I "grew up" from 76 to 58 years back. We kids ate and drank everything, most of it calorie-laden. As best I recall, there were no diet sodas available back then. Although I recall a few overweight kids in school, not one of my outside playmates was overweight. In JHS, I was right next to my grandma's house and would go there every day for lunch. My favorite - maybe three or four days a week - was corn fritters, which were like pancakes, but maybe half the size. My gram would FRY six or eight at a time and I'd eat about two dozen, this for lunch, with afternoon school to go, and then supper and snacks. Never gained an ounce, nor did my friends, this at a time when nobody had ever heard the word 'cholesterol' and were only vaguely aware of calories. Nobody was concerned about them and we were very healthy. We were also extremely physically active, usually in summer for an easy 12 hours a day. No wonder we never gained weight. Later on, I could easily put on a lot of weight, so when diet drinks came along, I indulged vociferously, because every zero calorie diet soda was saving me 100 or more calories that I could then make up in food. That's a good 55 years ago. I drink an average of one 2-liter bottle a day, more in hot weather), use diet sweeteners in coffee, etc. 55 years now, and there is no deleterious effect that I or any medical tests have noted. Healthwise, horses look to me for inspiration. Maybe I should be considered a National Medical Anecdote? Good article!
My kids eat fast food every day, drink pop every day, eat hamburgers, eat potato chips,zero vegetables except corn and potatoes. We just got back from red Robin. Big hamhurgers, chocolate malts, fries etc. My sister cooks every meal at home. My kids are tall and slim, good students, good athletes and great kids. My sisters kids are great kids. One is 80 pounds overweight, one 50, my sister 80, my brother in law 100. Go figure. It's genetics and portion size period.
1
Thanks, Doctor. Your responses seem reasonable, thoughtful and measured. Obviously water is the best option, but sugar-free sweeteners do, as you rightly say, eliminate hundreds of utterly empty calories a day. Let us not, as we so often do in our dietary zeal, let the perfect be the enemy of the good. I would vastly prefer single payer to Obamacare, but I am also very glad that close to 20 million people now have health care coverage who did not before.
9
I enjoyed reading about the debate, especially regarding what people did when they were growing up. We also had milk at every meal and orange juice was a special treat, once a week with donuts on Sunday. We children were allowed no coffee. Soda (which was referred to as 'tonic' in the part of Massachusetts where I was raised) was completely absent from the house. A fond memory I have is of going with a friend to the soda fountain (not the tonic fountain), where we would request a soda, made with flavoring and fizzy water and served in a tall, attractive glass with ice and a slice of lime. That was an occasional treat, perhaps once a month. I know many of us grew up like that, so it stands in striking contrast to what we have today. There were no mountains of discarded plastic bottles. In Massachusetts, a deposit was paid and my sister and I would comb the beach during vacation, collecting bottles and returning them for a very hefty sum of money. How society has changed, with ubiquitous vending machines and vast amounts of waste generated by discarded containers! The result is a triumph for the soda industry, a scourge on the environment and questionable at best benefits for our health.
5
Professor Carroll, welcome to the public discourse on food additives, particularly sugary soda ( or diet soda) drinks available to our children. The highly charged comments you received about your article reflect the passion of some citizens, who feel that our country has for too long turned a blind eye to the damage done to our collective health by highly promoted soda drinks. Increasing rates of childhood obesity, and diabetes, are only 2 of the maladies we all now face -- as taxpayers. These same purveyors of soda now hawk artificially sweetened sodas to our children, claiming these chemically sweetened drinks are not harmful. Any wonder why so many people are skeptical ?
6
Your language is downright deceptive and contradictory. In your first article, you wrote: "My wife and I limit our children’s consumption of soda to around four to five times a week." In defending that stance in your second article, you write: "Once in a while, I let them have a diet soda if they like." Four to five times per week sounds like consumption that takes place pretty regularly to me, not just "once in a while." This is an unconvincing attempt at backtracking and rationalization.
