Updated: 12:37 PM CST Feb 14, 2019 By Sandee
LaMotte,
More bad news
for diet soda lovers: Drinking two or more of any kind of artificially
sweetened drinks a day is linked to an increased risk of clot-based strokes,
heart attacks and early death in women over 50, according to a new study by the American Heart Association and American Stroke Association.
The risks were
highest for women with no history of heart disease or diabetes and women who
were obese or African-American.
Previous
research has shown a link between diet beverages and stroke, dementia, Type 2
diabetes, obesity and metabolic syndrome, which can lead to heart disease and
diabetes.
"This is
another confirmatory study showing a relationship between artificially sweetened
beverages and vascular risks. While we cannot show causation, this is a yellow
flag to pay attention to these findings," said American Academy of
Neurology President Dr. Ralph Sacco, who was not involved in the latest study.
"What is it
about these diet drinks?" asked lead study author Yasmin Mossavar-Rahmani,
an associate professor of clinical epidemiology and population health at the
Albert Einstein College of Medicine in the Bronx, New York. "Is it
something about the sweeteners? Are they doing something to our gut health and
metabolism? These are questions we need answered."
More than 80,000
postmenopausal U.S. women participating in the Women's Health Initiative, a
long-term national study, were asked how often they drank one 12-fluid-ounce
serving of diet beverage over the previous three months. Their health outcomes
were tracked for an average of 11.9 years, Mossavar-Rahmani said.
"Previous
studies have focused on the bigger picture of cardiovascular disease," she
said. "Our study focused on the most common type of stroke, ischemic
stroke and its subtypes, one of which was small-vessel blockage. The other
interesting thing about our study is that we looked at who is more vulnerable."
After
controlling for lifestyle factors, the study found that women who consumed two
or more artificially sweetened beverages each day were 31 percent more likely
to have a clot-based stroke, 29 percent more likely to have heart disease and
16 percent more likely to die from any cause than women who drank diet beverages
less than once a week or not at all.
The analysis
then looked at women with no history of heart disease and diabetes, which are
key risk factors for stroke. The risks rose dramatically if those women were
obese or African-American.
"Women who,
at the onset of our study, didn't have any heart disease or diabetes and were
obese, were twice as likely to have a clot-based or ischemic stroke,"
Mossavar-Rahmani said.
There was no
such stroke linkage to women who were of normal weight or overweight.
Overweight is defined as having a body mass index of 25 to 30, while obesity is
over 30.
"African-American
women without a previous history of heart or diabetes were about four times as
likely to have a clot-based stroke," Mossavar-Rahmani said. But that
stroke risk didn't apply to white women.
"In white
women, the risks were different," she said. "They were more 1.31
percent as likely to have coronary heart disease."
The study also
looked at various subtypes of ischemic stroke, which doctors use to determine
treatment and medication choices. They found that small-artery occlusion, a
common type of stroke caused by blockage of the smallest arteries inside the
brain, was nearly 2½ times more common in women who had no heart disease or
diabetes but were heavy consumers of diet drinks.
This result held
true regardless of race or weight.
This study, as
well as other research on the connection between diet beverages and vascular disease,
is observational and cannot show cause and effect. That's a major limitation,
researchers say, as it's impossible to determine whether the association is due
to a specific artificial sweetener, a type of beverage or another hidden health
issue.
"Postmenopausal
women tend to have higher risk for vascular disease because they are lacking
the protective effects of natural hormones," North Carolina cardiologist
Dr. Kevin Campbell said, which could contribute to increased risk for heart
disease and stroke.
"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 adviser for the Calorie Control Council, an
international association representing the low- and reduced-calorie food and
beverage industry.
Yet, said Sacco,
who is also chairman of neurology at the University of Miami's Miller School of
Medicine, the more studies there are coming up with the same associations,
"the more you begin to question. The more you begin to feel strongly about
the association being real."
Critics also
point to the possible benefit of artificially sweetened drinks for weight loss,
a critical issue considering the epidemic of obesity in the United States and
around the world.
For example, two
World Health Organization meta-analyses of existing research on non-sugar sweeteners called those studies
"low-quality and "inconclusive," said William Dermody Jr., vice
president of media and public affairs for the American Beverage Association, a trade organization.
"Low- and
no-calorie sweeteners have been deemed safe by regulatory bodies around the
world," Dermody said, "and there is a substantial body of research
that shows these sweeteners are a useful tool for helping people reduce sugar
consumption.
"We support
the WHO's call for people to reduce sugar in their diets, and we are doing our
part by creating innovative beverages with less sugar or zero sugar, clear
calorie labeling, responsible marketing practices and smaller package
sizes."
The American
Heart Association issued an advisory last year, saying that short term use of
low-calorie and artificially sweetened drinks to replace sugary ones "may
be an effective strategy" to promote weight loss in adults, but not
children.
The guidance is
aimed at those who "find it difficult to move directly from sugary drinks
to water," said University of Hawaii nutrition professor Rachel Johnson,
chairwoman of the writing group for that scientific advisory. "Low-calorie
sweetened drinks may be a useful tool to help people make this
transition."
On the whole,
Johnson said, "there is solid science that consumption of sugary drinks is
associated with adverse health outcomes. Thus, it may be prudent to limit
intake until we know more about how they may impact people's risk of
stroke."
While science
continues to explore the connection, Americans are turning more and more to
water and other non-calorie beverages, according to the Beverage
Marketing Corporation, a data and consulting group. In 2016, bottled
water surpassed carbonated soft drinks to become the No.1 beverage by volume
and has continued to dominate the market in 2017 and 2018.
In 2018,
Americans are projected to drink just over 3 billion gallons of diet sodas out
of a total of 12.2 billion gallons of carbonated sodas, according to data from
the Beverage Marketing Corporation.
"Personally,
I've stopped drinking artificially sweetened beverages," Sacco said,
adding that he sees the emerging research as "an alert" for hard-core
fans of diet drinks and anyone thinking of turning to them for weight loss.
"We should
be drinking more water and natural beverages, such as unsweetened herbal
teas," Mossavar-Rahmani said. "We can't just go all day drinking diet
soda. Unlimited amounts are not harmless."
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