Many people make the mistake of believing artificially sweetened beverages and products are healthier since they have fewer calories and no sugar. Yet, a study revealed that both sugar-sweetened and artificially sweetened beverages are harmful to your heart, even if you only drink about half a can a day.
The study was led by a group of scientists from Sorbonne Paris Nord University and published in the Journal of the American College of Cardiology.1 It followed years of research linking sugar sweetened and artificially sweetened beverages to obesity, a risk factor for cardiovascular disease.2,3
Many experts believe the rising rates of obesity and cardiovascular disease can be attributed in large part to junk food, of which sugary beverages and soft drinks are contributing factors.4 According to a report from Healthy Food America, the majority of people in the U.S. drink at least one sugary beverage each day.
Although consumption has decreased since a peak in 2000, industry sales data have not shown a recent decline.5 At the time of the report, nearly half of all added sugars were coming from sugary drinks.
However, this may have recently changed with COVID-19. If sugary beverage consumption is following alcohol use during the pandemic, the numbers are rising, which could have serious implications on heart health — even if sugary beverages are swapped for diet versions.6
Regular or Diet Soda Raises Risk of Cardiovascular Disease
Over the years, there has been an increasing number of studies demonstrating the risk of artificial sweeteners. A recent study from France, however, finds about half a can of soda, sweetened with sugar or artificially sweetened, increased the risk a person would experience a cardiovascular event compared to those who drank none.7
The researchers adjusted for compounding factors including alcohol, whole grains, legumes and overall calorie count. The analysis also accounted for other comorbidities that affect cardiovascular diseases, such as high blood pressure and Type 2 diabetes. The endpoint of the study was first-time cases of cardiovascular diseases such as heart attack, stroke, acute coronary syndrome and a transient ischemic attack.
The data revealed people who drank 6.26 ounces or more per day of regular, sugar-sweetened soda had much higher risk of cardiovascular events over a median 6.6 years of follow-up. Those who drank 5.97 ounces of artificially sweetened beverages per day similarly experienced an increased risk of cardiovascular disease.
People who drank 1.58 ounces or less per day did not experience any negative events. This meant people who drank one can of soda every eight days had no negative effects, but people who drank one or more cans every two days were at high risk.
There were 104,760 people who volunteered for the study and kept a 24-hour dietary record every six months. An average of 5.7 records were collected for every person during the follow-up. The scientists acknowledged there were limitations to the study, including potential confounding factors that had not been included in the adjustments.
Soft Drinks Raise the Risk of All-Cause Mortality
These results were similar to another 20-year study involving 451,743 people from 10 European countries.8 The data revealed there was higher all-cause mortality in people who drank two or more glasses of soft drinks per day, whether those drinks were sugar-sweetened or artificially sweetened.
In this study, there was an association between artificially sweetened soft drinks and circulatory diseases, as well as a link between sugar-sweetened beverages and digestive diseases. It is important to note that one glass in the study was equivalent to 250 milliliters (8.4 ounces), which is less than the standard soft drink can in the U.S., which contains 355 milliliters (12 ounces).9
In other words, one can of soda is nearly 1.5 times one serving, and two cans would be well over what was measured in the study. The results of both studies also suggest that policies aimed at cutting sugar consumption by reformulating products with artificial sweeteners may likely have disastrous consequences.
More Children Have Fatty Liver Disease
Before 2006, the prevalence of fatty liver disease in children was relatively unknown. Following a retrospective review of 742 autopsies in children ages 2 to 19 years, the results revealed fatty liver was present in 13% of the children and showed the highest rate in obese children at 38%.10 It's possible that consumption of sugary beverages is playing a role in these increases.11
Nonalcoholic fatty liver disease (NAFLD) is also found in adults. When excess fat is stored in the liver it can result in one of two types of NAFLD: the more serious nonalcoholic steatohepatitis and simple fatty liver.12 These are two different conditions and children will typically have one or the other.
Experts estimate with rising obesity in children, NAFLD has become more common, and one study found 23% of those examined had excess fat in their liver. The condition can be found in children of all races and ethnicities, but is more commonly found in Hispanic and Asian American children.
Risk factors include insulin resistance, obesity, diabetes or prediabetes and abnormal cholesterol and triglyceride levels.13 There are often no symptoms until serious scarring in the liver has happened. The condition is reversible when people make lifestyle changes, including weight management and routine physical activity.
PepsiCo ranks second in sales behind the Coca-Cola Co., which garnered 43.7% of the market.14 Despite years of scientific evidence demonstrating the link between high fructose corn syrup (HFCS), obesity and NAFLD,15,16,17 PepsiCo continues the campaign to justify HFCS in their products:18
“Despite its name, HFCS is not high in fructose. HFCS and table sugar contain about the same amount of fructose and neither has been shown to be harmful when consumed at typical levels.
HFCS and table sugar have the same calories and sweetness so the decision to use one or the other is based on a variety of other factors. For example, HFCS is an easier ingredient to work with because it is a liquid. It also costs less than table sugar which helps us keep the cost of our products down for consumers.”
