g per 100ml threshold for the "sugar tax".

Coca-cola "classic"/"original taste" is still available with only sugar, but typically at a higher price than other options.

I don't think this is true. Last time I checked, the supermarket default options are still Coke/Pepsi/etc with 11g sugar per 100ml and zero artificial sweeteners.

I haven't seen any sugar/sweetener mixes even after the sugar tax - they are either full-on sugar or zero-sugar.

It's pretty much only "original taste" Coke and Pepsi, and a few premium/boutique brands like Fever Tree that are still full sugar.

Pick up anything else (Sprite, Dr Pepper, Orangina, Irn Bru, San Pellegrino, generic brands, etc) and they are all reformulated with sweeteners or a sugar/sweetener blend.

Even Coke has relabelled "Coke Zero" with a traditional red can/bottle and "zero sugar" in small letters, rather than the distinct black label that it used to have.

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.

I drink Coke Zero all the time, and I have been described as skinny by at least one ultrasound technician. I think you might just not be noticing when non-fat people drink it.

> 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.

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.

As someone that drinks around 10oz of soda a week, I don’t think it qualifies as unhealthy consumption. It’s not perfect, but it’s below the threshold of meaningful impact on my weight.

People seem to focus on the daily consumption which is sadly common. But, there is a huge range between daily and never. I also eat fast food a few times a year which is fine.

I drink a whole lot of diet soda, and I'm skinny. (If I lost 10 pounds, I'd have an "underweight" BMI.)

Of course, I also drank diet soda when I was overweight. And it's fair to say that when I switched from regular soda to diet, I was hoping it would help me lose weight.

Diet sodas appeal to people who are looking for an easy answer to the problem of losing weight. It just so happens in my case I eventually found and committed to a not-easy answer.

I still drink diet sodas for two reasons. One is that I enjoy the variety. At times I have drunk just tea and water, but I get bored with that. The other is I do feel like they make it marginally easier for me to maintain a healthy weight. Without them, I'd probably indulge in non-diet sodas from time to time.


> Creator of Film Theory, Game Theory, and co-host of GTLive. Diet Coke addict. Owner of a cat and a baby.

I don't know if he counts as "a skinny person", but he's not exactly a FatPat either.

Caffeine, sugar, (and alcohol) aren't necessarily bad for you. Joe Rogan repeats a phrase on his podcast all the time that I quite like, "keep all things in moderation, including moderation itself"

That's originally Oscar Wilde “Everything in moderation, including moderation.”

"It has been my experience that those with no vices have very few virtues."

That feels like just anecdotal evidence from one fat diet coke drinker.

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

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


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

same, what gives?

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.

> 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".

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

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


I had a coworker who insisted diet sodas were worse for you than regular sodas. I just don't understand how people reach that kind of conclusion.

I guess it's because other scientists and studies say low-calorie sweeteners can lead to weight gain or increase the risk of developing type 2 diabetes, and in lab experiments aspartame exposure lead to increased lymphoma and leukemia. It's not that obvious which study is right and which maybe had a flawed methodology, or which is the result of correlation rather than causation.

A random example that does not definitively settle anything but is enough to make you keep asking the question [0].

And one common sense argument is that many people consume way more diet sodas than they would regular ones. Since they have no sugar and almost no calories the assumption is that there is no danger to consume more of them, they are "healthy". Since artificial sweeteners have their own sets of risks in mechanisms that are perhaps even less understood, suddenly this assumption is that more dangerous. It could be jumping from the frying pan into the fire.

[0] https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2008.28...

Right! Good point! The study should not be per-person risk, but per-bottle risk to answer that question. How much more does one can of diet Pepsi put your health at risk than the regular kind? Its the question we must answer when faced with the soda cooler at the gas station. But the study gives a different, not-very-actionable per-average-person-lifetime answer.

No study at this time has quantified the risk of sugary vs. diet sodas. They just point out that each one increases the risk of specific medical problems but with no certain indication of which one is worse or by how much. And even deciding what worse means is a big deal. They can simply kill you or decrease your quality of life in different ways. Doesn't make one better.

It's the same recently with cigarettes and e-cigs. Determining smoking or drinking coke is bad compared to not doing it is relatively straight forward. Determining what's better out of 2 alternatives that just harm you in different ways and that weren't studied enough is harder.

If you want to play it safe go for none of them.

And on top of that, it's not like you need to drink some kind of soda, and have to worry about whether sugar, HFCS, or artificial sweeteners are worse. You can avoid the problem altogether by simply not drinking soda!

> it's not like you need to drink some kind of soda

Sugar is pretty addictive so for many people the need is very real. And you can see this from the worldwide sales of sodas.

Um, no, that's not a "need", that's just an addiction. You don't need to feed an addiction and maintain it. Instead, a better alternative is to break the addiction.

I believe the sugar industry was successful in creating the perception that artificial sweeteners can cause cancer. One of the first, sodium cyclamate, was in fact, banned.

> 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.

I suppose because there already is a consensus that sugary drinks are bad for people and cause all the mentioned problems. Now the eye turns on the sugarless ones. However a comparison would be indeed welcome.

It is quite possible that people who drink diet coke also drink coke. So separating the groups could have been interesting.

"...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?

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!

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...

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

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.

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.

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.

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.

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

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.

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.)

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.

Ill just have one then....


It's the phosphoric acid, which binds and prevents the absorption of other micronutrients.

So far as I know, regular soda also has phosphoric acid.


TL;DR: it's an association, not a causal relationship.

It may as well be that people more prone to stroke or heart attacks pick up diet beverages.

I think I'll go grab a diet coke.

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

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.

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 ;)

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.

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