2020 - "future studies should consider the metabolic pathways of different artificial sweeteners. Further (long-term) human research investigating the underlying physiological pathways of different artificial sweeteners on microbiota alterations and its related metabolic pathway is warranted to evaluate the potential impact of their use on body weight control and glucose homeostasis."
edit: this is wrong, see reply below
> Random-effects summary all-cause mortality HRs for overweight (BMI of 25–<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30–<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5–<25).
Some studies show extra mortality in normal to underweight people, including from common causes relevant to average people, but there's also a ton of work on calorie restriction?
Is low BMI dangerous, or does it just commonly go along with a lifestyle that might lead to injuries and rhabdomyolysis and a case of diarrhoea in a place without hospitals?
It would be interesting to see adventurousness treated as a separate category for controls.
In the past there was no fridge, people stored their own energy, and there was no pepper spray and cops and forklifts, exercise programs had the extra constraint of physical activity being directly needed to survive.
What amount and type of activity should a modern person who has reason to believe they'll probably never be in a serious fair fight with no weapons or need to walk 3 days to get help do?
How much should someone eat when they do not ever plan to drink untreated water or go somewhere away from medical help if they catch some parasite that causes rapid weight loss?
Is the ideal profile of nutrition changed for someone who will not be exposed to woodsmoke, bacterial illness, etc?
And then furthermore, if higher BMI isn't helpful by itself, what should people who ARE in poverty or otherwise exposed to more stresses do?
Is there a subgroup that needs a metabolic reserve? Should those people eat less to save money and be able to DoorDash if needed and have external reserves like people without poverty or adventurousness?
Or is there a real independent benefit to some level of fat?
Higher BMI can simply mean more athletic.
I wish we could tell!
Incidentally, when I drink diet soft drinks now they taste like chemicals. Completely unnatural sweetness. I don't find them enjoyable at all. But when I used to drink them daily, I liked them, really almost craved them.
It's not that hard after several years of changing your eating habits slowly.
It helps that I've always preferred drinking water.
Anecdotally, switching from full-sugar soda to diet has been a hugely beneficial change to my own health. Would water be better? Maybe, but I’ll settle for harm reduction.
I think that depends on how much it takes to have this effect. If the equivalent of one diet soda every couple days (the doses in the article seemed pretty small to me?) is acting like a kind of pesticide, even in small doses, and killing a lot of calorie-eating gut flora, the harm might exceed the benefit. On the other hand if the artificial sweetener is replacing the sugar in 64+oz of soda per day rather than 16ish oz every couple days, sure, the benefits probably overwhelm any harm.
The problem with artificial sweeteners is that we have “taste buds” for sweet in our intestines, and there’s a theory that reacting to that increases absorption, so your body pulls more carbs from French fries you ate with your Diet Coke.
This is likely a big part of why lecturing people about CICO is such a dick move.
“Calories” in food are net calories, not gross calories. We didn’t calculate the calories in bread by burning it in a sensor chamber. We got it by isolating volunteers, measuring the energy in their food versus the energy in their poop, assuming the rest ends up in your body.
But of course any heat generated by gut microbes might be shed, and the hydrogen bonds in your burps are also lost calories.
I was a very gassy person when I was a young beanpole. Not so much anymore.
The provision is that you can’t outrun a bad diet by exercising a half hour a day. That 30 minutes is a number doctors settled on not to scare sedentary people into not starting an exercise program. You really need an hour or more a day.
I’m trying to get my walk route down to 90 minutes, in prep for a half marathon next year. If I stop for a matcha at the halfway point, I’ve still burned well over twice what I consumed. If I get the smoothie still come out ahead.
The real “secret” there is that when I watch TV I nibble. Not getting food on books is the only reason I don’t nibble when reading. What I’ve done in a 90 minute walk is to forestall eating more than one single thing in that ninety minutes. And lowered my stress level. Cortisol is the other killer here.
Even before that the nearest good coffee shop was a mile away and my net calories were ~100. If I avoided a certain cream based beverage.
For some people, banning prepared foods does a similar thing. Preparing a snack takes fifteen minutes instead of fifteen seconds. You just don’t have as much time in the day to stuff your face once the convenience is gone.
The other aphorism is that you lose weight at the grocery store, which I do believe. If you come home with fruit instead of pie and chips you’ve already fought half the battle.
If you dont care about health or improvment in things like strength stamina, then the "dont exercise it is waste" knee jerk response makes some sense. If you care about health, it does not at all.
To your point on mood: there’s definitely a feedback loop or three there. Once you say “fuck it” a lot of things unravel and everything spirals. Better mood means more chores get done, which is both more exercise and improves self image and mood. Being happier about the mirror does the same thing.
Before the pandemic I wanted to walk a 10k. Now that’s practically my baseline, and new goals I wouldn’t allow myself are popping up. You can get a lot of places in 10k round trip, especially if you aren’t a sweaty mess on the other end. That’s 75% of the way to downtown for me.