5
In child time 'once in a while' is about every other day, in my experience with three children. My youngest both have diet fizzy drinks (as we call them in the UK) about every other day and only a small glass with lots of ice, and no sugar drinks apart from fruit juice. They also drink water and milk and one likes a cup of milky tea. If you let your kids drink lots of fruit juice it's also important for them to use a straw to protect their teeth.
1
Ah, for the days when we could just enjoy our food, stress-free, without the side order of strident self-righteousness!
11
Thank you for the follow-up article.
1
"In the last few years, I’ve watched a continuing battle among my friends about which is worse for you: artificial sweeteners or sugar. Unless you want to forgo all beverages that are sweet, you’re going to run into one of these.:
So Stevia doesn't exist?
So Stevia doesn't exist?
4
Go ahead, drink all the artificial sweeteners you want. The studies aren't (yet) conclusive). But do so at your peril. People don't get cancer from moderate amounts of sugar, or fruit-derived sweeteners. Aspartame, sucralose or saccharin? Well, the studies aren't definitive, so what is the worry?
5
Have Americans become so accustomed to political biases affecting scientific inquiries like climate change and childhood vaccinations that they always expect that straight-up-or-down studies like food issues to be politicized as well?
Once the truth-be-hanged crowd gets its orders and starts directing entire political parties toward the fringe, everything starts looking like it came here on the orders of the Chicago political machine, or the Koch Brothers, or angry George Soros.
Once the truth-be-hanged crowd gets its orders and starts directing entire political parties toward the fringe, everything starts looking like it came here on the orders of the Chicago political machine, or the Koch Brothers, or angry George Soros.
1
What may be missing from the discussion is the element of normal business warfare. Each time a new contestant enters a market, and this applies across nearly all industries, the market leader starts rumors and funds "research" to attack and malign, thus minimizing the new player's growing marketshare. This is the equivalent of asking a man, "have you stopped beating your wife."
It remains a highly effective technique because most people are too lazy to research a topic or are so poorly educated in logic that they fail to understand the issues and arguments.
One simple tool of mental investigation I use is to ask, "if that was true, what would it mean?" In this case, if the artificial sweeteners were deadly, it would suggest there would be vast amounts of evidence to support the claim since billions of gallons are consumed. Where is that evidence? There absolutely is evidence that sugar has greater impact by several orders of magnitude. I expect for every real case of artificial sweetener caused health problem, there are more than a thousand caused by corn syrup...and probably ten thousand.
It remains a highly effective technique because most people are too lazy to research a topic or are so poorly educated in logic that they fail to understand the issues and arguments.
One simple tool of mental investigation I use is to ask, "if that was true, what would it mean?" In this case, if the artificial sweeteners were deadly, it would suggest there would be vast amounts of evidence to support the claim since billions of gallons are consumed. Where is that evidence? There absolutely is evidence that sugar has greater impact by several orders of magnitude. I expect for every real case of artificial sweetener caused health problem, there are more than a thousand caused by corn syrup...and probably ten thousand.
15
As a working scientist, I'm struck by the author's statement that he tries not to "cherry pick," but then proceeds to do so in a manner that supports his primary argument. There is nothing sacred about reviews, which often carry the selection bias of their authors, nor of meta approaches, which are trendy but carry their own statistical dilemmas. Medicine rests on animal studies, and many medical and nutritional problems do not lend themselves to large samples. Ignoring the Nature review and other studies that work against the author's argument, and then defending his lawyer-like approach on scientific grounds is disingenuous at best.
8
"many medical and nutritional problems don't lend themselves to large samples." Exactly! If some bad thing happens rarely to a few people, it's good to be aware of, but representing it as a hazard everyone should avoid at all costs is inflammatory and inaccurate. Way too many people die in car wrecks, but being a passenger or driver in a car is a risk that is generally considered acceptable. Claiming otherwise is rather suspect.
6
As a scientist, you know that there are different kinds of studies with different goals and objectives. Pre-clinical (not in human) studies, say using mouse models of disease action, are intended to understand mechanism, initially through proof of concept. What Dr. Carroll did not go into was the pathway to Phase I, II, III trials that can follow from the pre-clinical work.
