> CLINICAL QUERIES
Is diet soda a healthy choice?
One of my adult patients drinks
diet cola all day long. What should
I teach my patient about this choice
of beverages?—S.F., N.Y.
Mary Ann Yantis, PhD, RN, and Kate
Hunter, RD, LD, reply: Many people
believe that diet soda is healthier than
the regular, calorie-containing kind,
but the literature isn’t clear on this.
The FDA, which regulates artificial
sweetener use in the United States,
currently considers the use of aspar-
tame, sucralose, saccharin, and acesul-
fame potassium to be safe and not
linked to the incidence of cancers.1
(Because stevia is classified as an herb-
al, it’s not regulated by the FDA.)
About 86% of Americans con-
sume low-calorie, reduced-sugar, or
sugar-free foods and beverages.2 Be-
cause of super-sized drinks and the
widespread use of artificial sweeten-
ers in food products, many people
may be reaching or exceeding the
acceptable daily intake of artificial
sweeteners set by the FDA.2 For
instance, a person weighing 150 lb
(68 kg) can drink 30 to 32 cans of
diet lemon-lime soda containing
acesulfame potassium daily but only
6 cans of diet cola containing sucra-
lose. For more details, see http://
www.mayoclinic.com/health/
artifical-sweeteners/my00073.
Many people believe that drinking
diet soda will help them reduce body
weight and lower the risk of obesity
and diabetes, but the evidence is un-
clear. Some studies in humans indicate
that sugar substitutes can help with
short-term weight loss, yet an equal
number suggest that they don’t.2
In one study, research subjects who
consumed more than one daily serv-
ing of diet soda had a 36% greater
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risk of metabolic syndrome: a cluster
of risk factors (including hyperglyce-
mia, hypertension, abdominal obe-
sity, and hypertriglyceridemia) that
significantly increases the risk of
heart disease, stroke, and diabetes.3
This study also found that people
who consume diet soda daily have
a 67% higher risk of type 2 diabetes
compared with those who didn’t
consume diet soda, possibly due to
artificial sweeteners’ effect on insulin
resistance and glucose metabolism.3
Artificial sweeteners are 200 to 13,000
times as sweet as sugar, and this en-
hanced sweetness is mildly addictive.
Sweet taste triggers the dopamine sig-
nal, the same pathway triggered by
2
drugs of abuse such as cocaine. If arti-
ficially sweetened sodas increase crav-
ings, a person may need more sweets
to feel satisfied, leading to excessive
calorie consumption and weight gain.4
The Framingham Osteoporosis
Study found diet and regular cola
drinks are associated with decreased
bone mineral density in women but
not in men.5 The caffeine and phos-
phorous in cola may interfere with
normal calcium absorption, increas-
ing the incidence of osteoporosis and
the risk of fracture.
Diet soda is considered devoid
of any nutritional benefit and may
displace more nutritionally rich
beverages in the diet, such as milk,
which contains calcium, vitamin D,
and protein, or water for hydration.
Consuming diet drinks is associated
with dental erosion because of their
acidic pH level.6 Because aspartame
is composed of two amino acids,
aspartic acid and phenylalanine, it’s
not recommended for those with
phenylketonuria.7
Assess your patient’s dietary intake,
paying special attention to their usual
intake of diet or regular sodas and
foods containing artificial sweeteners.
Discuss the health risks of diet soda,
then refer the patient to a registered
dietitian or the primary healthcare
provider for long-term support. ■
REFERENCES
1. National Cancer Institute. Artificial sweeteners
and cancer. http://www.cancer.gov/cancertopics/
factsheet/Risk/artificial-sweeteners.
2. Whitehouse CR, Boullata J, McCauley LA. The
potential toxicity of artificial sweeteners. AAOHN J.
2008;56(6):251-261.
3. Nettleton JA, Lutsey PL, Wang Y, Lima JA,
Michos ED, Jacobs DR Jr. Diet soda intake and risk
of incident metabolic syndrome and type 2 diabetes
in the Multi-Ethnic Study of Atherosclerosis (MESA).
Diabetes Care. 2009;32(4):688-694.
4. Swithers SE, Davidson TL. A role for sweet taste:
calorie predictive relations in energy regulation by
rats. Behav Neurosci. 2008;122(1):161-173.
5. Tucker KL, Morita K, Qiao N, Hannan MT,
Cupples LA, Kiel DP. Colas, but not other carbon-
ated beverages, are associated with low bone min-
eral density in older women: The Framingham
Osteoporosis Study. Am J Clin Nutr. 2006;84(4):
936-942.
6. Lussi A, Jaeggi T. Erosion—diagnosis and risk
factors. Clin Oral Investig. 2008;12(suppl 1):S5-S13.
7. Mayo Clinic. Phenylketonuria. Treatments
and drugs. http://www.mayoclinic.com/health/
phenylketonuria/DS00514/DSECTION=treatments-
and-drugs.
Mary Ann Yantis is a nurse educator for Nursing
Education Consultants in Dallas, Tex., and Kate
Hunter is a clinical dietitian at Adventist Medical
Center in Portland, Ore.
DOI-10.1097/01.NURSE.0000389036.71877.61
November l Nursing2010 l 67
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Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.