{"id":17224,"date":"2019-06-20T14:55:21","date_gmt":"2019-06-20T18:55:21","guid":{"rendered":"http:\/\/caloriecontrol.org\/?p=17224"},"modified":"2022-07-19T15:58:30","modified_gmt":"2022-07-19T19:58:30","slug":"low-calorie-sweeteners-are-safe-no-increase-in-stroke-risk","status":"publish","type":"post","link":"https:\/\/caloriecontrol.org\/low-calorie-sweeteners-are-safe-no-increase-in-stroke-risk\/","title":{"rendered":"Low Calorie Sweeteners Are Safe and Do Not Increase Your Risk of Having A Stroke"},"content":{"rendered":"\n<p>By  <strong>Keith Ayoob, EdD<\/strong> <\/p>\n\n\n\n<p>As a clinician of some 30+ years, I doubt I\u2019ve seen a\nnutrition issue more polarizing than that of low-and no- calorie sweeteners (LNCS).&nbsp; <\/p>\n\n\n\n<p>You may have read sensational headlines about these\nsweeteners. &nbsp;You <em>should<\/em> also be hearing about their benefits, but alas, good news\nnever sells.&nbsp; <\/p>\n\n\n\n<p>Example: a recent study in the journal <em><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30802187\">Stroke<\/a><\/em> looked\nat the \u201cassociation\u201d between LNCS-containing beverages and the risk of stroke,\ncoronary heart disease and \u201call-cause mortality\u201d, the latter meaning\nessentially death for any reason at all.<\/p>\n\n\n\n<p>The study focused on the consumption of artificially-sweetened\nbeverages (ASBs) in over 82,000 women who were part of the Women\u2019s Health\nInitiative Observational Study (WHIOS).&nbsp; The\nwomen were enrolled quite a while ago, between 1993 and 1998, then followed for\n12 years.&nbsp; They reported their ASB intake\nonly ONCE \u2013 3 years after their initial enrollment. <\/p>\n\n\n\n<p>This study is \u201cobservational\u201d, as no intervention was involved.&nbsp; Studies like the WHIOS generate huge\ndatabases, are relatively easy to do and don\u2019t tend to cost much, given the\nnumber of research publications they can produce. However, this kind of data\nalso has serious limitations (think \u201cfine print\u201d) to it.&nbsp; Read on.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/p>\n\n\n\n<p>The authors acknowledged the following limitations of the\nstudy:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Though the authors note that this type of study\nis incapable of showing a cause-and-effect relationship, still, they tend to\ndraw very specific conclusions from very generalized data.&nbsp; Observational studies are only able to\ngenerate a hypothesis, even if headlines suggest otherwise.<\/li><li>Since the intake of ASBs was recorded only once\nand was self-reported, it cannot be validated.&nbsp;\nIt should also be noted that diet quality was also taken at the time of\nenrollment and was not assessed again during the 12-year follow-up period. <\/li><li>The authors noted that women with a higher\nintake of ASBs \u201cmay have differed systematically\u201d from women with little or no\nintake, \u201csince they were more likely to be obese and have a higher energy\nintake.\u201d The authors acknowledged that they may have been components of their\ndiets that were not accounted for by the diet quality measure utilized in the\nstudy.&nbsp; <\/li><li>The ASB intake assessment did not consider the\nuse of LNCS in coffee, tea, or foods.&nbsp; Therefore,\nsubjects who are simply not soda drinkers and may use LNCS in their hot\nbeverages, or eat sugar-reduced foods such as \u201clite\u201d yogurt were not captured\nin this study.<\/li><\/ul>\n\n\n\n<p>How likely is it that your current health status is a result\nof what you usually ate on a typical Wednesday, 12 years ago?&nbsp; The authors felt that, in weight-stable older\nwomen, \u201cthe likelihood of changes in dietary patterns is likely low.\u201d&nbsp; <\/p>\n\n\n\n<p>That\u2019s a big assumption.&nbsp;\nStable weight does not indicate a stable intake of calories, as activity\nlevels and metabolisms often decline over time.&nbsp;\nIt also doesn\u2019t indicate a stable dietary quality.&nbsp; People move, jobs change, life happens, and\nthis often impacts our eating style, none of which can be accounted for by this\nstudy. <\/p>\n\n\n\n<p><strong>Reverse Causality<\/strong><\/p>\n\n\n\n<p>This is the concept that people at higher risk for stroke\nand cardiovascular disease may be more likely to choose to drink ASBs.&nbsp; Conditions like stroke and heart disease\nbuild for years with few or no symptoms.&nbsp;\nPeople drinking the most ASBs were also the LEAST likely to be physically\nactive.&nbsp; While being sedentary increases\nthe likelihood of all the health risks measured, these individuals may be\ninactive due to health issues that were not accounted for.&nbsp; <\/p>\n\n\n\n<p><strong>The Good News and\nThere\u2019s Plenty of It<\/strong><\/p>\n\n\n\n<p><em>Controlled\nintervention<\/em> studies produce higher quality evidence.