I searched for this in the hope of enlightenment regarding diet soda and diet energies because with 2 cans a day I'm a high consumer and wanted to know my risks.
The 3 biggest concerns I found for me after doing a little research:
- An up to 3x times higher risk of ischemic strokes for those drinking more then 2 cans a day BUT already "adjusted" for "unhealthy" blood markers, BMI and diabetes etc. (doi:10.1161/STROKEAHA.116.016027 and doi:10.1161/STROKEAHA.118.023100)
- Artificial sweeteners have shown to change the gut microbiome in rats, in a way that "some" might have a higher ratio of bacteria that are transforming food into energy more efficiently.
- Artificial sweeteners Aspartame and Stevia have shown a higher insulinogenic index 120 min post lunch, so that might increase the risk of insulin resistanc and type 2 diabetes. (doi:10.1016/j.appet.2010.03.009)
If I read correctly it is assumed by the scientists evaluating the effect on the gut microbiome that this could be the reason why people using a lot of artificial sweeteners are getting fatter over time.
There are also studies showing that longtime consumers of artificial sweeteners having higher rates of metabolic syndrome then those not consuming artificial sweeteners which includes that these people are also fatter then non-consumers.
The paper evaluating a 3x times higher risk of strokes and dementia with y man and x woman was the most frightening for me because for me the data didn't show any significant difference regarding blood markers and other health values of those not consuming artificial sweeteners:
(doi:10.1161/STROKEAHA.116.016027)
For comparison: According to ChatGPT the hazard ratio for strokes from high blood pressure is about 1.5 - 2.0 and NO, I will not take time asking for these papers just to confirm it's the case, you can do that if you want.
There was another paper using data of the Women’s Health Initiative Observational Study with 81,714 female participants showing only a 1.3 higher risk of strokes for those consuming a lot of artificial sweeteners in comparison to those not consuming them. (doi:10.1161/STROKEAHA.118.023100)
But age is important here, as the papers focus on ages above 40, the incidence ratio rises with age, so to have a very high risk of a stroke from artificial sweeteners I assume you had to be over 50.
My guess is, that some "breakdown product" of Aspartam and/or Ace-K deposit in arteries in the brain, basically "plaque" that will lead to a stroke if they suddenly detach in a greater amounts.
If I would be a scientist searching on this, I would try to gather MRI scans of people having an especially high consumption of artificial sweeteners and compare "stroke markers" with those not consuming any sweeteners as well as using sugar sweetened beverages. If there is considerable more plaque for older high consumers of artificial sweeteners, I would then analyze the chemical composition of that plaque and see if they can be chemically explained with the most common artificial sweeteners.
Interestingly no link between stroke risk and consumption of sugar sweetened beverages were found.
To wrap it up: You can either choose diabetes (sugar) or a stroke (artificial sweetener).
The most realistic option would be to reduce the consumption of both as much as possible without going crazy and that seems to be the case for 2-3 diet cokes a week.
The occasional consumption of sugar-sweetened beverages and artificially sweetened beverages (1–5 servings/wk) was not associated with the incidence of metabolic syndrome in middle-aged and elderly individuals at high risk of CVD. The consumption of >5 servings/wk of all of the types of beverages analyzed was associated with an increased risk of metabolic syndrome and some of its components.
Frequent Consumption of Sugar- and Artificially Sweetened Beverages and Natural and Bottled Fruit Juices Is Associated with an Increased Risk of Metabolic Syndrome in a Mediterranean Population at High Cardiovascular Disease Risk
doi:10.3945/jn.116.230367
Diet Soda Intake Is Associated with Long-Term Increases in Waist Circumference in a Biethnic Cohort of Older Adults: The San Antonio Longitudinal Study of Aging
doi:10.1111/jgs.13376
The artificial sweetener acesulfame potassium affects the gut microbiome and body weight gain in CD-1 mice
doi:10.1371/journal.pone.0178426
At least daily consumption of diet soda was associated with a 36% greater relative risk of incident metabolic syndrome and a 67% greater relative risk of incident type 2 diabetes compared with nonconsumption (HR 1.36 [95% CI 1.11–1.66] for metabolic syndrome and 1.67 [1.27–2.20] for type 2 diabetes). Associations between diet soda consumption and type 2 diabetes were independent of baseline measures of adiposity or changes in these measures
Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)*
doi:10.2337/dc08-1799
A total of 12 studies (eight cross-sectional, four prospective cohort studies) with 56 244 participants were included in the review. Our pooled analysis found that soft drink intake is associated with metabolic syndrome ... sugar-sweetened beverage consumption (RR 1.46, 95% CI 1.18-1.91) ... artificially sweetened beverage consumption (RR 2.45; 95% CI 1.15-5.14; RR 1.32, 95% CI 1.21-1.44 ...)
Soft drink intake and the risk of metabolic syndrome: A systematic review and meta-analysis
doi:10.1111/ijcp.12927
A total of 66,118 women were followed from 1993, and 1369 incident cases of T2D ... Compared with nonconsumers, women in the highest quartiles of SSB and ASB consumers were at increased risk of T2D with HRs (95% CIs) of 1.34 (1.05, 1.71) and 2.21 (1.56, 3.14) for women who consumed .359 and .603 mL/wk of SSBs and ASBs, respectively
Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes in the Etude Epide´ miologique aupre` s des femmes de la Mutuelle Ge´ ne´rale de l’Education Nationale–European Prospective Investigation into Cancer and Nutrition cohort
doi:10.3945/ajcn.112.050997
There were seven aspartame consumers and seven acesulfame-K consumers. Three individuals overlapped groups, consuming both sweeteners. There were no differences in median bacterial abundance (class or order) across consumers and nonconsumers of either sweetener. Overall bacterial diversity was different across nonconsumers and consumers of aspartame (P < .01) and acesulfame-K (P ¼ .03).
