This is actually a solid study, despite what the current top comment might suggest. It's frustrating how frequently shallow, dismissive takes that don't engage with the substance of a paper rise to the top on HN. I genuinely don't understand what drives such upvotes. That's not how science works, folks.
If you're going to criticize a study, the least you can do is read it carefully and refer to specific sections and quote specific excerpts where you believe the authors went wrong. Anything less is just noise.
Their study also indicates an association between high Artificially Sweetened Beverage ("ASB" in the study) consumption and high total calorie intake/obesity. The link may therefore that obesity was the cause of all diabetes incidents and that obese individuals tend to want to reduce weight by drinking diet soda (and are less likely to have preference for foods and drinks traditionally considered healthy like plain water or tea), without the diet soda consumption itself being a contributing factor.
(There will be many correlations like this - e.g., if you look at statistics for knee problems you might find a large overlap between people with diabetes and with knee problems, because obesity causes both more load on the knees and a higher risk of diabetes.)
Quote:
> The mechanisms linking high habitual consumption of ASBs and the risk of type 2 diabetes are not fully understood. It is suggested that reverse causality between obesity and ASB intake may partly explain the observed association, where individuals with relatively high BMI at baseline might be using ASB to try to reduce weight and follow a healthy lifestyle [35,37]. Our results, showing the attenuation of the association of ASB with type 2 diabetes after adjustment for body size measures, were consistent with supportive of obesity being a confounder of the association.
I agree that people at high risk of diabetes are probably much more likely to drink diet soft drinks than average people
The paper does explore the possibility of a linkage and attempts to justify why the observed relationship may be more than just a simple association. They even go a step further by presenting arguments against the likelihood of reverse causality. That they need to consider reverse causality and prepare a defense against it is sort of admitting that they are far from proving causality.
Here are some excerpts from the paper that illustrate this:
A sensitivity analysis excluding cases at the first follow-up was conducted to examine whether the observed association reflects a possible reverse causality."
Our results, showing the attenuation of the association of ASB with type 2 diabetes after adjustment for body size measures, were consistent with obesity being a confounder of the association."
In addition, to rule out the likelihood of reverse causality, we interpreted appropriate models and conducted sensitivity analyses, which strengthen the robustness of our findings."
What's frustrating is that the paper never explicitly states that causality is NOT established. While they argue against reverse causality, the absence of reverse causality does not, in itself, imply causality. It may still be a case of correlation. So your point is completely valid.
Some folks are gleefully holding open the doors to let measles and polio back into society.
The sweetest I can tolerate is the 1/4 tsp of raw honey I add to my oatmeal. There are very few restaurants I can eat at any more and most processed foods taste and smell horrible.
But yes, a lot of food is excessively oversweetened (it's a cheap way to win kids and therefore long-term habits), and you become desensitized to anything you constantly taste and will notice differences when you stop.
However, everyone has different taste, both genetically and because of whatever else they eat and is more or less sensitive to, so there's no such thing as "flavor perfectly enhanced", only your own particular preference for a particular dish. Someone eating less sour or being genetically predisposed to bitter might violently disagree with your flavoring for example.
In this particular study it is even worse, because there is very likely to be confounding reporting related to what is being tested, i.e. the type of person who specifically seeks out diet soda is probably going to report their other intake in a different way to the person who YOLOs on sugar.
If I'm understanding the article correctly, drinking sugary beverages makes you fat, and then you only have a 23% higher chance of diabetes than an equally fat person who doesn't drink sugary sodas.
While drinking artificially sweetened drinks doesn't make you fat but does make you more likely to have diabetes than an equally non-fat person.
So the obvious but unanswered question seems to be, would you rather be fat and have the absolute risk of diabetes 23% more than that standard fat person plus other health problems of being overweight, or be thinner and have a 43% more chance of diabetes than a thinner person? What's the actual risk, not percentage increase compared with different baselines?
Answering that straightforward question would let you know "is it better to drink artificial sweetened than sugary beverages" that always seems to go unanswered in these studies while heavily implying that it's worse than sugar, presumably because they're funded by big sugar.
That the paper explicitly says we should hold off on taxing sugar because of their very weak evidence that sugar alternatives might have issues supports this
† To explain the reference, once evolution had clearly taken the lead over creationism in the struggle to be taught in American schools they shifted to "Intelligent Design" (creationism dressed up as science) and "Teach the Controversy" i.e. position them as equals because who can say which is more correct, as strategies to manage the retreat and keep a foot in the door.
> Obesity is considered the main modifiable risk factor for type 2 diabetes, and it's estimated to account for 80-85% of the overall risk, according to Nice CKS
Now add genetic variability to risk/predisposition, exercise levels, bmi, gender, age, co-morbidities..
Anecdotal point - I'm fit, it doesn't matter if I drink sugar free soda or water. My calorie intake doesn't change because of that at all. It changes due to other factors like lack of sleep or stress levels.
Soda is poison.
Your brain will tell you "no that won't work", but after the water your body will approve and your brain will accept that.
LaCroix: https://www.lacroixwater.com/
Bubly: https://www.bubly.com/#/
If it is the latter can I ask what this is based on? Genuinely interested, not being snarky or anything like that.
https://old.reddit.com/r/MapPorn/comments/18fyz9q/use_of_pop...
It's probably super local still but I really do like "teaballs"
4 parts seltzer water + ice
1 part lemonade
It's 50 calories, or something like that (obviously depends on lemonade, size of drinking glass, etc)
fulfills my sweetness craving and is also filling
Spindrift the best. Water with light bubbles and a splash of real fruit juice. ~10 calories
So if you look at the participants in the study, it's 40,000 people between 40 to 60.