&nbsp; A comprehensive review (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4786736\/\">Rogers, et al., 2016<\/a>)\nof such studies has shown significant benefits from the use of low- and no-calorie\nsweeteners (LNCS):<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Total calorie intake and body weight are reduced\nwith the use of LNCS when used in place of at least some sugar.<\/li><li>Use of LNCS does NOT increase desire for sweet\nfoods.&nbsp; <\/li><li>No evidence that the use of LNCS undermines\nweight loss efforts.<\/li><\/ul>\n\n\n\n<p>It is well-known that healthy weight loss can reduce the\nrisk of cardiovascular disease and stroke.&nbsp;\nBut, should we place the burden of achieving weight loss and other\npositive health outcomes on the use or non-use of ASBs?&nbsp; That seems inappropriate because they were\nnever developed for that purpose.&nbsp; They\nhave been a lifesaver for diabetics, most certainly, helping them control blood\nglucose levels while having a satisfactory eating style that helps them feel\nless deprived.&nbsp; Indeed, it is accepted\nthat all LNCS have no effect on blood glucose levels and, if used in place of a\nsugar-sweetened beverage (an ideal use) can help prevent rises in blood glucose\nlevels.&nbsp; <\/p>\n\n\n\n<p><strong>Careful Spending of\nSugar Calories<\/strong><\/p>\n\n\n\n<p>For diabetics and non-diabetics, LNCS are a tool.&nbsp; Like every tool, and every food, for that\nmatter, they need to be used wisely.&nbsp; The\nreal question to anyone considering using LNCS is: How will you, as an <em>individual<\/em>, not a <em>population<\/em>, use them?&nbsp; You\ncan decide if ASBs will be an asset to your eating style.&nbsp; When I have clinic visits with obese patients\nwho want to lose weight, or just spend fewer calories on sugar, I always go\nover where their dietary sources of excess calories are.&nbsp; If they eat a lot of added sugars, these are easy\nplaces to focus their efforts.&nbsp; A simple\nswap of a calorie-free drink for their usual soda has BEEN SHOWN to reduce\ntotal calorie intake.<\/p>\n\n\n\n<p>The lead author states,\n\u201cWe can\u2019t assume these diet drinks are harmless, especially when consumed at\nhigh levels,\u201d which is confusing to consumers.&nbsp;\nCan we assume ANYTHING, even foods like kale and garbanzo beans, are\nharmless when consumed at high levels?&nbsp;\nOf course not.&nbsp; On the other hand,\nmore reliable evidence has shown us they can be a beneficial tool.<\/p>\n\n\n\n<p>Finally, my own pet peeve about the potential damage of\nthese observational studies: Since they are not capable of showing\ncause-and-effect, why do headlines imply there is one?&nbsp; &nbsp;Such\nimplications are incorrect, irresponsible and are misleading to consumers.<\/p>\n\n\n\n<p><strong>References:<\/strong><\/p>\n\n\n\n<p>Rogers PJ, Hogenkamp PS, de Graaf C, et al. Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. <em>Int J Obes (Lond)<\/em>. 2016;40(3):381\u2013394. doi:10.1038\/ijo.2015.177<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>About Dr. Keith Ayoob<\/strong><\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignleft\"><img decoding=\"async\" src=\"https:\/\/steviabenefits.org\/wp-content\/uploads\/2018\/07\/Keith_Ayoob-headshot-HiRes-square-150x150.jpg\" alt=\"\" class=\"wp-image-1345\"\/><\/figure><\/div>\n\n\n\n<p><strong>Keith Ayoob, EdD, RDN, FAND <\/strong>is  an Associate Clinical Professor Emeritus at the Albert Einstein College  of Medicine. As a pediatric nutritionist and registered dietitian, Dr.  Ayoob is also a past national spokesperson for the Academy of Nutrition  and Dietetics.<\/p>\n\n\n\n<p>Dr. Ayoob is a consultant with the Calorie Control Council Advisory \nBoard and the Global Stevia Institute (GSI), GSI is supported by \nPureCircle Ltd, a global leader in purified stevia leaf extract \nproduction.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Keith Ayoob, EdD As a clinician of some 30+ years, I doubt I\u2019ve seen a nutrition issue more polarizing than that of low-and no- calorie sweeteners (LNCS).&nbsp; You may have read sensational headlines about these sweeteners. &nbsp;You should also be hearing about their benefits, but alas, good news never sells.&nbsp; Example: a recent study [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1179,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6,61],"tags":[],"class_list":["post-17224","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-profesionals","category-heart-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Low Calorie Sweeteners Are Safe and Do Not Increase Your Risk of Having A Stroke - Calorie Control Council<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/caloriecontrol.org\/low-calorie-sweeteners-are-safe-no-increase-in-stroke-risk\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Low Calorie Sweeteners Are Safe and Do Not Increase Your Risk of Having A Stroke - Calorie Control Council\" \/>\n<meta property=\"og:description\" content=\"By Keith Ayoob, EdD As a clinician of some 30+ years, I doubt I\u2019ve seen a nutrition issue more polarizing than that of low-and no- calorie sweeteners (LNCS).&nbsp; 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