The consumption of diet soda was self-reported. People don’t always remember what or exactly how much they eat or drink, and sometimes they don’t tell the whole truth.

According to a new study from the American Heart Association and American Stroke Association, drinking diet soda is linked to an increased risk of stroke, heart disease and early death in older women. 

The research authors used the Women’s Health Initiative Observational Study, which tracked nearly 82,000 postmenopausal women over almost 12 years, to analyze the effects of diet drink consumption. Their research found that those who drank two or more diet drinks per day had a 23 percent increase in overall stroke risk compared to those who consumed a diet drink less than once a week. The association was stronger in obese women and black women.

It is unknown if the findings would apply to men or to younger women. However, previous studies have shown a link between diet beverages and stroke, dementia, Type 2 diabetes, obesity and metabolic syndrome. 

Although the findings may be a cause for concern, keep in mind that the latest study was an observational study and that association does not imply causation. In other words, this type of study cannot show whether the association between diet soda and stroke is caused by a specific artificial sweetener, a type of beverage or other hidden health issues. Although the study controlled for many risk factors, including blood pressure, smoking history, physical activity and age, it still failed to address several key points:

The diet soda drinkers may have been drinking diet soda because they already were struggling with weight issues, which would have put them at higher risk for stroke.

The consumption of diet soda was self-reported. People don’t always remember what or exactly how much they eat or drink, and sometimes they don’t tell the whole truth. These women were asked just one time how frequently they consumed diet beverages over a three-month period.

The study did not evaluate such factors such as whether the women were dieting or under stress. It also did not take into account their overall dietary pattern or whether they consumed other foods that contained artificial sweeteners.

These were postmenopausal women, who tend to be at an increased risk for vascular disease due to lacking the protective effects of natural hormones. 

The women did not identify which if the many different types of artificial sweeteners were in their diet sodas.

If the diet beverages were used to replace more nutritious drinks, such as milk or 100-percent fruit juice, then these women missed out on valuable nutrition, which may have been the real problem.

Regulatory bodies around the world have deemed low- and no-calorie artificial sweeteners safe. In 2018, Americans were expected to drink 12.2 billion gallons of carbonated sodas, with 3 billion gallons of that being diet soda, according to the Beverage Marketing Corporation. 

If you use artificial sweeteners to control your weight, you are on shaky ground. Some evidence suggests that artificial sweeteners make people crave sugary, high-calorie foods, negating the sweetener’s potential to cut overall calories. Plus, use of artificial sweeteners may cause you to find naturally sweet foods, such as fruit, less appealing and unsweet foods, such as vegetables, unpalatable. 

The Women’s Health Initiative Observational Study was a government-funded study. These tend to provide more credible data than do industry-funded studies, which tend to be biased. There is still a lot about artificial sweeteners that we don’t know, such as how they impact our gut microbes. We can’t assume that diet drinks and artificial sweeteners are completely harmless, especially when consumed in large amounts. Thousands of products use artificial sweeteners. In the history of food, artificial sweeteners are still a relatively new food product. More research, especially controlled studies, is needed to find out why these associations between artificial sweeteners and health issues keep popping up.

In the meantime, if you want to cut your intake of artificially sweetened beverages, try these healthy substitutes:

Infused water. Flavor your water with fruit, vegetables or herbs.

Sparkling water. This can satisfy a desire for carbonated beverages. Just read the label carefully to be sure the brand you choose doesn’t have artificial sweeteners.

Coffee. Whether caffeinated or caffeine-free, coffee can be a part of a healthy diet.

Unsweetened tea. Green, black or even flavored tea can help squelch the urge for a sweetened beverage. 

Anita Marlay, R.D., L.D., is a dietitian in the Cardiopulmonary Rehab department at Lake Regional Health System in Osage Beach.