Monday, February 27, 2012

Do Artificial Sweeteners Help with Weight Loss?


While it's always possible that real and conclusive dangers linked to the consumption of modern day artificial sweeteners will emerge, to date the data suggesting risk has been underwhelming to say the least, in great part due to the fact that the studies have been flawed in that they look at all comers' dietary consumption patterns and without very careful controls for diet, their conclusions are highly suspect. Reason being that there's a very real possibility that many people out there who drink artificially sweetened beverages do so as a means to assuage their guilty consciences in making less than stellar dietary choices - the "I'll have the super-sized combo with a Diet Coke please" phenomenon. Consequently it's certainly possible that artificial sweeteners are serving as a marker for chronic disease inducing diets rather than the chronic diseases' actual cause.

But that's a whole separate debate. Today I want to talk about the role of artificially sweetened beverages in a population that's actively trying to manage their weight, because after all, if there's any reason to encourage the consumption of artificial sweeteners, it has to be in the context of their use as overall calorie reducers, and unlike all comers, folks actively trying to lose weight are the ones I see on an every day basis in my practice.

This month's American Journal of Clinical Nutrition has just such a study where 318 folks with obesity who were drinking 280 or more calories daily from beverages were randomized to 6 months of either:

A) A control group that received monthly weigh ins, weekly monitoring and monthly group sessions on weight management.
B) A group where they received the same education but were encouraged to replace 200 or more of their liquid calories with water.
C) A group where they received the same education but were encouraged to replace 200 or more of their liquid calories with artificially sweetened beverages.

The results?

Somewhat to the chagrin of my own confirmation bias, they were rather underwhelming too. All groups lost roughly the same small amount of weight - including the control group who perhaps unsurprisingly, without explicitly being told to do so, also reduced their liquid calorie intake.

My take?

It was still the wrong population. These weren't the folks drinking 2L (808 calories) of Coca Cola a day, these folks were drinking on average 348 liquid calories a day, from all sources of liquid calories, not just sugar-sweetened ones. So yes, while it might have been soda pop, it could just have easily have been a few coffees with cream, half a glass of juice and a glass of wine a night, or for someone else, 2 fancy lattes. Yes, all targets worthy of reduction, but relatively tiny and potentially unfair targets - after all, it's improssible to replace milk, coffee cream, juice or alcohol with Splenda. Moreover, given the study folks aren't drinking enormous numbers of calories to begin with, reductions will likely be rather small, and indeed, at the end of the intervention the treatment groups were down about 200 liquid calories a day whereas the control group was down 100.

So perhaps it's not actually surprising to see an underwhelming result and I do wonder,would it really have been that difficult to specifically select a group already drinking a large amount of sugar-sweetened beverages with obviously available artificially sweetened alternatives?

So do I recommend artificially sweetened beverages?

Yes and no.

In an ideal world we'd drink far fewer sweet beverages. Whether they're sweetened by means of sugar or by means of artificial sweeteners, having palates craving cloyingly sweet isn't going to help in navigating through lower calorie choices or healthy fare.  For many, liquid calories, are the low hanging fruit of weight management - easy to reduce and consequently, I think it's certainly worth your own personal exploration of liquid calories, and if indeed you're drinking huge amounts of them, especially sugar sweetened ones, as a step-down strategy if you think you can use artificially sweetened beverages as you reduce the sweet drinks overall, I say go for it.

As far as I'm concerned, everyone's end goal is simply the smallest number of liquid calories they need to be satisfied, and ideally, the smallest amount of "sweet" beverages regardless of how the beverages got their "sweet" in the first place.

Tate, D., Turner-McGrievy, G., Lyons, E., Stevens, J., Erickson, K., Polzien, K., Diamond, M., Wang, X., & Popkin, B. (2012). Replacing caloric beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial American Journal of Clinical Nutrition, 95 (3), 555-563 DOI: 10.3945/ajcn.111.026278

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18 comments:

  1. The only calories I consume in liquid is via coffee and tea.. and that is 2 at beginning and 1 at end of day. I use approx 8 packets of splendar a day.. Is that too much? I have researched the use of splendar but have not found anything worthwhile to guide me on this.

    To comment on the use of AS in drinks as a whole, I am not sure you can be committed to a healthy lifestyle or weight loss whilst drinking soda's or other calorie laced drinks outside of tea and the occasional coffee. The HFCS has a negative effect on weight loss..