In the face of an obesity epidemic, internal documents from Coca-Cola have revealed the company's effort at targeting teenage customers. The Washington Post reported on the public relations campaign called “Movement Is Happiness,” which was “to increase Coke brand health scores with teens” and “cement credibility in the health and well-being space.”19
The information was produced by Australia's Deakin University in collaboration with U.S. Right to Know (USRTK), a nonprofit public health group. After a review of thousands of pages, Gary Ruskin, co-director of USRTK, found a theme emerging. He spoke with a reporter from The Washington Post about his concerns that the conglomerate is targeting vulnerable populations:20
“Even though the health problems are quite severe in the U.S., we live under de facto corporate control; the food industry is incredibly powerful in the U.S. What's insidious here is a health campaign that is using tobacco's tactics, promoting alternative science in a way that advances the notion that sugary sodas aren't really so bad for people's health.”
Sweeteners Alter Gut Bacteria
Your gut bacteria are important to overall health, including your immune system. Negatively altering your gut microbiome may also increase your risk of obesity. This is one mechanism through which sugar and artificially sweetened beverages work to expand your waistline.
The risks associated with metabolic and cardiovascular diseases are mediated in part by your gut microbiome. The composition and functionality of your gut microbiota is impacted by your dietary intake. Studies have demonstrated a high intake of sugar increases the abundance of proteobacteria and decreases the populations of Bacteroidetes.21
This alteration creates an imbalance in the microbiota and increases inflammatory response, decreasing the regulation of epithelial integrity leading to leaky gut. By modulating the microbiota, sugar creates systemic inflammation and metabolic dysregulation.
Research has also demonstrated that artificial sweeteners that have been approved and deemed safe by the U.S. Food and Drug Administration cause DNA damage in, and interfere with the normal and healthy activity of, gut microbiota.22
Business Insider reported the research team concluded that all the sweeteners tested “had a toxic, stressing effect, making it difficult for gut microbes to grow and reproduce.”23 While the authors do not directly refer to them as having antibiotic effects, when something is killing bacteria, that's essentially what's happening. The tested artificial sweeteners included:
|Artificial sweetener||Brand name(s)|
|Aspartame||NutraSweet, Spoonful, Canderel, Equal, NatraTaste Blue|
|Sucralose||Splenda, Zerocal, Sukrana, SucraPlus, Candys, Cukren and Nevella|
|Saccharin||Sweet ‘N Low, Sweet Twin, Sugar Twin, Necta Sweet|
|Advantame||(No brand names)|
|Acesulfame potassium-k||Sunnette, Sweet One, ACE, ACE K, Sweet ‘N Safe|
Zero Calorie Doesn't Mean Zero Impact on Your Health
The lure of artificial sweeteners started with reduced calories. Yet, years of exposure to them have demonstrated it has not made a positive impact on the obesity epidemic. In fact, the impact has been decidedly the opposite.
Since the 1980s, the prevalence of obesity has continued to rise among adults. Data from the 2019 report from The State of Obesity showed that in 2012 no state in the U.S. had an obesity rate greater than 35%, yet the most recent statistics revealed there are currently nine states with obesity rates over 35% and only one state where the obesity rate is less than 25%.24
In an effort to lower the number of artificially sweetened and sugar-sweetened beverages sold in Philadelphia, a beverage excise tax was levied in 2017. One study compared the changes in prices and sales following the tax as compared to Baltimore, which served as a control city without tax.25
They found the tax was associated with a substantial decline in the number of beverages sold. However, that volume was partially offset by rising sales in the neighboring areas. A second study demonstrated the positive impact employers could have by banning sales of sugar-sweetened beverages in the workplace.26
The before-and-after study with 214 adults found a reduction in waist circumference without a change in body mass or insulin sensitivity. However, the ban existed only during work hours and employees were free to drink as they wished outside of work. This meant reducing sugar sweetened beverages for eight to 10 hours, five days a week was enough to impact the employees' waistlines.
American Beverage Association Protecting Profits
To protect profits, the American Beverage Association (ABA), the trade Association representing the nonalcoholic beverage industry, pushes back against the media and science. In the same article in which Fox Business reported on the study demonstrating the negative effects of soft drinks across 10 European countries,27 a spokesperson for the ABA, William Dermody, told the Fox reporter:28
“Soft drinks are safe to consume as part of a balanced diet and the authors of this study acknowledge their research does not indicate otherwise. America's Beverage Companies are committed to innovation and working to reduce the sugar people get from beverages by introducing more options than ever before with less sugar and zero sugar.”
The ABA has released similar statements in the past when research regarding low-calorie artificial sweeteners was published. In 2013, the organization published a press release to address what they called an opinion piece published in Trends in Endocrinology & Metabolism.29
The report included charts, a glossary and 54 citations to past published studies supporting the assertion that artificial sweeteners induced metabolic derangements. The ABA wrote:30
“This is an opinion piece not a scientific study. Low-calorie sweeteners are some of the most studied and reviewed ingredients in the food supply today. They are safe and an effective tool in weight loss and weight management, according to decades of scientific research and regulatory agencies around the globe.”
USRTK has summarized some of the past work of the ABA.31 They wrote the ABA defends the use of flame retardant chemicals in soda, excusing the toxic load by claiming water is polluted as well. They have downplayed the risks associated with benzene after it was discovered in soft drinks and refer to questions about artificial sweeteners as “internet myths.”
While the advertising for clean, pure water may not be as enticing, the health benefits are life-giving. If you enjoy flavored water, make your own by adding a slice of lemon or lime. Carry your own water in a glass bottle and avoid the multiple problems associated with plastic containers as well.