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Artificial Sweeteners and the Risk of Dementia
July 16, 2018References: Stroke, Obesity, Washington Post,
Whoa, Nellie! Now artificial sweeteners are bad! Help, help, help. We've been telling everyone not to eat sugar, and now you turn around and point at sweeteners. What's the deal? Better, what's the evidence?
Ok, an observational study from the long-term, Framingham heart study prospectively followed 4,272 older adults for 10 years with follow-up for risk of stroke and dementia. They found 97 strokes and 81 cases of dementia over that time period and compared those outcomes to the frequency of sugar and artificial sweetener use. Compared to controls within those groups, after statistically accounting for the proper variables, they found a 2.97 times increased risk of stroke and 2.87 for increased risk of dementia by drinking one diet soda a day. One measly, little diet soda. Sugar didn't show any negative effect.
Well, out come the critics in full force (from the soda industry, of course). They claim it was a lousy observational studies without any proof of causation. (True) They attacked because it wasn't large enough. They griped because the sugar use wasn't found to be dangerous when every other study shows it has. And the accompanying editorial in the journal pointed out that the risks go away when incident diabetes and vascular risk factors were taken into account.
Ok, ok, so the evidence isn't perfect. But it is there. Is there a plausible mechanism we can construe that carries a tiny bit of credibility?
Well yes, there is. Here it is. First and foremost, drinking diet soda has been shown to lead to weight gain, not weight loss. The means by which that happens is thought to be by confusing your brain's appetite sensor into thinking calories are coming because you taste sweet, and then you secrete some insulin, which lowers your sugar, and 4 hours later, you eat more. Presto, fatso.
It may be along this line that we will find an answer. The interplay of human hormones is so complex, it is extremely hard to parse out a single hormone in isolation. The breadth of knowledge is advancing in that direction. Here is one plausible bench research explanation: there is pretty good evidence that being fat makes you insulin resistant, and higher insulin with higher glucose leads to your tummy fat making more amyloid precursor protein (APP). And it's APP that breaks off in your brain to make agglomerations of beta-amyloid plaque. Ok, so you drink diet soda, make a little extra insulin, get fatter and gain weight, make more beta-amyloid and there you have it. Diet soda makes for more dementia.
WWW.What will work for me. Well, well. Not the strongest of evidence but the gun is smoking never the less. I just drove for 4 hours yesterday and got a big gulp of 32 oz of diet Pepsi at a QuickTrip because I was sleepy. Bummer. I can feel the beta-amyloid crawling up my neurons. I'm weaning myself off sweeteners bit by bit. Sounds like it's time to increase that effort. Is Stevia just as bad? Haven't got a clue.
If you believe this study, you triple your risk of dementia by drinking artificial sweeteners. T or F Answer: True unless you nit-pick over 2.87 fold vs 3.0
Women who drink diet sodas stay thin. T or F Answer: False, they gain weight.
Belly fat makes amyloid precursor protein, which is the protein that then calves beta-amyloid in your brain, the cardinal sign of Alzheimer's. T or F Answer: Bingo
Is sugar safe to put in your drinks? Answer: No, not at all. In fact, to me, that was the weakest sign of this paper because, on every other front, more sugar is worse for you in ever so many ways. This study sort of absolved it.
Now that you know belly fat makes APP, want to lose weight? Answer: oh my goodness, yes.