High-intensity sweetener consumption and gut microbiome content and predicted gene function in a cross-sectional study of adults in the United States
doi:10.1016/j.annepidem.2015.06.083
In rats ... Aspartame consumption increased the fasting glucose concentrations in both the standard feed pellet diet and high-fat groups independent of body composition. To our knowledge, there are no data on the potential influences of aspartame on the human gut microbiome.
Within NNSs, only saccharin and sucralose shift the populations of gut microbiota. The ingestion of saccharin by animals and humans showed alterations in metabolic pathways linked to glucose tolerance and dysbiosis in humans.
Effects of Sweeteners on the Gut Microbiota: A Review of Experimental Studies and Clinical Trials
doi:10.1093/advances/nmy037
We studied 2888 participants aged over 45 for incident stroke (mean age 62 [SD, 9] years; 45% men) and 1484 participants aged over 60 for incident dementia (mean age 69 [SD, 6] years; 46% men).
When comparing daily cumulative intake to <1 per week (reference), the hazard ratios were 2.96 (95% CI, 1.26–6.97) for ischemic stroke and 2.89 (95% CI, 1.18–7.07) for AD. Sugar-sweetened beverages were not associated with stroke or dementia.
Model 3 adjusts for age, sex, total caloric intake, systolic blood pressure, treatment of hypertension, prevalent cardiovascular disease, atrial fibrillation, left ventricular hypertrophy, total cholesterol, high-density lipoprotein cholesterol, prevalent diabetes mellitus, and waist to hip ratio.
Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia: A Prospective Cohort Study
doi:10.1161/STROKEAHA.116.016027
The analytic cohort included 81,714 women from the Women’s Health Initiative Observational Study, a multicenter longitudinal study of the health of 93,676 postmenopausal women aged 50-79 yrs at baseline who enrolled in 1993-1998.
In women with no prior history of CVD or diabetes, high consumption of ASB was associated with more than a two-fold increased risk of small artery occlusion ischemic stroke HR=2.44, (95% CI: 1.47-4.04.) High consumption of ASBs was associated with significantly increased risk of ischemic stroke in women with BMI ≥ 30; HR= 2.03, (95% CI: 1.38-2.98).
Artificially Sweetened Beverages and Stroke, Coronary Heart Disease and All-Cause Mortality in the Women’s Health Initiative
doi:10.1161/STROKEAHA.118.023100
Higher all-cause mortality was found among participants who consumed 2 or more glasses per day (vs consumers of <1 glass per month) of total soft drinks (hazard ratio [HR], 1.17; 95% CI, 1.11-1.22; P < .001), sugar-sweetened soft drinks (HR, 1.08; 95% CI, 1.01-1.16; P = .004), and artificially sweetened soft drinks (HR, 1.26; 95% CI, 1.16-1.35; P < .001).
Association Between Soft Drink Consumption and Mortality in 10 European Countries
doi:10.1001/jamainternmed.2019.2478
The Atherosclerosis Risk in Communities (ARIC) study is a prospective cohort of 15,792 middle-aged (45–64 years), predominantly black and white men and women from four United States communities. 1.83-times (95% CI, 1.01 to 2.52) higher risk of End Stage Renal Disease after adjusting for age, sex, race-center, education level, smoking status, physical activity, total caloric intake, eGFR, body mass index category, diabetes, systolic BP, and serum uric acid (P value for trend ,0.001).
Diet Soda Consumption and Risk of Incident End Stage Renal Disease
doi:10.2215/CJN.03390316
Heavy artificial sweetener use (>1680 mg per day) leads to an increased relative risk of 1.3 for bladder cancer in humans. A more precise determination of the exact agents is not possible, because many artificial sweeteners are combined in current food products.
Artificial sweeteners—do they bear a carcinogenic risk?
doi:10.1093/annonc/mdh256
SUGAR SWEETENED BEVERAGE consumption (,1/mo, 1–4/mo, 2–6/wk, 1/d, and 2 servings/ d) were 1.0, 0.96 (0.87, 1.06), 1.04 (0.95, 1.14), 1.23 (1.06, 1.43), and 1.35 (1.07, 1.69) (P for trend , 0.001). Additional adjustment for body mass index, energy intake, and incident diabetes attenuated the associations, but they remained significant. Artificially sweetened beverages were not associated with CHD.
Sweetened beverage consumption and risk of coronary heart disease in women
doi:10.3945/ajcn.2008.27140
We sought to evaluate the relationship between incident MetSyn and dietary intake using prospective data from 9514 participants (age, 45 to 64 years) enrolled in the Atherosclerosis Risk in Communities (ARIC) study. After further adjustment for intake of meat, dairy, fruits and vegetables, refined grains, and whole grains, analysis of individual food groups revealed that meat (P(trend)<0.001), fried foods (P(trend)=0.02), and diet soda (P(trend)=< 0.001) also were adversely associated with incident MetSyn (metabolic syndrome), whereas dairy consumption (P(trend)=0.006) was beneficial.
Dietary intake and the development of the metabolic syndrome: the Atherosclerosis Risk in Communities study
doi:10.1161/CIRCULATIONAHA.107.716159
At 60 minutes post-lunch, there was a significant difference in the insulinogenic index, the ratio obtained by dividing increments of plasma insulin levels above fasting values by the relative net increase of plasma glucose levels (i.e., Δ insulin/Δ glucose at 30 minutes), between the aspartame and sucrose conditions (p < .05; see Figure 4).
Effects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels
doi:10.1016/j.appet.2010.03.009
https://www.healthline.com/nutrition/artificial-sweeteners-and-gut-bacteria
https://www.healthline.com/health/food-nutrition/is-phosphoric-acid-bad-for-me