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If you’re living with diabetes, you’ve probably made peace with cutting back on the strawberry margs on Taco Tuesdays, but what about those soda cravings? Do you really have to kick Diet Coke to the curb?

Unfortunately, research has shown that diet soda isn’t the harmless treat we once thought it was. As someone with diabetes, here’s everything you should know about your bubbly habit:

Diet soda, of course, has much less sugar and zero calories when compared to regular, sugary (and oh so delicious) soft drinks, technically making it a good alternative. You can even snag some popular choices that are delicious and totally sugar-free (e.g., Diet Coke, Diet A&W Root Beer).

But let’s be real, diet soda is not actually “good” for us — living with diabetes or not. It doesn’t contribute any nutritional value but could help control blood sugars if substituted for the sugar-laden type.

In fact, a new study that tracked 450,000 Europeans over 16 years found that heavy drinkers (more than 2 servings per day) of sugary sodas OR artificially sweetened beverages were more likely to die prematurely than those who hardly ever consumed sodas.

Those who gulped down two or more glasses of regularly sweetened (sugary) soft drinks per day had a higher chance of dying from gut disorders, while those who drank the same number of diet drinks had a higher chance of dying from heart disease.

The authors did point out that those who consumed more soda were more likely to be current smokers and that participants who were overweight may have switched to sugar-free soda to help control weight. (Perhaps the non-soda crowd was including other beverages like milk or juice that contributed important nutrients?)

This is just one study, so we’re not going to tell you to never touch soda again. Instead, you might try subbing out some of your daily soda for one of the following diabetes-friendly beverages:

  • water (plain or sugar-free flavored versions)
    • Bonus: If you can down enough daily water (9 cups a day for women and 13 cups for men is suggested), it can help your body get rid of extra glucose (simple sugar) through your urine. Ew, but helpful.
  • sugar-free sparkling water (e.g., LaCroix)
  • coffee
  • hot tea or iced tea
  • low-sugar cranberry juice cocktail (e.g., Diet Ocean Spray)
  • low-sugar juice drinks (e.g., Diet V8 Splash)

Studies on the impact of artificial sweeteners on blood glucose levels and insulin levels can produce some conflicting headlines.

In short, cracking open a can of diet soda won’t directly raise your blood sugar levels. However, certain artificial sweeteners can have a long-term impact. (More on that below).

Here are some of the most common no calorie sweeteners:

  • sucralose cyclamate
  • aspartame
  • saccharin
  • acesulfame-k

Not all diet sodas are created equal. The type of sweetener used can take a soda from OK to Noooope.

The concerning thing for people with diabetes is, some artificial sweeteners have been accused of messing with the balance of healthy bacteria in the gut, which might in turn affect appetite hormones and insulin sensitivity.

Sucralose: One study exposed this sweetener for its potential to raise blood sugar when carbs are consumed later on. Despite having minimal calories (2 calories as compared with sugar at 14 calories), sucralose caused a spike in insulin levels in subjects who did not regularly consume sucralose.

But the study only involved 17 subjects and the study authors admit that most of the studies conducted in humans do not show changes in blood glucose, insulin or other gut hormone levels. (And just an FYI, her brand name is Splenda.)

Acesulfame-k: This common sweetener has been linked to bacteria changes in the gut and weight gain in mice. It’s worth noting these results were found inanimal studies and those same metabolic results are not seen in human subjects. This guy masquerades as Sunnett or Sweet One — yep, that Sweet One.

But it’s not all bad news!

Stevia: Extracted from the leaves of stevia plants, it’s a safe, incredibly sweet, no-calorie alternative to sugar.

It’s been used as a sweetener by our South American neighbors for over 200 years. Whew! Stevia may even have a positive effect on insulin or glucose levels as it’s broken down in the gut and then rapidly eliminated from the body.

Erythritol: The corn-based sweetener (lower in calories but mighty in flavor) does not increase blood sugar or insulin levels. It’s 60–80 percent as sweet as sugar. More than 90 percent of it is not metabolized by humans and makes a graceful, unchanged exit via your pee. Get this, it’s even been shown to be protective for people with diabetes.

The recent news about risks associated with diet soda has been bouncing around all over the place. So, it’s understandable if you’re feeling a little freaked out.

The truth is, experts have yet to determine if drinks brimming with artificial sweeteners are indeed the culprits, or if it’s simply that those who load up on sweet diet drinks tend to live a less than healthy lifestyle overall, leading to premature death.

Many of these studies show an association but cannot conclude a cause and effect relationship.

  • In observational studies, diet soda has been associated with increased risk of obesity. (OR were the obese subjects drinking more diet soda to cut down on sugary versions?)
  • Preliminary research has linked diet soda with a higher risk of type 2 diabetes. (OR were subjects with prediabetes replacing sugary beverages with diet soda to stave off diabetes?)
  • In one study, those who consumed more than seven glasses of diet soda per week had almost twofold the risk of developing kidney disease. (OR did these subjects rarely drink some good ole H2O?)

Unfortunately, increased mortality rates aren’t the only bad news surfacing from diet soda studies.

A 2018 study found that people with diabetes who consumed more than 4 cans of diet soda per week were two times more likely to develop a diabetes complication called proliferative diabetic retinopathy (vision impairment issues and even blindness).

But if you read the entire study, the authors reported that those with increased risk of retinopathy were those with type 1 diabetes, had a greater BMI, 55 percent were current smokers, had elevated blood fat levels, and high blood pressure… which can all contribute to the development of eye disease.

When authors adjusted the results for variables such as A1c levels (an indicator of blood glucose control), age, gender, smoking, etc., there was no difference in eye disease between the diet soda drinkers and the non-consumers except those with the highest consumption.

So, everything in moderation — even no calorie soda — is still a good motto to live by.

Now for the good stuff. If you’re not ready to say goodbye to diet soda, here are some good varieties to reach for:

  • Virgil’s Zero Sodas. Maybe you’re already familiar with Virgil’s, but did you know they have a line of sodas that come free of artificial sweeteners, carbs, calories, and caffeine? They sweeten these guys using a mix of natural sweeteners like stevia and erythritol. As an added bonus, they’re also Keto-friendly, if you’re into that. There’s a slew of zesty flavors so you’ll rarely get bored.
  • ZEVIA. Gluten-free and vegan-friendly, this trendy soda company is serving you low-cal beverages that come free of artificial sweeteners like aspartame. They also have a ton of different flavors to try.
  • Certain Coke products like Coca-Cola Life, Vitaminwater zero, and Fuze Meyer Lemon Black Tea all sweeten using stevia. The last two might not be diet sodas, but they’re livelier than water and can give you more peace of mind than your typical can of diet.

And if you MUST drink mainstream diet, try these. They have aspartame, but are free of other artificial sweeteners:

  • Diet Coke
  • Fanta Zero
  • Diet Barq’s Root Beer
  • Sprite Zero
  • Pepsi Zero
  • Diet A&W Root Beer

tl;dr

  • An occasional diet soda is fine in the short-term.
  • Excessive consumption of regular or diet soda can be associated with health risks.
  • Check out fun diet soda options that use natural sweeteners.
  • Per usual, moderation is king.
  • Remember, always check in with your healthcare provider before making any changes to your diet.