Participants who consumed low and no-calorie beverages saw positive effects similar to those researchers would expect from water, says Tauseef Ahmad Khan, MBBS, PhD, a researcher at the University of Toronto department of nutritional sciences and a coauthor of the study. “Ideally, you would replace sugary beverages with water as much as possible, but our findings show that people have another choice — a low-calorie or no-calorie beverage is a good option as well,” says Dr. Khan.
America’s Sugar Habit Is Fueled by Sweetened Drinks
The average American consumes 22 teaspoons (tsp) of added sugar a day, which translates into about 350 calories, according to the Harvard T.H. Chan School of Public Health. One tsp of sugar is equal to 4 grams (g) of sugar. The American Heart Association (AHA) recommends that people cut back on added sugar to help reduce the risk of heart disease and obesity by limiting daily intake to about 6 tsp or 24 g of sugar for women and 9 tsp or 36 g of sugar for men. Here’s a sampling of how much sugar is found in a 12 ounce (oz) serving of some popular drinks, according to the Harvard T.H. Chan School of Public Health:
Coca-Cola Classic, 41 g or 10 tsp of sugarMinute Maid Orange Juice, 41 g or 10 tsp of sugarGatorade G Orange, 22 g, 5 tsp of sugarStarbucks Frappuccino, 40.5 g, 10 tsp of sugar
Previous Research on Sweeteners Used in Low and No-Calorie Drinks Had Mixed Results
The overall effects of nonnutritive sweeteners (NNSs) — the scientific name for sweeteners such as aspartame, stevia, and sucralose — on metabolism and weight is unclear. Although artificially sweetened beverages may help save on calories, experts have been divided on whether they may cause unintended negative effects on metabolism and even impede weight loss efforts. A study published in Nature found that artificial sweeteners induced glucose intolerance and weight gain in mice. Glucose intolerance increases the risk of diabetes and cardiovascular disease, according to StatPearls. It’s also been found that drinks containing sucralose (which goes by the brand name Splenda) may increase food cravings and appetite in women and people with obesity, according to a study published in JAMA Network Open in September 2021. Some observational studies have suggested that the use of NNSs, such as sucralose and aspartame, is associated with higher body weight and type 2 diabetes, according to a review published in Obesity in March 2018. Because those studies were not interventions — researchers simply observed and compared what people were already doing, it’s unclear whether the alternative sweeteners were actually contributing to those issues or if people were drinking low calorie drinks in response to already having overweight or diabetes. But the same review found that when researchers looked at prospective randomized controlled trials, NNSs actually helped with weight loss, especially when used with behavioral weight loss support.
Analysis Found That Switching to Low-Calorie Drinks Was Linked to Weight Loss
“Because health experts and organizations have been instructing people to reduce their consumption of sugary drinks, we wanted to find out if people who want to switch from sugar-sweetened beverages to water or low-calorie sweetened beverages would see any benefit,” explains Khan. Researchers analyzed 17 randomized trials that investigated how drinking water, no or low-calorie drinks, or sugar-sweetened drinks impacted body weight, other measures of fat, and cardiometabolic risk. The trials included a total of 1,733 adults with overweight or obesity who were at risk for or already had diabetes. Participants were 77.4 percent women and 22.6 percent men, with an average age of 33. The included studies lasted anywhere from just three weeks to a year, with the average trial lasting 12 weeks. The effects were modest, but overall beneficial, according to the findings. On average, switching to the sugar-free drinks reduced body weight by about 2 pounds (lb), lowered BMI by .2 points, and reduced body fat by about half a percent. Water or alternatively sweetened drinks were also linked to a reduction in intrahepatocellular lipid (IHL). IHL accumulation (nonalcoholic fatty liver disease) is associated with cardiovascular disease and type 2 diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases. “Our analysis is unique in that in addition to comparing sugary drinks to alternatively sweetened drinks, we also included water in our study. We found the benefits of switching from sugary drinks to either no- or low-calorie beverages or water were very similar,” says Khan.
Long-Term Impacts of Alternatively Sweetened Drinks Still Largely Unknown
There are a few limitations to the findings, he says. “Our analysis grouped all no- and low-calorie sweetened drinks together — it didn’t separate and compare according to what was used to sweeten them,” says Khan. For example, if you are wondering about the difference between drinking Diet Coke (which uses aspartame as its sweetening agent) or Coke Zero (which uses both aspartame and acesulfame potassium), these findings won’t help you figure that out, he says. Any questions about long-term impact — positive or negative — of drinking no- or low-calorie drinks are still unanswered, says Khan. “The longest study included in our analysis lasted one year, and so further study is needed to look at what the health impacts might be 5 or 10 years down the line,” he says.