From my perspective, what was published in "the Nature study" referenced in the column was designed to provide the data to justify subsequent studies, moving towards what may be going on in humans.
Dr. Carroll's cherry-picking is a preference toward evidence that is worth sharing with the public, some of whom may be interested in new insights or hypotheses about mechanism, and people wanting to know what to eat. These are very different goals for a news column.
From my perspective, what was published in "the Nature study" referenced in the column was designed to provide the data to justify subsequent studies, moving towards what may be going on in humans.
Dr. Carroll's cherry-picking is a preference toward evidence that is worth sharing with the public, some of whom may be interested in new insights or hypotheses about mechanism, and people wanting to know what to eat. These are very different goals for a news column.
5
I'll try to respond to both Optimystic and Simon. Optimystic, cars are a good example of how we tend to underestimate risk when we're engaged in a habitual activity. I didn't say anything about avoiding cars (or sugar substitutes) at all costs. And my comment about large samples was referring to the methods needed to ferret out particular strains of bacteria inside us and their chemical responses to our diet. It's a laboratory intensive design, sometimes using animals, that can't work realistically for large population, epidemiological style studies.
Simon, I'm not clear why readers must be protected from pre-clinical and animal studies. The author rejects them out of hand, and (incorrectly) states that artificial sweeteners are "easy to study" in people. (Only if your outcome variables are crude measures like weight gain.) Animal and bacterial studies are an integral part of the scientific process; not, as the author suggests, innately untrustworthy because they are not based on human case-control trials. (Which in turn are not the statistical gold standard physicians like to portray.)
Finally, I'm curious that the author states he's trying not to cherry pick, then you state that he is, but it's a "preference for evidence worth sharing." Which can be reasonably defined as evidence a writer sifts out to advance a point of view. Which to Dr. Carroll is about what to eat, not about insights or mechanisms. So we seem to agree he's cherry picking, but you think that's fine?
Simon, I'm not clear why readers must be protected from pre-clinical and animal studies. The author rejects them out of hand, and (incorrectly) states that artificial sweeteners are "easy to study" in people. (Only if your outcome variables are crude measures like weight gain.) Animal and bacterial studies are an integral part of the scientific process; not, as the author suggests, innately untrustworthy because they are not based on human case-control trials. (Which in turn are not the statistical gold standard physicians like to portray.)
Finally, I'm curious that the author states he's trying not to cherry pick, then you state that he is, but it's a "preference for evidence worth sharing." Which can be reasonably defined as evidence a writer sifts out to advance a point of view. Which to Dr. Carroll is about what to eat, not about insights or mechanisms. So we seem to agree he's cherry picking, but you think that's fine?
One point that seems to be missed in the comments is that use of artificial sweeteners has to be weighed against the alternative - use the usual sweeteners sugar, high-fructose corn syrup, and others. An unbiased review of the literature, I think, indicates that high calories sweeteners are much worse for human health than the artificial ones.
Caroll is also correct in paying much more attention to larger randomized controlled trials in humans. Small human trials are highly dependent on subject selection and adventitious factors, and they are often worthless. And mouse physiology differs from human physiology significantly, so murine trials can best indicate the need for human trials to be done.
Caroll is also correct in paying much more attention to larger randomized controlled trials in humans. Small human trials are highly dependent on subject selection and adventitious factors, and they are often worthless. And mouse physiology differs from human physiology significantly, so murine trials can best indicate the need for human trials to be done.
6
This article and the comments make me reflect on the difference between the way I was brought up, many years ago, and changes over the years. As a child, I was offered water between meals. Guests would be offered a glass of water, not other beverages unless they had come for afternoon tea, or it was evening and my father might offer alcohol to adults before dinner. Later, in my teens on a farm, people who were working in the fields on a hot day would drink both water and soft drinks, but soda wasn't ubiquitous, and I don't think diet soda had been invented. By the time I had my own children, little children were offered more apple juice than water (I remember rivers of apple juice spilled on the floor by unsteady little hands). Why??? And after that, soft drinks were more likely to be available at people's homes - possibly because people had become accustomed to having more taste in their beverages?
