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Diet Soda Linked to Diabetes

Choosing diet drinks over sugar-sweetened drinks may not be such a good idea after all. A new study from France found that both artificially-sweetened and sugar-sweetened beverages are associated with diabetes risk. For both types of beverage, consumption and risk increased together. More consumption translated to more risk. Surprisingly, artificially-sweetened beverages were associated with more diabetes risk than sugar-sweetened beverages.

The study, published online January 30, 2013, in the American Journal of Clinical Nutrition, followed 66,118 women for 14 years and found more diabetes in women who consumed artificially-sweetened or sugar-sweetened drinks. As you might expect, the women consumed more artificially-sweetened soda on average than sugar-sweetened soda: 19 ounces per week compared to 11 ounces. It stands to reason that women who believe that diet soda is the healthy alternative would feel free to drink more of it. (The relatively low weekly amounts are because the women were not queried about all meals during the day.)

Thatís interesting, but hereís the bombshell.

Compared to nonconsumers, women who drank more than 20 ounces of diet soda a week had more than double (+ 121%) the risk of Type 2 diabetes, while women who drank more than 12 ounces of sugar-sweetened beverage had a 34% increase in T2D risk. (Ninety percent of diabetes is Type 2, which is most common in older individuals.)

How consequential is this study? Should we believe it? Should we act on it?   

Letís look at some details that help to put the findings into perspective.

First, itís important to understand that the study does not prove a causal link between diet drinks and type 2 (T2D). The French researchers found an association, a strong positive trend, not a cause and effect connection. The women who drank either diet or regular soda had more diabetes than women who didnít drink soda of any kind. ďWe cannot rule out that factors other than artificially sweetened beverage (ASB) consumptionÖare responsible for the association with diabetes, and randomized trials are required to prove a causal link between ASB consumption and T2D,Ē the researchers cautioned.

Secondly, the type of artificial sweetener was not specified. The women were simply asked about their consumption of sugar or artificially sweetened beverages. They were also asked about consumption of 100% fruit juice. (No association was observed for 100% fruit juice consumption. Iíll have some comments on fruit juice below.)

So the findings apply to all forms of calorie free sweeteners.

While the consumption of sugar-sweetened beverages (SSBs) has been widely associated with T2D, lead researcher Guy Fagherazzi and colleagues say the association of artificial sweeteners and diabetes is unsettled; some studies have found an association and others havenít. For example, a recent study concluded that aspartame [Equal] produced an insulin concentration similar to that induced by sugar. Another study, however, found that glucose and insulin concentrations were lower for artificial than for sugar-sweetened beverages.

Importantly, it has been established that artificial sweeteners produce an insulin response. The body responds to sweetness, even if it comes without calories. That would no doubt come as a surprise to most consumers of diet soda. It changes the landscape on diet drinks.

Bottom line: The jury is still out on artificially-sweetened beverages, but the alarm bells are sounding.

*  *  *

What actions, if any, should we be taking now? Iíll tell you some of the changes Iím making. Perhaps they will give you some ideas on improving your own diet.

My father had T2D late in life, and thatís one area where I do not want to follow in his footsteps. Doctors have long told me (because of my family tree) that my lifestyle is the only thing that keeps me from developing T2D. As National Institutes of Health Director Francis S. Collins, MD, PhD, said recently on C-Span, ďGenes load the gun, but lifestyle pulls the trigger.Ē If there is anything I can do to ward off this devastating disease, sign me up.

Except for sharing a small diet Coke when we go to a movie, Carol and I donít consume soft drinks. We prefer water. That wonít change.

We also avoid fruit juice. Whole fruit is more filling and satisfying. The whole fruit takes longer to eat and digest and, unlike fruit juice, doesnít cause a spike in blood sugar. Using the apple as an example, whole apples produce long-term hunger satisfaction. Apple juice and applesauce, on the other hand, go down in a flash and cause a spike in blood sugar. Soon after consuming apple juice or applesauce your blood sugar spikes, and soon after drops below normal. It's called "rebound hypoglycemia." The result is that you are hungry again sooner than you would be after eating the whole apple..

High blood sugar is, of course, the trademark of diabetes. Keeping blood sugar on an even keel protects against diabetes and is also a good way to control hunger. While the French researchers didnít find an association with diabetes, they acknowledged that most studies in the literature do show an association between fruit juice consumption and T2D. Fruit juice is not recommended for those predisposed to diabetes.  

Needless to say, Carol and I will not be adding fruit juice to our diet.

Breakfast is a place where I am making a change. I have been adding Splenda to my ďOld ReliableĒ breakfast mixture. I enjoy the added sweetness, so I decided to make a trade off. I dropped the Splenda and added a tablespoon of raisins. That adds about 30 calories and not quite as much sweetness. An added bonus is that chewing the raisins adds more eating pleasure. If switching from Splenda to raisins makes me less diabetes prone, itís a painless bargain. (I also include nuts to slow absorption and help control blood sugar.)

I may decide that I donít need the added sweetness from the raisins, but I want to make the change gradually. It would not be good psychology to tell myself, No more sweet stuff!  Itís better to make a deal with yourself thatís easy to tolerate. (More about that below)

What about coffee? I have one cup of coffee with my mid-afternoon snack. I enjoy coffee, but not black. Once again, Iíve been adding Splendaóalong with one part water and two parts skim milk, and a teaspoon of canola oil. The canola oil adds smoothness and slows absorption. With Splenda, coffee is really good; I like it a lot. Another trade off was in order. I dropped the Splenda, and added one-half teaspoon of sugar. Again, itís not as sweet and adds about 7 calories. Less sweetness means less blood sugar and less insulin response. Another good deal.

Another safeguard is that I donít drink coffee alone. I always have it with food. Having the coffee with my mid-afternoon snack slows absorption, minimizing blood sugar and insulin response.

Perhaps more important, I never say never. I donít tell myself I canít have a specific food. That only makes me want it more; itís human nature. A better idea is to make compromises you can live with comfortably. Thatís what I have done here.

These are all small changes, but my experience is that small changes over time can make a big difference. My doctor at the Cooper Clinic monitors my hemoglobin A1c, which measures average blood sugar over the past 8 to 12 weeks. (My fasting blood sugar is good at 78.) A1c is the gold standard in blood sugar monitoring. It will tell us whether my changes are making a difference.

A balanced diet of whole foods is ideal for eating satisfaction and weight control. It is also good for keeping blood sugar under control; that's part of the reason why it helps to control hunger. For more about my eating style, see Diet and Training Philosophy, in Brief: http://www.cbass.com/PHILOSOP.HTM

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