Diabetes - acquittal for Diet Coke?

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Do light drinks really make you fat? Or even sick? The current state of research on sugar substitutes.

They are called "light", "zero" or "sugar-free" and are sugar-sweet with almost zero calories. Artificial sweeteners have long made this possible. But they fell into disrepute again and again - at first it was suspected that they could cause cancer - a hypothesis that now seems to have been dispelled. But now the sweeteners are again under suspicion: Are they, like their sugar-heavy relatives, contributing to the rampant obesity epidemic? Do they even promote type 2 diabetes? And if so, how is that supposed to work, practically calorie-free as it is?

“We have known for a long time that sugary drinks and type 2 diabetes are linked. Now we have asked ourselves the same question with regard to drinks with artificial sweeteners, ”says Fumiaki Imamura from the University of Cambridge. "We were also interested in whether such a connection also exists independently of body weight."

Together with his colleagues, he evaluated a total of 17 studies that looked at the influence of different types of drink on body weight and the risk of diabetes - a total of around 38,000 participants were recorded. In addition to sugary soft drinks and their low-calorie counterparts, fruit juices and milk were also examined.

Even slim sugar-slicers live risky lives

It was hardly surprising that regular consumption of sugary soft drinks increased the risk of diabetes. Even with a can of Diet Coke & Co. daily it rose by 18 percent. This not only has something to do with the fact that the sugar puffs make you fat (and thus automatically increase the risk of diabetes): Even when the scientists excluded weight as an influencing factor, the risk remained higher - at 13 percent.

“This means that even slim people have a higher risk of illness if they regularly drink sugary lemonades,” Imamura said in an interview with The dissolved sugar gets into the blood particularly quickly and thus provokes blood sugar injections. The pancreas reacts to this and releases large amounts of insulin, which are supposed to move the sugar from the blood into the cells - hard work for the organ. If this is often the case, it can gradually overwhelm the pancreas - insulin production is exhausted. There is a risk of diabetes.

Do sweeteners fool the brain?

In the case of sweeteners, on the other hand, this mechanism shouldn't work - or should it? At least there is research to suggest this. In what is probably the most famous study, researchers led by Yanina Pepino from Washington University in St. Luis were able to show that the insulin level of overweight test subjects rose as soon as they consumed drinks containing sweeteners. The hypothesis: The sweet taste of artificial sugar could trigger reactions in the brain that promote insulin release.

Imamura, however, is not really convinced of the study: "To get the same amount of sucrose as the participants in the study consumed, you would have to drink around 40 cans of light drinks a day," the scientist points out. In addition, the test subjects had already shown insulin resistance - a preliminary stage of diabetes.

Nevertheless, Imamura and his team also found a connection between type 2 diabetes and diet cola - and that was even stronger than that of sugary drinks. The risk of becoming diabetic was 25 percent higher for participants who took light limos. But this amazing effect largely evaporated when the overweight factor was factored out. The increased risk was then only eight percent. “That is not significant,” says the researcher - so it is not conclusive.

Those who are fat tend to drink light

People of the same weight would therefore have the same risk of diabetes, regardless of whether they enjoyed consuming light drinks or not. The results of the study also mean that the proportion of overweight consumers is particularly high among light consumers. And that in turn comes as no surprise: people who are already struggling with their weight are probably more likely to use light versions of soft drinks than lean contemporaries.

An additional explanation: It is possible that people who consume light drinks simply ate more and therefore put on weight, according to Imamura. For example, because they believed they could treat themselves to a high-calorie snack in return. In addition - and there is also experimental evidence for this - artificial sweeteners may stimulate the appetite. That means: light drinks can make you fat, even if in an indirect way.

And the researcher has yet another suspicion: “It may be that studies are preferred that show a connection between artificial sweeteners and diabetes.” For the simple reason that such a connection appears more exciting than the opposite. Overall, the study situation rather suggests that drinks containing sweeteners could prevent obesity and thus diabetes rather than promote it, Imamura cautiously summarizes the results.

Does sweetener promote fattening intestinal bacteria?

But that may not apply to all people. Israeli researchers led by Jotham Suez from the Weizmann Institute of Science discovered, first in experiments with mice and later also in humans, that artificial sweeteners can change the intestinal flora. As a result, more bacteria colonized the intestine, which can break down long-chain sugar molecules particularly effectively - those that would otherwise have been excreted undigested.

As a result, humans and mice turned into particularly good feed converters. “But that was only the case with about half of the test subjects,” write the researchers. Once again it shows that every human body reacts differently - what is advantageous for one has a negative effect on the other. That could explain why studies on the effects of sweeteners on weight are so inconsistent.

A final judgment on the subject of sweeteners, obesity and diabetes is still pending. The fact that sugary soft drinks should be consumed with caution, however, seems to be certain - regardless of the figure.

F. Imamura et al .: Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction, BMJ 2015; 351: h3576

M.Y. Pepino et al .: Sucralose affects glycaemic and hormonal responses to an oral glucose load. Diabetes Care 2013; DOI: 10.2337 / dc12-2221

Jotham Suez et al .: "Artificial sweeteners induce glucose intolerance by altering the gutmicrobiota", Nature, DOI: 10.1038 / nature13793

Swithers SE et al .: A role for sweet taste: calorie predictive relations in energy regulation by rats; Behav Neurosci. 2008 Feb; 122: 161-73. doi: 10.1037 / 0735-7044.122.1.161.

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