The only thing we know about them is some of them drink some artificially sweetened drinks. We don't know anything else about their diet or their lifestyle age 20-40.
So first, people who don't have a problem with sugar or their health, they don't drink artificially sweetened drinks.
People who are 40 years old and they drink diet soda, a great deal of them, not all, do it because they already have a problem.
Nobody drinks artificially sweetened soda unless they have a problem because it just tastes bad. A healthy person would just pick soda sweetened by sugar.
And health councious people don't even drink soda because they've never built an addiction to that type of drink in first place - mind that this study is not in the US.
So the fact that this group is more likely to end up with diabetes, there might be a million factors that lead to that result.
Maybe because drinking diet soda already makes a chunk of them preselected to be more likely to develop some kind of metabolic disease.
Again, I don't generalize this study returns some kibd of arithmetic average. You only need 10% of participants to be off limits and you get very different result vs. general population. Because if you look at diabetes 2 rates, out of 40k people maybe 4k max gets it (edit. 1.7k in the study) that's a sample that can show wild variation.
Edit. people seem to have problem with the verbiage. "Nobody drinks artific..." ok that's a way to make a point what I wanted to say "you're more likely to pick diet soda if you already habe a problem" especially for 40-60 demographic who probably includes 100% of people ordered to drink diet soda by their doctor. Also yes people drink soda outside the US. But not people 40-60 where a chunk of them comes from generation that weren't subject to heavy advertising by american sugar soda companies. This is Europe New Zeland and just do a wuick search on the demographics of diet soda consumers in the Europe - it's 25-44 age group.
What a bizarre statement. I have no health problems and will always pick the 'zero' variant of any soda, because to me it tastes exactly the same, but minus all the calories.
Exactly, I don't have diabetes and I always choose the sugar-free ones because of their reduced calories.
I'm not implying that artificial sweeteners are completely safe as I simply don't know—and that's the real problem.
What's damn annoying about these studies is that there are many artificial sweeteners with vastly different chemical structures but generally they're all lumped together. If the gut microbiome is affected and it increases diabetes risk then it's hard to believe that these vastly different chemistries would all have the same effect.
On the other hand, if the body responds badly to the sensation of sweetness then that could explain the result—all other factors being equal.
It seems obvious to me the first job is to determine whether sweetness itself is a factor before anything else.
The 'debate' over artificial sweeteners has been raging for many decades and it's high time it was resolved to avoid confusion. For example where I am the star rating system gives artificially sweetened drinks typically 3.5/5 versus a worse figure of 1–2/5 for those sweetened with sugar.
We need to have faith in officially sanctioned government health warnings.
Mimi: "If you close your eyes."
However despite my strong objection to this point in the post I'm still very sympathetic to the idea that this study is bullshit.
(AND I also think drinking sweetened drinks every day is likely a bad idea. I just think this is very hard to prove. I think almost all nutritional claims finer-grained than "eating lots of vegetables seems to be good for you" are probably poorly founded and we are mostly forced to operate on vibes).
I don't necessarily disagree with you in general, but you're also pulling ideas out of the air. Better to point out the problems with the study than claim that people only drink diet soda for XYZ reason because I think you'd need a whole study to figure out the edges of who drinks what and why.
Claiming such a large study is bogus requires a more statistically founded argument than "I think people who drink diet soda are unhealthy to begin with".
It turns out it's not the "obvious" better choice they wanted it to be. So looking into it is definitely interesting.
I mean I just don't agree? I'm young-ish (approaching 30), don't have a problem with excessive sugar in my diet, I don't have medical conditions which make sugar a problem, but most of the time when I drink soda I pick one without sugar. I find it tastes fine and I don't exactly want more sugar in my diet.
I'm not saying that your comments about bias introduced by the selection criteria is wrong, I haven't read the study so I don't know if they corrected for it or designed the study in a way which makes it a non-issue. But you seem to have some very strong personal preferences regarding soda, and you've assumed that those personal preferences are universal. They're not.
What a bogus claim! Plenty of people drink artificially sweetened drinks because they don't want to enjoy a soda but not add calories to their daily consumption! Which world do you live in? Have you even been to cinema lately? I bet every other person orders a diet soda before entering the theatre. I know because I see it happen all the time all around me!
Yes, we don't! And that's perfectly acceptable.
When you're studying a cohort aged 40 to 60, you don't try to reconstruct their exact diet or lifestyle from two decades earlier. You don't rely on their memories from age 20 and treat that as reliable data. It simply isn't.
It's okay not to know what cannot be known, and still move forward with meaningful research. If scientific studies were only allowed to proceed after accounting for every possible confounding variable, then no health research would ever be conducted. None. Zero. Because it's impossible to identify and control for every unknown factor.
What researchers do is control for the known variables, publish their findings, and invite scrutiny. Other researchers then explore new confounding factors, conduct follow-up studies, and expand or refine the conclusions. That's the essence of scientific progress. That's how human knowledge evolves.
It is, frankly, lazy and armchair critiquing to dismiss a study simply because it didn't account for your favorite confounding variable. You know what's not lazy and armchair? Actually conducting research that investigates that variable. And that's when you come to appreciate just how difficult or outright infeasible some of these variables are to measure or control for.
Actually show me a 10+ year study that found no surprising result.
If the fact that bunch of foundational Alzheimer's studies were found to be faked recently by a guy who profited from them for 20 years and many such cases doesn't make you more realistic then well ... you must have an exceptionally good heart :)