9
That's interesting. In my (large) family in the NY metro area, if you offered water to a guest it would have been seen as an insult. And vice versa. We always offered coffee! It seemed to be ubiquitous and even children knew how to make a pot when told. If they came later, after dinner, they were offered coffee or beer. All children drank milk, rarely juice, maybe orange at breakfast. Soda drinking was rare. I myself, don't like plain water, I usually flavor it with something. Also drink a lot of coffee!
2
How families can differ! My mother never offered coffee except at breakfast, or in tiny after-dinner cups after, of course, dinner. Milk was the standard beverage for everyone at meals, though we might have water at lunch or dinner if we had company. Orange juice was standard at breakfast but my mother often drank grapefruit juice instead. Tea was not common except for guests invited for afternoon tea (not that often during World War II, because you couldn't get lump sugar - my mother nursed one box of lumps through 1945 by hiding it from her children). After I was old enough to read some English children's books and asked for tea, we sometimes had tea at Sunday supper, and I was allowed "cambric tea," which is mostly milk, until I was in high school. Iced tea was common in very hot weather.
2
@Concerned, not sure when and where you grew up, but even in the '50s parent faught a battle with soft drinks. Soda consumption has been building for a long time.
Good for your family. You seem to have accepted the water without question. But soda companies were all over television with their ads and sponsorships. It wasn't easy for parents to offer only water in my neighborhood.
Good for your family. You seem to have accepted the water without question. But soda companies were all over television with their ads and sponsorships. It wasn't easy for parents to offer only water in my neighborhood.
1
While it is true that the studies that were ignored in Dr. Carroll's original article were small in scale, I do not believe that they should have been omitted. In doesn't hurt to indicate that there is new, although inconclusive, research (that doesn't support your conclusion) when you write about a topic in a manner that can influence behavior.
In a country where an estimated 29.1 million people have diabetes, including 26 percent of those over the age of 65, and it is estimated that as many as 50 percent (!) of those of 65 have prediabetes, it is important to understand what may be significant as well as what has already been shown to be significant in raising blood sugar. We clearly need larger-scale experiments to understand the causal link (if any) between artificial sweeteners and blood sugar. In the meantime, as an over-sixty-five prediabetic, I have decided to err on the side of caution and eliminate as much artificial sweetener from my diet as possible.
In a country where an estimated 29.1 million people have diabetes, including 26 percent of those over the age of 65, and it is estimated that as many as 50 percent (!) of those of 65 have prediabetes, it is important to understand what may be significant as well as what has already been shown to be significant in raising blood sugar. We clearly need larger-scale experiments to understand the causal link (if any) between artificial sweeteners and blood sugar. In the meantime, as an over-sixty-five prediabetic, I have decided to err on the side of caution and eliminate as much artificial sweetener from my diet as possible.
9
"I’m saying that if I had to choose between the diet drink and the one with added sugars, I’d go with the diet drink."
To me, that is the key quote from this series of articles. I find that most people I talk to somehow overlook sugar (or other items with sucrose like honey, agave, juice, etc...) when evaluating the harm of a beverage. Sugar is harmful! I encourage them to consider the cancer risk of obesity vs. aspartame.
Thank you Aaron for the followup.
To me, that is the key quote from this series of articles. I find that most people I talk to somehow overlook sugar (or other items with sucrose like honey, agave, juice, etc...) when evaluating the harm of a beverage. Sugar is harmful! I encourage them to consider the cancer risk of obesity vs. aspartame.
Thank you Aaron for the followup.
23
No one needs "beverages". Water is always available, free from the tap, and (in the developed world and much of the rest) completely safe.
2
such old news....why does it have to keep getting repeated?
4
"I don’t think that letting my children drink diet soda once in a while makes me a monster, but apparently some of you think it does."
Nobody called you a monster. We were simply questioning your judgement.
More people need to realize that criticism is not the same as persecution.
Nobody called you a monster. We were simply questioning your judgement.
More people need to realize that criticism is not the same as persecution.
16
Criticism is a form of persecution that allows one person to get away with saying a negative thing. Questioning someone's judgement is definitely a negative reaction. Stop hiding behind semantics: you have decided that the doctor is wrong. Admit it.
