Calorie Control Council Response to “Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis”

ATLANTA (January 20, 2009) The Calorie Control Council is concerned about findings published in the January 2009 issue of Diabetes Care.  The study findings do not reflect the scientific literature confirming the safety and benefits of low-calorie sweeteners and the products that contain them.  The following outlines concerns with the study.

  • This study is observational and does not show cause and effect.  Further, the study authors offer no definitive conclusions or reasons as to why diet soda may lead to weight gain, impaired glucose control and eventual diabetes.  The study authors note, “We are cautious not to conclude causality between diet soda and the diabetic or pre-diabetic condition.  The possibility of confounding by other dietary and lifestyle/behavioral factors cannot be excluded from these observational studies.”
  • The author’s allege a link between diet soda and components of metabolic syndrome however, after excluding participants with any existing component of metabolic syndrome, no significant association between diet soda and metabolic syndrome was found.
  • Dietary intake patterns of diet soda consumers in the study indicate dietary patterns inconsistent with an increased risk for metabolic syndrome.  The author’s report, “Regular diet soda consumers ate more whole grains, fruit, low-fat dairy, desserts and coffee but less high-fat dairy, processed meat, refined grains and sugar-sweetened soda.  These differences are consistent with dietary patterns that have been independently associated with lower risk of metabolic syndrome or type 2 diabetes.”  This finding was confirmed by a study published in the Journal of Food Science that found people who use reduced-calorie products, containing low calorie sweeteners, not only had a better quality diet but also were more likely to consume fewer calories than those who did not use reduced-calorie products.
  • The researchers did not control for weight gain, which is related to the development of metabolic syndrome, nor did they exclude overweight individuals from the study.  Further, diet soda consumption patterns were only collected at baseline which deems it unclear if consumption patterns changed over the course of the two year study.
  • The researchers claim diet soda consumption was associated with a greater risk of metabolic syndrome indicated by a greater risk of developing high waist circumference or high fasting glucose.  However, the highest user group (> one diet soda serving per day) had the highest waist circumference at the beginning of the study.  Thus, it is not clear if diet soda consumption is related to an increased risk of developing high waist circumference (which may lead to metabolic syndrome) or if participants used diet soda to help manage their weight, diabetes, etc.
  • The study findings are illogical.  It is physiologically impossible for foods and beverages without calories to cause weight gain.  Even the study authors note, “Artificially-sweetened beverages, like diet soda, are commonly considered ‘benign’ as they contribute no energy and few nutrients to the diet.”
  • The authors’ statement, “Current literature provides data on single sweeteners only, mostly aspartame, with few using saccharin and none using sucralose,” is inaccurate and does not reflect the relevant and existing literature on low calorie sweeteners.  Low-calorie sweeteners are the most thoroughly studied ingredients in our food supply.  For example, many studies conducted using aspartame, saccharin and sucralose individually demonstrate the benefits of these products as well as their important role in assisting with weight control.  In terms of weight control, several studies in humans have shown that low-calorie sweeteners can be helpful in weight loss and maintenance.
  • The authors fail to reference a two year, clinical trial (the gold standard of research) conducted by Harvard’s Dr. George Blackburn which showed that aspartame was helpful not only in weight loss, but also in weight control.
  • The author’s statement, “No studies [using artificial sweeteners] were long term nor did they include measures of glycemic control or insulin sensitivity is also inaccurate.  Numerous studies using low calorie sweeteners have shown that intake of low calorie sweeteners by subjects, with or without diabetes, did not affect blood glucose.  Low-calorie sweeteners and the products that contain them are not drugs and do not stimulate physiological or hormonal changes.”

Low-calorie sweeteners and the products that contain them are not “magic bullets” for weight loss.  Instead, light products and low-calorie sweeteners are tools to help people reduce and control their caloric intake.  Leading health authorities agree that “light” products can be used as “tools” as part of an overall weight control program, which includes a reduction in calories and an increase in activity.  Leading health groups also agree that low-calorie sweeteners and the products that contain them can help people manage their weight as part of an overall healthy diet. No major health group has made changes to its dietary recommendations based on observational studies.  Many studies have supported the benefits of low calorie sweeteners.  A few may be found below.
Bellisle, F. and Drewnowski, A. (2007).  Intense sweeteners, energy intake and the control of body weight.  European Journal of Clinical Nutrition. 61, 691-700.

Blackburn, G. L., et al. The effect of aspartame as part of a multidisciplinary weight-control program on short- and long-term control of body weight. American Journal of Clinical Nutrition. 1997. Vol. 65. 409-418.

Ludwig, D. S. et el. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. 2001. Vol. 357. 505-508.

Raben, A., et. al. Sucrose Compared with Artificial Sweeteners: Different Effects on Ad LibitumFood Intake and Body Weight After 10 Weeks of Supplementation in Overweight Subjects.American Journal of Clinical Nutrition. October 2002. Vol. 76. No. 4. 721-729.

Rodearmel, S.J., et al.  Effectiveness of Families on the Move! A Family Based Approach for Preventing Excessive Weight Gain in Children.  2006.  Pediatric Academic Societies’ Annual Meeting. 

Sigman-Grant, M., and Hsieh, G. (2005) Reported use of reduced sugars foods and beverages reflect high quality diets. Journal of Food Science.  70(1), S42-S46.

faq2Do you have questions about low-calorie sweeteners? Want to learn more about maintaining a healthy lifestyle? You asked and we listened. Our resident Registered Dietitians answered the most popular questions about low-calorie sweeteners.

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