- Jennifer Middleton, MD, MPH
Perhaps your patients have been asking you, as several of mine have, about a new study getting lay press attention regarding stroke risk and artificially sweetened beverages. Published last week, this study from the Women’s Health Initiative (WHI) found an increased risk of stroke, coronary heart disease (CHD), and mortality among post-menopausal women who consumed 2 or more artificially sweetened beverages a day. Although observational studies like this one can only demonstrate correlation, and not causation, it still may provide an opportunity for discussing dietary changes that can meaningfully affect health.
Perhaps your patients have been asking you, as several of mine have, about a new study getting lay press attention regarding stroke risk and artificially sweetened beverages. Published last week, this study from the Women’s Health Initiative (WHI) found an increased risk of stroke, coronary heart disease (CHD), and mortality among post-menopausal women who consumed 2 or more artificially sweetened beverages a day. Although observational studies like this one can only demonstrate correlation, and not causation, it still may provide an opportunity for discussing dietary changes that can meaningfully affect health.
This WHI observational study examined the diet soda habits of over 80,000 postmenopausal women. Participants self-reported their artificially sweetened beverage consumption, and researchers followed them for an average of 11.9 years. Only 5.1% of participants consumed 2 or more artificially sweetened beverages a day, but these participants were more likely to have a stroke (hazard ratio 1.23 [95% confidence interval 1.02, 1.47]) or coronary heart disease (HR 1.29 [1.11, 1.51]), and the risk of stroke was even higher in women with a body mass index of 30 or greater (HR 2.03 [1.38-2.98]). It’s difficult to know, in an observational study such as this one, whether these women had other risk factors that increased their stroke and CHD risk; the researchers state that recalculating their results excluding women with known diabetes, hypertension, and/or CHD from their analysis “did not materially change the association with risk.” As this study only included postmenopausal women, any conclusions generalizing its results to men or premenopausal women could be premature.
Certainly, however, this study may prompt some people to decrease their diet soda consumption. Plain water, water infused with fruit, and unsweetened sparkling/seltzer beverages are all reasonable alternatives. Working with parents and our youngest patients to avoid developing a preference for sweetened beverages is also important, as outlined in this Centers for Disease Control and Prevention (CDC) Guide to Strategies for Reducing the Consumption of Sugar-Sweetened Beverages. From a public health perspective, education campaigns such as this one urging people to “Stop. Rethink Your Drink. Go on Green,” which categorizes beverages as “Red: Drink Rarely” (sugar sweetened beverages), “Yellow: Drink Occasionally” (100% fruit juice, artificially sweetened beverages), and “Green: Drink Plenty” (water, seltzer water, milk) may help encourage new beverage consumption norms.
Conversations about beverage choice can easily lead to overall diet discussions as well; emphasizing a diet rich in whole foods and recommending apps to help with healthy food choices can empower our patients to make better choices. There's an AFP By Topic on Nutrition if you'd like more resources for yourself and/or your patients.