Drink two or more diet sodas a day, associated with a high risk of stroke, heart attack



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The risks were highest for women with no history of heart disease or diabetes, and obese or African-American women.

"This is another confirmatory study showing a relationship between artificially sweetened beverages and vascular risks, and although we can not demonstrate the cause, it is a yellow flag to pay attention to these results," said the president. from the American Academy of Neurology, Ralph Sacco, who is involved in the latest study.

"What about these dietary drinks?" asked the lead author of the study, Yasmin Mossavar-Rahmani, associate professor of clinical epidemiology and population health at Albert Einstein School of Medicine in Bronx, New York. "Is it something that concerns sweeteners, do they do anything for our intestinal health and our metabolism? These are questions we must answer."

Weight and race increased risk

More than 80,000 postmenopausal American women participating in the Women's Health Initiative, a long-term national study, were asked about the frequency with which they ate a 12-ounce portion of dietary drink over the course of three months precedents. Their health outcomes were followed for an average of 11.9 years, said Mossavar-Rahmani.
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"Previous studies have focused on the global situation of cardiovascular disease," she said. "Our study focused on the most common type of stroke, ischemic stroke and its subtypes, one of them being the blockage of small vessels. The other interesting aspect of our study is that we have sought to determine who is the most vulnerable. "

After taking lifestyle factors into account, the study found that women who ate at least two sweetened beverages each day were 31% more likely to have a clot stroke, 29% more likely to have heart disease and 16% more likely to die. any cause than women who drank diet drinks less than once a week or not at all.

The analysis then focused on women with no history of heart disease and diabetes, who are key risk factors for stroke. The risks increase considerably if these women are obese or African-American.

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"The women who, at the beginning of our study, had no heart disease or diabetes and were obese, were twice as likely to have a clot – based stroke or a stroke. ischemia, "said Mossavar-Rahmani.

There was not such a blow link with women who had normal weight or excess weight. Overweight is defined as having a body mass index of 25 to 30, while obesity is over 30 years old.

"African-American women with no history of heart or diabetes were about four times more likely to have a clot-based stroke," said Mossavar-Rahmani, but that risk of stroke was not enough. did not apply to white women.

"In white women, the risks were different," she said. "They were 1.3 times more likely to have coronary artery disease."

The study also examined various subtypes of ischemic stroke, which doctors use to determine treatment and drug choices. They found that occlusion of small arteries, a common type of stroke caused by blockage of the smallest arteries in the brain, was nearly two-and-a-half times more common in women without heart disease or diabetes but who consumed a lot of diet drinks.

This result is true regardless of race or weight.

Only an association

This study, as well as other research on the link between dietary drinks and vascular diseases, is observational and can not show cause and effect. Researchers say it's a major limitation because it's impossible to determine if the association is due to a specific sweetener, a type of drink or another hidden health problem.

"Menopausal women tend to have a higher risk of vascular disease because they do not have the protective effects of natural hormones," said Dr. Kevin Campbell, a North Carolina cardiologist, which could help increase the risk of heart disease and stroke.

"This combination can also be fueled by high blood pressure and sugars that have not yet been diagnosed as hypertensive or diabetic, but that warranted weight loss," thus bringing the women involved in the study to take dietary drinks, "said Dr. Keri Peterson, Medical Advisor. for the Calorie Control Council, an international association representing the low-calorie food and beverage industry.

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However, said Sacco, who is also chairman of the board of neurology at the Miller School of Medicine at the University of Miami, more numerous studies offer the same associations, "the more you begin to question yourself." The more you start to question you the association being real. "

Critics also point to the potential benefit of artificially sweetened beverages for weight loss, a crucial problem considering the obesity epidemic in the United States and around the world.

For example, two World Health Organization meta-analyzes of existing research on sweeteners other than sugars described these studies as "poor quality and inconclusive". said William Dermody Jr., vice president of media and public affairs of the American Beverage Association, a commercial organization.

"Low calorie and calorie-free sweeteners have been deemed safe by regulators around the world," said Dermody, "and many research shows that these sweeteners are a useful tool to help people reduce their sugar intake.

"We support the call by the WHO for people to reduce their sugar consumption, we are doing our part by creating innovative drinks with less sugar or sugar, clear labeling of calories, practices responsible marketing and smaller packaging. "

Benefits for weight loss?

Last year, the American Heart Association issued a notice that the short-term use of low-calorie sweet drinks and artificially to replace sugary drinks "could be an effective strategy" to promote the loss weight in adults, but not in children.
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The guidelines speak to those who "have a hard time switching directly from sugary drinks to water," said Rachel Johnson, professor of nutrition at the University of Hawaii, chair of the editorial group of this scientific opinion. "Sugary low calorie drinks can be a useful tool to help people make this transition."

Overall, said Johnson, "it is scientifically proven that the consumption of sugary drinks is associated with adverse health effects." It would therefore be prudent to limit ingestion to that point. we know more about the impact that they can have on the risk of stroke. "

According to the Beverage Marketing Corporation, a consulting and data consulting group, as science continues to explore this link, Americans are turning more and more to water and others non-caloric drinks. In 2016, bottled water surpassed carbonated soft drinks to become the number one drink in volume and continued to dominate the market in 2017 and 2018.

By 2018, Americans are expected to drink just over 3 billion gallons of diet sodas out of a total of 12.2 billion gallons of carbonated soda, according to data from the Beverage Marketing Corporation.

"Personally, I stopped drinking artificially sweet drinks, "said Sacco, adding that he considered emerging research as" an alert "for hardcore diet drinkers and for all those who were considering turning to them for weight loss.

"We should drink more water and natural drinks, such as unsweetened herbal teas," said Mossavar-Rahmani. "We can not just drink sodas all day, unlimited quantities are not harmless."

Correction: A previous version of this story wrongly cited the risks to white women of Mossavar-Rahmani

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