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  2. I grew up with a Mom that always had Tab in the fridge. I never got into sugary soda but drank my fair share of diet ones. Now as a Mom myself my kids drink diet as well. Its what I have when I buy it and during the occasional restaurant trip that is what they order because that is what they are used to. We also buy Crystal Light lemonade.

    When my youngest was a toddler (she is 9 now) I had to ban juice boxes from the house because she would drink one after another like a college boy and a case of beer. The calories do add up so quickly and she could drink 4 in a row no problem.

    I do worry that something will be found wrong with drinking diet soda regularly from a young age and I do encourage them to drink water instead, but so often it is a fight if I don't have tasty options in the house. I opt for the artificially sweetened ones because I don't want them to have all those extra calories because they add up.

    - nicole

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  3. Roman Korol8:18 am

    Drs. J. Mercola MD and Kendra Deaken Pearsall NMD wrote a strongly condemnatory book aobut artificial sweeteners, Sweet Deception, Nelson Books 2006, ISBN 0-7852-2179-4. Dr. Mercola writes specific and detailed comments on the topic at http://products.mercola.com/sweet-deception/

    I have a feeling that the following cite from Dr. Mercola is well worth keeping in mind:

    If you’re consuming a food or beverage created in a lab instead of by nature, you can be assured your body doesn’t recognize it. This opens the door to short-term and long-lasting health problems for you and your family.
    http://articles.mercola.com/sites/articles/archive/2009/10/13/Artificial-Sweeteners-More-Dangerous-than-You-Ever-Imagined.aspx

    Does your blog's omission of this useful information (references are provided in the second article) imply that it merits no attention?

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    1. Roman, I don't subscribe to the natural fallacy and think Mercola is as far from a credible voice as one can get.

      Coincidentally Mercola's the prominent feature of today's Science Based Medicine blog post. You've always struck me as a thoughtful gentleman, I'd encourage you to read it.

      They've also covered the safety of aspartame (from an evidence base, not one of natural fallacy), and if you're really interested, here's another on Mercola.

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    2. Roman Korol7:45 pm

      Thanks for the links Yoni, I did check them out. I found the criticisms of Dr. Mercola to be in large part ultra-aggressive hysterical "over-the-top" ad-hominem which, for me, causes red warning flags immediately to pop up. In addition, I saw no commentary there whatsoever regarding Splenda, and Splenda was, after all, the whole point of my post. Sorry to be underwhelmed.

      I see the blog you reference exhonerates HFCS (high fructose corn syrup). As to that, they are at serious variance with Dr. Robert Lustig MD, of UCSF. See the Lustig video Sugar, the Bitter Truth. Check out his comments at about 56:10 on fructose. I guess the Science Based Medicine blog put their foot in their mouths on this one. Happens.

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  4. Two reactions to this great piece: in the study you referenced, there was no TRUE control group--it sounds like all three groups had some intervention. Even the "control" group described had monitoring which would have impacted change; that's a known effect of accountability, such as record keeping.

    So glad to hear your take on artificial sweeteners. They are a valuable substitution for those who do rely on sweetened beverages, not just those struggling with obesity but with their blood sugars as well.

    My biggest issue with diet beverages is that dieters often use them to mask their hunger. To learn a more intuitive approach to self regulating food intake, you need to know when you are hunger--as well as when you are full!

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  5. I just picked one of the stats from Mercola's piece - the 10% increase in brain cancer after aspertame was put on the market in the 80's.

    If I did the math correctly - accounting for incidences of brain tumors in Americans (about 23,000 in 311,000,000 Americans) then a 10% increase would add about 230 incidences in 311,000,000 or less than 1 in a million extra incidences.

    Whoo. I don't know if I did the math right... but I don't think that added extra 10% risk would get me to stop drinking Diet Coke. He needs to get better stats than that!

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  6. Hi there,

    @people citing Joe Mercola: please stop reading quack websites that are devoid of any legitimate information. Ask Mercola why he publishes on a scummy website instead of legitimate scientific journals.

    @yoni, I applaud your article. I personally am sick of people attacking artificial sweeteners, especially those that only quote the observational study performed by Fowler in San Antonio. Even in that study that found a correlation between weight gain and artificial sweetener use, the author admitted it was likely because the people consuming most artificial sweeteners were already on weight gaining trajectories. I whole heartedly agree with your assessment that there was no true control group in this study, which would have been nice.