14
"Criticism is a form of persecution"
Please tell me you are joking.
Please tell me you are joking.
9
Bystander,
Let me explain - the doctor used the word "monster" to indicate that many people felt strongly (negatively) about his giving his kids diet soda. He is not actually accusing you of calling him "monster". Also, nowhere did the doctor actually accused you of "persecuting" him. So calm down.
Btw, your "all-or-nothing" food philosophy is indeed superior. Only those possessing of the strongest discipline, such as yourself, can achieve it. Most of us are just common people who, like the doctor himself, have a much better chance of staying healthy by following the rule of moderation.
Let me explain - the doctor used the word "monster" to indicate that many people felt strongly (negatively) about his giving his kids diet soda. He is not actually accusing you of calling him "monster". Also, nowhere did the doctor actually accused you of "persecuting" him. So calm down.
Btw, your "all-or-nothing" food philosophy is indeed superior. Only those possessing of the strongest discipline, such as yourself, can achieve it. Most of us are just common people who, like the doctor himself, have a much better chance of staying healthy by following the rule of moderation.
4
How many diet sodas are too much?
I probably drink 25 cans a week.
It is better than smoking two packs a day but is it better than being 30 pounds overweight?
I probably drink 25 cans a week.
It is better than smoking two packs a day but is it better than being 30 pounds overweight?
6
I think so.
1
Except that diet soda is fattening. .
My son was encouraged to drink water from the get go. He is now 13, and has never touched a soda at all, so it is up to parents to teach them this...kids don't naturally gravitate to these drinks. As with everything else, they learn from the people around them.
When you speak about sugar, you are really talking about high fructose corn syrup, which is added to nearly all processed foods, and is made from GMO corn. It is more dangerous than natural cane sugar, in that it is stored as fat in the body because it cannot be metabolized. The body cannot process man-made substances in the same way as those found in nature...something we tend to overlook when we consume processed foods. Their molecular structure is foreign, and they are seen as toxins.
The same can be said for artificial sweeteners...and they can acrually make you fatter. According to a study, published in the journal Nature, non-caloric artificial sweeteners directly contribute to enhancing the exact epidemic that they themselves were intended to fight. They found clear evidence that artificial sweeteners, including saccharine and sucralose, can affect gut bacteria, which in turn affect how food is digested and metabolized.
When you speak about sugar, you are really talking about high fructose corn syrup, which is added to nearly all processed foods, and is made from GMO corn. It is more dangerous than natural cane sugar, in that it is stored as fat in the body because it cannot be metabolized. The body cannot process man-made substances in the same way as those found in nature...something we tend to overlook when we consume processed foods. Their molecular structure is foreign, and they are seen as toxins.
The same can be said for artificial sweeteners...and they can acrually make you fatter. According to a study, published in the journal Nature, non-caloric artificial sweeteners directly contribute to enhancing the exact epidemic that they themselves were intended to fight. They found clear evidence that artificial sweeteners, including saccharine and sucralose, can affect gut bacteria, which in turn affect how food is digested and metabolized.
11
yes...not "good" for you as a nutritious food item, but better than sugar. It can have a nasty after taste.
Sugar is sugar. The body does not see a difference.
Please include the link to the study in Nature to which you refer.
This article is increasing proof that the NYT is hostage to those who advertise. Are you really defending cherry picking studies bought and paid for by industry to defend the cheap chemicals that most unthinking Americans consume? I wish your children luck.
6
What about stevia use? Any comments appreciated..
9
I don't know about anyone else but I've found that a substitute of a Monk Fruit blend in my coffee with a dash of Lime juice is a great substitute for Sugar and milk. It drops my cal/carb use from 84/14 to a mere 8/2.
The combo should be zero according to the advisory on the package but I noted that the USDA allows any reading under 3 cals per portion to be listed as zero. Therefore I list out at 8 calories to 3 pkgs. and the 2 carbs is to adjust for that "Less than One" reading on the package.
