Earlier this year, the American Heart Association/American Stroke Association (AHA/ASA) released the results of a study warning women over 50 about the stroke risks connected to drinking artificially sweetened drinks. News outlets quickly spread the word, warning that drinking two or more artificially sweetened drinks each day can increase the risk of experiencing stroke, heart attack, or even an early death.
The study is part of the Women's Health Initiative (WHI), a long-term national health study focused on strategies for preventing heart disease, breast and colorectal cancers, and osteoporosis in postmenopausal women. More than 80,000 participants were asked how often they drank one 12-fluid-ounce serving of diet beverage over the previous three months, and their health outcomes were tracked for 12 years.
After controlling for lifestyle factors, the study found that women who consumed two or more diet beverages each day were at an increased risk for a clot-based stroke (ischemic stroke), heart disease, and death from other causes. Women with no history of heart disease and diabetes were twice as likely to have a stroke, and that risk increased significantly for women who were obese or African American.
Are the headlines directly linking diet beverages and stroke risk correct?
Not necessarily, says neurologist Daryl Story, MD, director of the Acute Stroke Team at Norwalk Hospital. According to Dr. Story, the results don't prove that artificially sweetened drinks are the cause of clot-based strokes. Instead, the study should encourage us to ask why diet drinks may be linked to an increased risk of stroke.
You can't view these types of studies in a vacuum. What else about these women and their behavior could cause them to have more strokes? For example, perhaps drinking diet beverages leads them to believe they can eat more. Overeating can lead to Type 2 diabetes and obesity, which are risk factors for stroke and heart disease. Also, because diet beverages impact blood sugar levels and can cause sugar cravings, diet drinks may not increase the risk for stroke, but what is consumed after having them might."
Dr. Story also questions whether other risk factors may have led to an increased stroke risk.
"If a woman is drinking diet beverages to control her diabetes, did they lead to an increased risk for stroke, or did the diabetes? Similarly, if a woman is drinking diet beverages to lose weight, did they increase her risk for stroke or did the obesity?"
While previous studies have reached similar conclusions about the dangers of diet beverages, the recommendation in this particular study actually contradicts the AHA's 2018 advice to drink diet beverages to help kick start weight loss. Dr. Story agrees with the AHA's 2018 recommendation, since artificial sweeteners can initially help people get away from sugar. But, he cautions, they should be used as a stepping stone towards the goal of drinking healthier beverages like water or herbal tea.
What do these results mean for diet beverage consumption?
Studies of this type raise many questions; most importantly, how consumers should use the results to guide their behavior.
The current advice from health professionals is to practice moderation when consuming diet beverages and other highly processed foods.
"This latest study adds to other interesting research about artificial foods. We know they are not the healthiest -; they contain artificial sweeteners, chemical additives, caffeine, and high levels of sodium," says Barbara Schmidt, MS, RDN. "So consume diet beverages and artificial foods in moderation. Water will always be a better choice than any type of diet beverage." Barbara is a Nutrition Lifestyle Program Specialist at Norwalk Hospital.
Dr. Story concludes, "The results of this specific study haven't proven that diet beverages cause strokes. So while it's good to consider healthier alternatives to diet beverages, definitely don't panic if you drink them."
May is Stroke Awareness Month
Stroke is the fifth leading cause of death in the United States and is a major cause of serious disability for adults. About 800,000 people in the United States have a stroke each year.
Stroke is an emergent situation and it's critical to seek care immediately to preserve as much brain function as possible. When it comes to stroke care, "time lost is brain lost."
To help identify stroke symptoms, remember the acronym B.E.F.A.S.T.:
- B: Balance -; sudden dizziness, loss of balance, or coordination
- E: Eyes -; sudden trouble seeing out of one or both eyes
- F: Face -; facial weakness, uneven smile
- A: Arm -; weakness, unable to raise one or both arms
- S: Speech -; impaired, slurred, difficulty repeating simple phrases
- T: Treat -; seek treatment immediately!
If you are experiencing any signs of stroke, call 9-1-1 immediately. Emergency service personnel are trained to recognize the signs of stroke, and will take you to the right hospital to treat your stroke. For instance, Norwalk Hospital has a rapid response team that is alerted and ready to treat stroke patients upon arrival at the hospital.