Ignore the headlines. Diet drinks don’t make you fat

The front pages of yesterday’s newspapers had some sensational news for the yo-yo dieters and temporary gym members of post-festive Britain. Readers of the Times were greeted with ‘Diet drinks no healthier than sugary versions, scientists warn’, while the Telegraph ran with ‘Diet drinks can pile on the pounds’. The Guardian was only slightly less excitable with the headline ‘No evidence sugar-free soft drinks aid weight loss – study’.

There are a few problems with this. For example, there was no study and diet drinks do not make you fat. It was worthless as health advice, but as an example of how to get ‘public health’ misinformation into the media it was almost flawless.

times I’ll say it again: there was no new research. All the media coverage was based on a commentary in a journal. Despite being essentially an opinion piece, readers could be forgiven for assuming it to be a fresh scientific study. Why else would the Guardian use the word ‘study’? Why would newspapers cover it at all, let alone on the front page, unless something new had been discovered? Those are questions for another day. Let’s just say that this is not the first time it has happened. Loyal readers will recall an opinion piece in the journal Addiction becoming front-page news on two national newspapers back in July.

The opinions expressed in the commentary are highly controversial and perhaps deliberately inflammatory. It was criticised by nutritional experts within hours and its most eye-catching claim — that diet drinks could be a ‘potential risk factor for highly prevalent chronic diseases’ — is unevidenced in the article and almost entirely speculative.

Insofar as it attempts to review the evidence on diet drinks and weight loss, the analysis is perfunctory, misleading and frequently inaccurate. The authors cite a number of randomised controlled trials to show that the evidence is ‘mixed’, with some studies finding no effect on weight and others finding a ‘modest reduction’, but several of the studies they reference do not even look at weight loss. They claim that this study found no evidence of weight loss (it did) and cite this study as evidence that diet drinks lead to both weight loss and no weight loss. In truth, the scientific base is not so ‘mixed’. The balance of evidence from randomised controlled trials strongly points to a positive effect.

To make the package even more irresistible to the press, the commentary was press released with additional comments from one of its authors, Christopher Millett, that were even more sensational than those in the article itself. ‘Far from helping to solve the global obesity crisis,’ he said, ‘artificially sweetened beverages may be contributing to the problem.’ Quite how the substitution of zero-calorie drinks for sugary drinks could contribute to obesity is barely explored, let alone proven, in his article.

A one-eyed view of the evidence, a bit of hyperbole, and a spot of exaggeration. That’s how you get front-page news coverage in the world of ‘public health’ without having to do any research of your own.

So what’s the reality? The fact is that virtually all randomised controlled trials which substitute artificial sweeteners for sugar find evidence of weight loss. Much the same is true of artificially sweetened soft drinks (see here, here and here, for example). The amount of weight loss is usually not great — diet drinks are not magic wands — but it is real, and they certainly don’t make you fatter.

To be fair, the evidence from observational studies is less impressive. It has often been noted that people who drink diet drinks are not always very thin. The next president of the United States once tweeted that he has ‘never seen a thin person drinking a Diet Coke’. This phenomenon can be seen in epidemiological studies which compare people’s dietary habits to their physical characteristics, but the authors of yesterday’s commentary correctly attribute this to ‘residual confounding’ (ie, people who drink fizzy drinks tend to eat more food than those who do not, regardless of how the drink is sweetened) and ‘reverse causality’ (ie, some people start drinking diet drinks when they get fat, but did not get fat by drinking diet drinks).

It is sometimes argued that people feel that having a zero-calorie drink gives them permission to have another doughnut, thereby increasingly their calorie intake. It has also been suggested that artificial sweeteners make people hungry. These theories seem to be the only basis for Millett’s claim that diet drinks are contributing to the ‘global obesity crisis’, but the only evidence cited for them in his commentary is a letter to the Lancet in 1986 and an evidence review that gives short shrift to both theories.

Don’t let them worry you. If you are trying to work off the mince pies, you would be well advised to switch from Coke to Diet Coke and start putting slimline tonic in your gin. It’s not the whole answer but it will do some good and it certainly won’t do you any harm.

The idea that zero-calorie products are a cause of obesity is absurd on its face and is unsupported by the evidence. It is not merely junk science, it is anti-science in that it implies that obesity is not caused by a surplus of energy but by some magical process involving bubbles and tin cans. It is front-page news because it is sensational, and it is sensational because it is not true.


  • Malcolm Stevas

    Don’t add “slimline tonic” to your gin. It’s not as good – not even Fever Tree Lite (or whatever they call it). If you want to lose weight, eat less and exercise more. No need to go mad and drink fewer G&Ts.

  • Chris Oakley

    I have observed the output of Christopher MIllett for some years now. I have written to journal editors to protest about his misleading papers that are clearly written with considerable bias and with no reasonable attempt to adhere to even basic scientific principles. I can therefore say with some confidence that I believe Millett to be first and foremost an activist. He is one of the few academics I believe to be genuinely and demonstrably dishonest. The fact that he holds tenure at a UK university is indicative of the declining standards and the lack of accountability that is undermining public trust in academia. The public long since stopped taking public health “science” seriously for very good reasons.

  • Rhoda Klapp

    It’s the fizziness they don’t like. And the suspicion that some people might be drinking something they like without permission from Nanny. There will always be a study, or something somewhat less than a study, to justify opposition to absolutely anything which is enjoyable to someone.

    And that global obesity crisis. It isn’t global. It is created by those whose object in life is to disapprove of what other people do, eat, drink or look like. If there could ever be an obesity crisis, it would be a private one, a personal one. Nobody else’s business.