The combo should be zero according to the advisory on the package but I noted that the USDA allows any reading under 3 cals per portion to be listed as zero. Therefore I list out at 8 calories to 3 pkgs. and the 2 carbs is to adjust for that "Less than One" reading on the package.
1
You have my sympathy. I'd rather be cornered in the parking lot of a deserted shopping mall by a horde of ravenous zombies than have to listen to the self-righteous lecturing of a food nazi.
70
Perhaps one issue is that people are literally drinking "gallons" of liquids when the need is much smaller. For instance, drinking 8 cups of water ON TOP OF tea, soda, milk, coffee and other stuff may lead to a form of addictive drinking, which it seems it pretty prevalent in our society. Some people think that they need to "hydrate" when they should cut back to reasonable servings of everything. Not a huge sipper cup of Gatorade, but 1/2 cup of Gatorade. Not a Venti latte, but a small one. Then also drink water. Moderation helps. Huge cups of soda, bottles of water and so forth may be causing other issues we just can't measure at this point.
11
You can actually do yourself harm by overhydrating. It dilutes the sodium content in blood and causes the excess water to flood cells, including the ones in the brain. The result is brain edema, which makes the patient very sick at best and dead at worst.
A relative was told to drop her lifelong habit of drinking a great deal of water all day because the dilution of sodium in her blood was reducing its ability to conduct the electricity her pacemaker needed in order to function properly.
Moderation in all things, I guess.
A relative was told to drop her lifelong habit of drinking a great deal of water all day because the dilution of sodium in her blood was reducing its ability to conduct the electricity her pacemaker needed in order to function properly.
Moderation in all things, I guess.
5
"[T]he maximum allowable amount of saccharin", according to the FDA, is 15mg/kg-body-weight, where 15mg is the equivalent of 45 packets). How much is that, really? For a 220lb person, that's 100[kg] x 15 [mg], or 1,500gr (3.3lbs)... *per/day*
I cannot imagine consuming that much artificial sweetener on a daily basis; can you?
I cannot imagine consuming that much artificial sweetener on a daily basis; can you?
12
Anyone that reads the history of how Aspartame was approved for the market will come away outraged by the procedures followed. This process involved ,
1) The FDA kept aspartame off the market for 8 years until Ronald Reagan with the help of Donald Rumsfeld fired the head of the FDA and hand picked a replacement and approved aspartame.
2) Criminal charges were prepared against the company that got the approval but when the case was to go to court the government's lawyer quit the case. By the time the a new lawyer could be appointed the statue of limitations had expired.
There are many people on the internet fighting aspartame.
The bottom line is that aspartame is addictive. It seems like a replay of the lies used by the tobacco industry.
1) The FDA kept aspartame off the market for 8 years until Ronald Reagan with the help of Donald Rumsfeld fired the head of the FDA and hand picked a replacement and approved aspartame.
2) Criminal charges were prepared against the company that got the approval but when the case was to go to court the government's lawyer quit the case. By the time the a new lawyer could be appointed the statue of limitations had expired.
There are many people on the internet fighting aspartame.
The bottom line is that aspartame is addictive. It seems like a replay of the lies used by the tobacco industry.
18
Except that the evidence shows aspartame to not be harmful (not to mention a big improvement over the sugar it is replacing). The evidence is nothing like what we see for cigarette smoking. Rather than getting carte blanche because the campaign against cigarette smoking was justified, campaigns against products like aspartame need to be tempered by the recognition that there also many such activist crusades against ultimately harmless or minimally harmful products. Contrary evidence, even scientific consensus that the contrary is true, does not seriously disrupt these campaigns. Such campaigns are based on anecdotes that inspire strong emotions in some people and unfortunately such methods (emotional stories) tend to be more effective in mobilizing people than scientific evidence.
21
Whatever the alleged flaws in the original studies, subsequent studies in the U.S. and overseas have found that there is no problem. The most recent studies also have the benefit of time and quantities consumed, so things that happened in 1981, while fodder for 60 Minutes, are no longer relevant.
Almost nothing tastes as good as outrage, tho.
Almost nothing tastes as good as outrage, tho.
12
If you don't want it, don't consume it. "Fighting it on the internet" just turns one into a crank.
3