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.
One important note (also mentioned in the study) is that this may be a reverse causality.
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 was diagnosed as pre-diabetic. The diet I went onto more or less cut out anything sweet. It's surprising how quickly I became sensitive to sweetness and now I just don't want it. And blood tests show the diet worked. Life goes on without sweet!
I gave up sugar because of my poor tooth health. My taste preference also quickly changed. It's surprising how many American products have ridiculous amounts of sugar added to them, how difficult it is to find unadulterated products, and how little sweetener foods actually require to have their flavor perfectly enhanced.
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.
Can we stop publishing diet studies that use self-reported diet journals/questionnaires as the method for controlling variables? They are completely unreliable and invalidate anything they touch.
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.
These things are all so confusingly written I can't help but feel it's a pro sugar conspiracy.
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.
> 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
I think its It's multivariate conditional. The sweetener doesn't provide direct calorific input, but that encourages more to be drunk and so exacerbates the problem. Weight for weight liquids taken, to energy, to signal received by endocrine system, to outcome on blood sugar levels.
Now add genetic variability to risk/predisposition, exercise levels, bmi, gender, age, co-morbidities..
No idea what LaCroix or Bubbly are, but there's a million flavors of tea and coffee. Coffee is the weirdest thing ever because one would intuitively expect it ought be unhealthy, but it seems to endlessly correlate positively with health. Obviously I mean just plain coffee - not the diabetes in a cup served at places like Starbucks.
Not sure if you are referring to the US meaning of soda (as in pop in the UK) or actual soda water (essentially fizzy water with sodium bicarbonate in it).
If it is the latter can I ask what this is based on? Genuinely interested, not being snarky or anything like that.
Also don't fall for holy or other synthetically sweetened brands of "water flavor powder" there are alternatives with real or no sugar (even if there aren't a lot)
It's probably super local still but I really do like "teaballs"
I wouldn't exactly put it that way but I've known a lot of people who take great care of their bodies and I never see them going anywhere near diet soda
Typical bogus study. This shows exactly what's the problem with most of these studies.
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.
> 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.
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.
I'm 42 and I drink 1 diet ginger beer every day. I don't have a problem with sugar (eating chocolate as I write this), I just didn't want the extra calories. I'm in good health otherwise, slightly overweight but 4-6 hours intense sport a week plus walks and runs and some weight lifting at home. Diet soda tastes fine to me. I know people who love the taste of diet coke.
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.
I know plenty of people who drink diet soda who are healthy and have good diets otherwise, because they want to avoid the insulin spike / insulin resistance that comes with high sugar intake.
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".
I don't agree. In many countries diet soda is the way more common thing at this point (sugar taxes) ex. Mainland Spain basically every soda except coca cola is based on sweetener instead of sugar.
It turns out it's not the "obvious" better choice they wanted it to be. So looking into it is definitely interesting.
> Nobody drinks artificially sweetened soda unless they have a problem because it just tastes bad.
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.
> So first, people who don't have a problem with sugar or their health, they don't drink artificially sweetened drinks.
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!
> 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.
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.
Typical bogus HN comment on a science article. Without reading the paper you somehow assume you're smarter than the researchers and that they didn't control for different population factors.
"Then, the association of sweetened beverage intake with the incidence of type 2 diabetes was assessed using modified Poisson regression and adjusted for lifestyle, obesity, socioeconomic and other confounding factors."
blenderob|7 months ago
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.
arghwhat|7 months ago
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.
khelavastr|7 months ago
I agree that people at high risk of diabetes are probably much more likely to drink diet soft drinks than average people
jsbisviewtiful|7 months ago
Some folks are gleefully holding open the doors to let measles and polio back into society.
aaron695|7 months ago
[deleted]
beardyw|7 months ago
stolencode|7 months ago
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.
fastball|7 months ago
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.
ZeroGravitas|7 months ago
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.
somenameforme|7 months ago
ZeroGravitas|7 months ago
> 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
ggm|7 months ago
Now add genetic variability to risk/predisposition, exercise levels, bmi, gender, age, co-morbidities..
mbirth|7 months ago
andsoitis|7 months ago
Soda is poison.
vorgol|7 months ago
Your brain will tell you "no that won't work", but after the water your body will approve and your brain will accept that.
somenameforme|7 months ago
makingstuffs|7 months ago
If it is the latter can I ask what this is based on? Genuinely interested, not being snarky or anything like that.
herbst|7 months ago
It's probably super local still but I really do like "teaballs"
JohnBooty|7 months ago
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
xnx|7 months ago
Spindrift the best. Water with light bubbles and a splash of real fruit juice. ~10 calories
emsy|7 months ago
mort96|7 months ago
JohnBooty|7 months ago
michalu|7 months ago
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.
Avalaxy|7 months ago
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.
jemmyw|7 months ago
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.
mzhaase|7 months ago
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".
herbst|7 months ago
It turns out it's not the "obvious" better choice they wanted it to be. So looking into it is definitely interesting.
mort96|7 months ago
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.
throwaway150|7 months ago
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!
blenderob|7 months ago
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.
guelo|7 months ago
nektaars|7 months ago