    • Obesity has an enormous economic impact, not to mention the diseases associated with it, such as heart disease, diabetes, etc.

      Also, I’m sure the children of those who cannot discipline themselves to treat their bodies and brains with respect, would probably be thankful if their mother or father or sister or daughter (or whoever it is) lived long enough to watch them graduate college.

      When you become obese and think it’s no one else’s business, you forget the impact to society.

      Lost wages. Lost productivity. Lost lives. Obesity isn’t a game. Wait until you have a heart attack or have your feet cut off.

      Maybe then reality will set in.

      • Rhoda Klapp

        What about that freedom thing?

  • the panda

    Esting chips makes you fat. Stop commiting suicide by obesity you ham beasts.

  • Nephthys

    ayo fam, wanna lose dem pounds?

    calories
    1) consume fewer
    2) expend more

    das it, mane

    Diet drinks help towards factor 1 but that’s bad news for the sugar-tax lobby (which is what this fake news is really all about). The establishment media isn’t stupid, just dishonest.

  • Pen

    But sweeteners do cause disruption of gut bacteria which may contribute to development of Type 2 diabetes and obesity.

    This page contains a link half way down to the paper in the science journal Nature demonstrating that artificial sweeteners affect the bacteria: http://www.npr.org/sections/thesalt/2014/09/17/349270927/diet-soda-may-alter-our-gut-microbes-and-the-risk-of-diabetes

    We’re all different; some humans can tolerate this stuff better than others. I suspect that those of you who keep repeating the mantra, “eat less, move more,” are part of the lucky group whose metabolisms have not been greatly affected. Those of us who are more sensitive to these and some of the other artificial additives found in the modern diet are finding that we have much greater success in losing weight by cutting sweeteners out of our diets.

    • Oliver Webb

      Actually there’s no evidence for either of those things. The research you mention relates to tests carried out on mice and aside from flaws in the study which relate to the predisposition of male mice develop bladder cancer anyway due to their own natural body chemistry the mains problems are:
      1. they’re mice, not humans
      2. the truly industrial quantities of the substance that was given to the mice, which would in no way reflect the quantities that any person would ingest even if they binged on sugar free products all day every day.

      A more balanced view of the use of artificial sweeteners can be found here:

      http://www.webmd.com/food-recipes/features/truth-artificial-sweeteners#1

      • Ok, first of all, WEBMD isn’t a reliable source and second, most published research is false.
        Source: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124

        That said, I don’t rely, and neither should any human, on these “studies” to figure out what to eat.

        Really, this is not rocket science.

        For 99.99% of human evolution, we’ve eaten food from the earth. Organic, not RoundUp Ready.

        Vegetables
        Fats
        Fruits in season
        Nuts and seeds
        Exercise
        Sunshine
        Sleep

        No study needed.

        Seriously, ask yourself this: how is it that humans got so confused as to what to eat?

        Answer: The Media and corporate “science.”

        My cat knows what to eat. All animals intuitively know what to eat. Except humans. And we’re supposed to be the smart ones.

        • Oliver Webb

          Interesting point you make there. I’ll agree that not all scientific/medical publishing is perfect and if you don’t already know of it, I would direct you to the works of Ben Goldacre on http://www.badscience.net

          He has spent a great deal of time deconstructing and exposing the tricks that can be employed to present medical information, however to say that ‘most published research findings are false’, is completely inaccurate.

          You do know that PLOS is an open access site which demands fees from the authors (in the case of PLOS medicine, $2900 per paper)? This is how they make the content free to access.

          This means that in effect you can publish more or less, any old rubbish on the site as long as you have the money to pay for it. I would also point out that your article link is an ESSAY and therefore simply the author’s personal opinion, so could not possibly be used as ‘proof’ of, well, anything really.

          Sadly many people misuse or misunderstand what open access content is and how it should be regarded, as I think you may have.

          Web MD might not conform to the very highest levels of scrutiny, but it is properly peer reviewed and it doesn’t require authors to pay for their content to be published unless it originates from a purely commercial source and then it is clearly stated where the content appears.

          My career is in medical publishing, so I do know what I’m talking about here.

          In effect you have used an unsubstantiated argument to attempt to defeat or dismiss a qualified piece of medical research.

          I’m certainly not disputing your claim that we need balanced diet composing of fruits, vegetables, fat etc. That’s all patently obvious, but I notice you omit meat and dairy from the equation which makes me suspect you may be vegan and (like many vegans) have a politicised view of nutrition in general – ironically, mostly based on very bad science indeed.

          Your inclusion of the RoundUp name makes me think you have also swallowed much of the anti Monsanto half truths and bile spread around the internet and most likely a ton of anti-corporate/capitalist rhetoric too.

          There’s nothing wrong with holding these beliefs at all but please don’t try and persuade us that your internet filter bubble informed world view is in some way the ‘truth’.

          To return to aspartame and the original topic, my point was to demonstrate that no one knows what the effect of diet drinks are. Claims that aspartame is dangerous or toxic have not been substantiated in any way at all (NO – they haven’t).

          I’m not saying there might not be a proven link at some point in the future, but given that billions of people enjoy diet drinks with sweetners every year and there has not been a world wide extermination of people as a result, i’d say if it was a person’s choice to drink these drinks it is probably no more dangerous than incorporating any other food into your diet.

          I would be very happy to bet that peanuts kill thousands or even hundreds of thousands more people per year than aspartame could ever do, so bang goes the theory that only natural products are good for you. There’s a whole host of food products that people can be killed by if they are allergic to them – organic or not!

          I’ll eat dead animals, you stick to your nuts. We both might die of cancer anyway.