Tuesday 19 March 2019

Artificial sweetener: sugar-free - but at what cost?

Resident dietitian Orla Walsh takes a closer look at fizzy drinks

Orla Walsh
Orla Walsh

In the immediate aftermath of the new sugar tax, it has been frequently suggested that soft drinks with added sweeteners are just as bad, if not worse. But is there any truth in that statement?

The sugar tax was put in place this year in a bid to help tackle the obesity crisis, alongside other measures. By encouraging reformulation and by creating a scenario where the drink with less sugar is the cheaper option, so those that drink fizzy drinks may reduce their overall sugar intake. We know that sugar, when eaten in excess, isn't good for us and we know that if we consume too many calories we'll gain weight.

Recently, there were many headlines gracing the pages of newspapers, suggesting that there was no proof that sugar-free drinks were healthier.

However, these headlines, although sounding definitive, were based on a scientists' opinion piece rather than new research or scientific evidence. The better and best type of review is a systematic one. This takes all the available evidence and systematically reviews the pooled results to answer a specific question.

There were many great points raised within the review. The authors concluded that there is an "absence of consistent evidence" that artificially sweetened drinks can improve health outcomes such as helping people achieve a healthy body weight.

Nevertheless, despite the lack of consistent evidence, there is still published research in favour of these artificially sweetened alternatives.

For instance, in 2016 a systematic review was conducted, reporting on the pooled results of the available Randomised Controlled Trials (RCT) on this topic. RCTs are used to figure out if something causes something else, rather than just a link or association. They involve randomly allocating groups within the study and conducting the study in such a way that both the subjects and researchers remain unaware of which group they fall into.

The above mentioned systematic review analysed the available RCTs on this topic and reported that consuming low-calorie sweeteners led to reduced body weight, when compared to sugar.

Generally speaking gaining weight is only a concern when it is fat gain. Few people worry about gaining weight if it is muscle.

Therefore, absolute fat gain must be discussed within this conversation. A big risk factor for disease is the amount of fat you store in and around your organs. This is called visceral fat and is problematic.

As this fat is in and around the organs, it gets in the way of them doing their job, which can lead to health issues.

The other concern is that visceral fat isn't just lying there dormant. It's active, secreting substances that increase disease risk. Having high levels of visceral fat has been linked to an increased risk of developing Type 2 diabetes and heart disease.

An analysis was conducted using previously collected data in approximately 2,600 middle-aged adults. Habitual intake of sugar sweetened beverages and artificially sweetened low-calorie alternatives was assessed using a validated food frequency questionnaire.

The fat in and around their organs (visceral fat) and the fat lying just below their skin of their waist (subcutaneous fat) was measured.

They found that consuming sugar sweetened beverages was positively associated with visceral fat. In fact, daily consumers of sugar sweetened beverages had a 10pc higher absolute visceral fat, whereas consumption of diet soda was not associated with either volume or distribution of visceral fat.

They also found that the more sugar sweetened beverages a person drank, the more fat they accumulated around their waist. Interestingly this link was also seen with diet drinks.

Looking at the evidence, it is consistent and solid when it comes to sugar sweetened beverages and health. They are not good for us. However, the inconsistencies and rockier evidence lies with the artificially sweetened alternatives.

Considering the currently available data, it is false to say that diet drinks are no better than sugary drinks in terms of body weight.

Future trials comparing sugary drinks with diet drinks are needed for any level of certainty on this topic. Intuitively a drink which contains lots of calories, versus one that contains few or none, must be worse for weight and possibly worse for other health markers and dental issues.

Artificially sweetened drinks are a way to cut calories. However, artificially sweetened drinks are to sugar-sweetened beverages as e-cigarettes are to cigarettes. It would be safe to say that neither may be ideal, but both appear better than the alternative.

Ultimately, it's probably better for you to abstain from both.

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