> 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?â€”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 isnâ€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, itâ€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 donâ€t.2
In one study, research subjects who consumed more than one daily serv- ing of diet soda had a 36% greater
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 didnâ€t consume diet soda, possibly due to artificial sweetenersâ€ 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
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, itâ€s not recommended for those with phenylketonuria.7
Assess your patientâ€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. â–
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. Erosionâ€”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.
November l Nursing2010 l 67
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