There doesn’t seem to be any good studies about that. Anecdotally, as someone who has been drinking 2-3 liters of Diet Coke or Coke Zero daily for over two decades, I haven’t experienced such an effect.
Anecdotes don’t mean shit for public policy.
And is this even an anecdote? Were you overweight before you started drinking diet and now you’re not, with no other lifestyle changes? Food? Mood? Exercise?
Right, and so yours doesn’t either.
My point is, the theory that artificial sweeteners somehow cause more “net” calorie intake doesn’t have much grounded evidence. Presenting it as a likely truth is fallacious.
Mine is "I stopped doing something and something good happened (3x)". I did a lot of single variable experiments on myself during that phase of my life. I didn't stop soda and start exercising. I was too 'lazy' for that, but it was more informative.
Anecdotes are lousy for public policy but they're great for research grants. Except for accidental discoveries, most medical advances come from looking at clusters of people or animals or microbes that don't behave the way you thought they would. Those are anecdotes, and the cause-effect variety are much easier to spot.
How much increased absorption are we talking about? If I don't drink a can of Coke containing 150 calories of pure sugar, and instead drink a Diet Coke with basically 0 calories, are you saying that my gut is going to somehow grab 150 calories that it would have otherwise ignored?
But it's probably harder for your body to deal with being both overweight and having a weird gut biome simultaneously.
It's possible that becoming overweight could cause a gut flora change, or a gut flora change could make you likely to become overweight.
There's no benefit to ending research into diabetes after you find an association between overweight and diabetes, or in making an assumption that the condition of one's gut flora and being overweight are independent.
I’m not sure what the pathology is there, other than hitting starvation cycles if you get certain illnesses, and possibly bone density.
If you put me in that dilemma, I would choose the artificial sweeteners every single time. So yes. Diets are difficult enough.
But...
Although I distrust all the studies that seem to nudge me into stopping dieting, and the article mentions some of them that are now discredited or impossible to reproduce, I don't simply ignore them. Maybe it's "Big Sugar", as a fellow HNer called it, but maybe not.
Flora disruption seems very real to me. I had to quit Coke years ago (don't ask) and now I've quit sodas alltogether. I don't like coffee, but fortunately caffeine is sold in pills, and much cheaper.
I mention soda specifically because that's what kept me needing sweeteners. Now I drink only water, beer when out with friends, and tea, that unless I'm actively trying to lose weight, I have with one cube or nothing.
The famous JAMA article from 2013 that everyone likes to cite, including in comments below, showed no significant increase in death rate for grade 1 obesity and the effects really kicked in strongly around grade 2 and 3 obesity.
The more recent BMJ article from 2016 that no one wants to cite, showed minimum death rate in the 20-24 BMI range depending on smoking history. That paper reported the most reliable looking studies of 'non-smokers followed up for over 20 years' had a minimum total death rate at a BMI around 20-22, but that does not support the "Healthy at Every Size" narrative so its memoryholed.
I try to keep up to date on diet and supplement journal articles; there's probably journal articles newer than 2016 thats not in my notes yet.
Something EVERY study seems to agree on is the death-curve looks very U shaped kind of like computer chip hardware failure rates. The point being that studies disagree on the exact minima death rate vs BMI which is only relevant for large scale population goals, however they all agree that going from, perhaps, 22 to 23 will have an effect that although possibly measurable if across enough people, will tiny and be deep in the decimal places, whereas going from "twenties" to "forties" for BMI means the patient is unquestionably going to die very young, although EXACTLY how young may vary from study to study.
The problem with BMI of course is it was originally a screening criteria to "find the worst quartile and counsel them" but as happens with all metrics over time eventually the rough and imprecise low resolution screening criteria turned into an "optimize for its own sake" metric and people getting very weird and hyperfocused about their personal metric calculated to five sig figs at least.
The way they lump them all together feels really odd to me.
It would be like a report saying non-hydrocarbon vehicles are bad for reason X. Why would anyone but the sugar industry care about all the different substitutes for sugar in such an undifferentiated way?
> They make sure to note that they’re not calling for consumption of sugar instead, because excess sugar is absolutely, positively linked to adverse health effects.
I think they care about the substitutes because that's an area where the harm is often debated and much is still unknown. They don't seem to be suggesting that sugar is preferable in any way.
Probably. However those outcomes can be achieved in ways that don't involve sugar substitutes (eg question implies a false dichotomy).
This study isn't saying that everyone should stop eating artificial-sweetners. It is saying that the previous understanding that artificial sweeteners are biologically inert and risk free.
This study shows that we need to do further research to understand what the gut biome changes entail. It also suggests that we should be a more circumspect about replacing sugars in our diet without worrying about trying to reduce our overall desire for sweet foods / drinks.
0.https://www.publichealthpost.org/research/can-sugar-substitu...
One of the American Ninja Warriors last season wore an insulin pump. While competing. I’ve since noticed pictures of a few competitive runners with them.
Weight and metabolic function are correlated, not equivalent.