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Comment by siliconc0w | Hacker News Reader

IMO more damaging fact is that it doesn't work. The evidence is pretty clear it doesn't actually help you lose weight and in some cases there is actually an increase in weight, obesity, and type-2 diabetes. (https://pubmed.ncbi.nlm.nih.gov/28716847/, https://pubmed.ncbi.nlm.nih.gov/27129676/)

For me this can be pretty easily observed eating a meal with water vs with diet soda. Especially if it's like a 'bad' meal with fast/fried food. There is definitely something that causes you to crave/eat more.

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No, that is called reverse causality. The type of people likely to drink artificial sweeteners most are those that are overweight, obese, or have diabetes. There is no insulin response from artificial sweeteners. And as an amateur bodybuilder, I utilize a lot of artificial sweeteners daily to curb my cravings while eating rice, chicken, and turkey to help me cut.

Sweeteners won’t make someone overeating stop overeating. But they can be used to lower overall caloric energy intake and reduce cravings as a tool.

>> I utilize a lot of artificial sweeteners daily to curb my cravings

What mechanism makes the cravings subside for you? Is it chemical or also like lifting a cigarette to your lips for nicotine?

You provide two reviews, the article provides many more, along with 8 that they decided did not meet their standards, but they linked them anyway.

In comparing reviews of reviews of medical papers, I find myself more swayed by the article. Perhaps you'll have a different take on that part and can provide compelling evidence of why your studies should carry more weight or why the authors conclusion is flawed. I would definitely be interested in a more critical reading of that, since I'm somewhat neutral but may have some biases towards wanting aspartame to be both safe and effective.

I think a confounding variable for this is the caloric load. Drink 5 cans of coke and thats what, 1000 calories at least? You feel it impact the rest of your food intake. Meanwhile, diet drinks are zero calorie. Many older people I know who consume diet soda do it to the exclusion of actual water, which they can do since its zero calories and doesn’t impact their appetite for their other meals. For what its worth all of them are overweight.

I realy don't understand how they've gotten where they did in your first link. They claim that:

"Data from RCTs showed no consistent effects of nonnutritive sweeteners on other measures of body composition and reported no further secondary outcomes"

So let's look at the RCTs.

1. https://pubmed.ncbi.nlm.nih.gov/26708700/

"NNS beverages were superior for weight loss and weight maintenance in a population consisting of regular users of NNS beverages who either maintained or discontinued consumption of these beverages and consumed water during a structured weight loss program. These results suggest that NNS beverages can be an effective tool for weight loss and maintenance within the context of a weight management program."

OK, so this found a significant benefit to NNS.

2. https://pubmed.ncbi.nlm.nih.gov/26537940/

This study finds that water is superior to to NNS, but does not compare to sugar consumption, which means you can't really draw the broader conclusion that NNS are ineffective in general; they're just less effective than water alone.

3. https://pubmed.ncbi.nlm.nih.gov/22301929/

OK this one is annoying because the abstract lumps water and diet beverages together, so we can't just read their conclusion. The full text is available, fortunately:

"All interventions groups showed statistically significant weight losses by 6 mo, but there were no differences between groups."

(In other words, both the diet beverage group and the water group lost about the same amount of weight.)

4. https://pubmed.ncbi.nlm.nih.gov/22205311/

This study is a somewhat odd inclusion, because they're actually examining the reverse question (do sucrose sweetened drinks increase fat storage?), but anyway:

"Daily intake of SSSDs for 6 mo increases ectopic fat accumulation and lipids compared with milk, diet cola, and water. Thus, daily intake of SSSDs is likely to enhance the risk of cardiovascular and metabolic diseases."

The full text is not available for free, but it shows a massive difference in fat storage between sugar and diet drinks (and a much larger difference, in fact, than between sugar drinks and water)

5. https://pubmed.ncbi.nlm.nih.gov/14693305/

"Patients took capsules containing 500 mg stevioside powder or placebo 3 times daily for 2 years."

What on Earth? Why is this study included?

6. https://pubmed.ncbi.nlm.nih.gov/16775813/

"The volunteers selected in this phase were randomly assigned to receive either capsules containing placebo during 24 weeks or crude stevioside 3.75 mg/kg/day (7 weeks), 7.5 mg/kg/day (11 weeks) and 15.0 mg/kg/day (6 weeks)."

Again. Including these trials with the others is simply bizarre.

7. https://pubmed.ncbi.nlm.nih.gov/9022524/

"The aspartame group lost significantly more weight overall (P = 0.028) and regained significantly less weight during maintenance and follow-up (P = 0.046) than did the no-aspartame group."

(I recommend reading the whole abstract; this one is nuanced, but it still shows a significant benefit for the aspartame group).

So what is going on with the systematic review? Why did it come to the exact opposite conclusion of all of its relevant RCTs?

This is probably because bread, potatoes, rice, etc and big portions in general are the main sources of glycemic load.

It seems likely to me that people get used to certain flavour profiles and the heavy use of sweeteners is going to prime people into desiring sweet foods and drinks. I don't know if the body then responds with hunger if it's promised sweet, highly calorific food/drink and then receives fake calories.

My personal observation with sugary food (maybe applies to aspartame as well): I eat a healthy meal and feel full. If I then eat some dessert, I want more and feel less full. As if my brain says: Look, you found a rare source of sugar. Sugar is good for me. Eat more while you can.

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