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Diet beverages pose no greater harm than sugar-sweetened
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Non-nutritive beverages cannot be conclusively designated as harmful in terms of obesity, diabetes or cardiovascular disease, according to a presenter at Obesity Week 2013. The latest research points to sugar-sweetened beverages causing greater harm in terms of visceral body fat.
“It’s difficult to make recommendations or conclusions. We definitely do not have good scientific support to recommend people steer clear from diet beverages. They’ve been studied for decades and now we’re looking at them in a different light, but I still don’t see the harm,” Mark Pereira, PhD, of the University of Minnesota department of food and nutrition, told Endocrine Today.
In his presentation, Pereira reviewed current literature looking at both non-nutritive, or diet, beverages and sugar-sweetened beverages. He said the existing research data on diet beverages consumed by humans is based mainly in large epidemiological cohort studies that exhibit measurement errors and biases, making them inconsistent.
“Unlike sugar-sweetened beverages, which in the literature seem to be consistently associated with type 2 diabetes, the diet beverages are not,” Pereira said. “Some studies show that they might increase risk and other studies show that they might actually decrease risk.”
Pereira attributed this to reverse causality in that participants with pre-existing risk factors for obesity, diabetes or CVD are more likely to drink diet beverages and then progress further in their diseases.
In addition, Pereira said soon-to-be published data suggest sugar-sweetened beverages are more closely associated with visceral fat, whereas diet beverages have been correlated with subcutaneous fat.
“That helps to support the hypothesis that the sugar-sweetened beverages may be operating through more fat storage in that intra-abdominal cavity and that’s why they may be truly increasing risk for cardiovascular disease and diabetes,” he said. “It’s looking like there’s not good scientific support to make really strong conclusions about the role of the diet beverages in either helping people or potentially causing harm.”
Lastly, Pereira looked at recent studies that tried to replace sugar-sweetened beverages with diet beverages in patients who are already overweight or obese. In these studies, which he said are “not surprising,” participants who switched to diet beverages from sugar-sweetened beverages lost weight.
“The bottom line from that research is if the diet beverages distorted appetite regulation and satiety in humans and, therefore, led to overeating and weight gain, you would have seen some evidence in those trials, but you actually see the opposite. At least when you’re comparing them to sugar beverages, the people are better off,” Pereira said. “It’s not a strong effect, but it’s all we have to go on right now.”
Pereira said sugar-sweetened beverages should be lessened in everyday intake, but the question is with what they should be replaced. Randomized controlled studies are needed across disciplines to determine whether there are truly harmful or beneficial effects from non-nutritive beverages.
As an aside, Pereira said the beverage that has been shown to play the largest role in prevention of type 2 diabetes is coffee.
“There’s so much preventive and therapeutic potential in the coffee bean that we are just beginning to learn about, and there have been some compelling meta-analyses on the topic, but there’s a lot more to learn about it,” he said.
For more information:
Pereira M. Role of non-nutritive sweeteners in regulation of weight: Obesity facts and fiction. Presented at: Obesity Week; Nov. 11-15, 2013; Atlanta.
Disclosure: Pereira received funding from the Robert Wood Johnson Foundation Healthy Eating Research as well as The Obesity Society. He declares no conflicts of interest.