    For more info:

    In 1991, a systematic review examined the claims that aspartame (and saccharin, and acesulfame-K) leads to increased hunger and weight gain. The review found that most investigations found that aspartame is associated with decreased or unchanged ratings of hunger. Both short-term and long-term studies have shown that consumption of aspartame-sweetened foods or drinks is associated with either no change or a reduction in food intake. Further, the review found that aspartame may be a useful aid in a complete diet-and-exercise program or in weight maintenance. The review concluded that intense sweeteners have never been found to cause weight gain in humans. (Rolls BJ. Effects of intense sweeteners on hunger, food intake, and body weight: a review. Am J Clin Nutr 1991;53:872–878.)

    In 2010, a study examined the effects of aspartame on food intake, satiety, and after meal glucose an insulin levels. The study found that aspartame was not associated with any additional food intake, that aspartame made users feel just as full as table sugar, and that there was no difference in after meal glucose or insulin levels between table sugar or aspartame. (Antona, SD. “Effects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels.” Appetite. Volume 55, Issue 1, August 2010, Pages 37-43.)

    
Clearly, no evidence supports the false assertion that aspartame causes weight gain.

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    Replies
    1. You know what? This is my first time visiting your blog, and I just realized it's all about weight loss and you've covered this information in detail. I apologize for posting those two studies, because you're likely already aware of them and have covered them. My bad.

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    2. No worries and welcome.

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  7. Call me paranoid but I think a lot of these studies are done in such a way as not to negatively influence consumers purchasing whatever it is they are studying. It is in Splenda or fill in the blank's artificial sweetener's best interest for consumers to read that there are no negative effects. There was a study recently done where Coke was the sponsor but claimed to have no undue influence . yeah right! I was told never to drink soda again after my weight loss surgery. I still have had a sip here or there but found it causes me a lot of problems so luckily for me it's no longer an option. I do, however, drink a moderate amount of Crystal Light. Not loads of it but enough for me to be curious as to the results of this study. I had a friend recently tell me that Crystal Light is bad for you. So all of this really has me wondering. I guess at the end of the day water is the best and that's where I need to focus. I still have my coffee!

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  8. Anonymous9:48 am

    I order a diet coke with my burger - not to allow myself extra calories, but simply because I like the taste of "diet" coke. Regular coke tastes like syrup - yuk.
    I also prefer dry wines over sweet wines.
    In developing a drink to save calories for dieters, they've also created an excellent drink for people like me who simply prefer tart to sweet.

    That kinda goes against the idea that "diet" drinks taste sweet just like sugary drinks - maybe different people have different perceptions of the taste.

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    1. I'm with you anon, I've always preferred the taste of diet soda to their sugared counterparts.

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  9. @Anon 6:48. I too like tart flavours. Unfortunately, I don't find aspartame tart (although I agree that its sweetness is different from that of sugar). I somtimes find myself wishing they'd make a soda with 50% the sugar of regular, with no added sweetener. It's probably good for me that they don't.

    Something I like to drink is pure (unsweetened) cranberry juice (NOT cranberry cocktail!) diluted with water or club soda. It's intensely sour and very low in calories. If you can stand to drink it undiluted, a whole cup has only 50 calories, due to the low sugar content... but I think that would make your head implode. I drink it diluted about 6:1, about 50 or 60ml (10-15 calories' worth) per serving. I find it very refreshing, especially on a hot day.

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  10. (To clarify: I don't sweeten it. Just dilute.)

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  11. CanadianChick10:18 am

    While beverages are probably the most used source of sweeteners, what about their use in other foods? Greek Yogurt with a splash of sugar-free Torani syrup is my new favourite way to increase protein in my diet...and it saves a bunch of calories, as well as giving me a taste of something sweet (I usually add fruit too, but without the syrup Greek yogurt is too sharp for me). After they do a proper beverage study I'd like to see one on yogurt *grin*

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  12. I tried switching from sugar to Splenda in my coffee, and it set up the oddest sugar cravings. I even ate plain (non-chocolate) cake, something I don't think I've ever done in my life. It took almost a week to make the connection. I still have a bit of Splenda, but only I'm drinking the coffee with food, or have already eaten, then I don't get that effect. Very strange.

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  13. Artificial sweeteners will increase the weight .We should not take this artificial sweeteners daily.It is not good for health.

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