The article should have begun with "What they found was a rather modest increase in cardiovascular events among those who consumed artificial sweeteners. Indeed, it barely reached statistical significance for the composite measure:" At that point the article should have ended before the good doctor damned Diet Coke because he didn't like the taste. The article is mostly piffle.
The taste is bad. Objectively. Like alcohol. Until it is acquired. His point is that it is rational to choose to consume unhealthy substances if they taste good. Choosing to acquire a taste for health-neutral substances because they are "healthy" ... less rationale.
(If the doctor had said .. these are delicious but very bad for you ... that is when I would have ended the article so I could go out and stock up on them while they are still legal).
I certainly say agree with your view on refined sugar and starch: it’s important that medical professionals can be honest about how unnecessary and often harmful so many of these foods are when consumed regularly in the diet.
I’m less certain about the impact of artificial sweeteners. Without a doubt swapping refined sugar for sweeteners lowers both the total calories and amount of refined sugars in the diet, which is of plausible benefit.
In contrast, any negative health effects of artificial sweeteners is largely speculative. None of the basic research studies demonstrate a definitive mechanism. And the data in these associative epidemiology studies is simply not that convincing.
Whereas the main findings of this paper refer to just one of those primary endpoints (“CVD”), and the selection of artificial sweeteners is not even included in the trial protocol (because they collected data on many different foods).
Statistically this type of study design is largely a “fishing expedition” which is prone to produce a lot of random “statistically significant” effects. I just don’t see how you can get around the multiple comparisons issue when the authors can mine such a vast data set and there are literally thousands of possible comparisons that are eligible and there is no one policing how they are adjusting for this statistically.
So artificial sweeteners might be a problem, but I don’t currently see a plausible reason why they are worse than straight up pure sugar. And, it doesn’t really matter how many epidemiology studies people publish, the data simply point to the reason why we use RCTs in the first place: the ability to differentiate random effects from real ones.
'I’m less certain about the impact of artificial sweeteners. Without a doubt swapping refined sugar for sweeteners lowers both the total calories and amount of refined sugars in the diet, which is of plausible benefit.'
I think that's an important point. Whatever the doctor's opinion on the matter, I think unsweetened coffee is an abomination, but where I used to dump sugar into my morning cups, now I dump Splenda.
I suspect I'm better off. The choice isn't between artificial sweeteners and nothing; it's between artificial sweeteners and sugar in some form.
Then too, other effects aside, there's the matter of calories; I could stand to lose some weight, and using Splenda in my coffee removes a good 100-200 calories a day from my diet.
At this point, I ignore epidemiological findings unless they're compelling on their face. Like smokers = 20x more lung cancer vs. non-smokers. Or that 80-year-olds die of Covid 1,000x more frequently than toddlers.
1.09 increased relative risk on an epidemiological survey.,...just doesn't move the needle for me. I'm sure you're familiar with the Ioannides paper that showed pretty much every ingredient in popular cookbooks is "associated" with one type of cancer or another? That's how I filter these kinds of results.
To talk out of the other side of my mouth for a moment: who needs research to tell them Diet Coke probably isn't awesome?
The problems with this study are numerous, the lack of any sort of control group actually throws any sort of generalizing conclusions of this study into serious doubt, when you don't know the baseline incidence of the measured cardiac and brain incidents among the target group, makes any conclusion of any sort of causal inference impossible, unreliable and inaccurate. The next problem is the self-report of the amount of artificial sweetener that the people ingested per time point. This is the biggest potential bias in these kinds of epidemiology studies. The problems with inaccurate and biased memories and social desirable responses are very serious. Combine this with the statistical fishing expedition that these multivariate study designs tend to be, and I would not call this study a strong one. This is just the typical problematic study design that has proved why double-blind trials are so important (as Zach has also stated in the comment section). And a change in the microbiome, any kind of ingested food or change in the diet changes the microbiome, and without knowing if these changes are an actual problem, it means nothing of importance. Without any actual double-blind trials of sufficient statistical power and time, I would not trust any of the conclusions based on a body of evidence that is just a sand castle that is waiting to dry up and become loose sand. These kinds of studies have incited numerous justified critiques over the years and is why nutrition science is not trusted and is the social psychology of the medical sciences when it comes to unreliable and irreproducible results (and I think considering the improvements in social psychology over the years, that social psych is even better off).
Nice try! Pretty clever: artificial sweeteners. I saw a similar article blaming cardiac issues in young people on herbal supplements. How about being honest? The most significant event in Americans’ lives in the last two plume years is Covid, and more specially, the mRNA jab that over two thirds of America has undergone. The published data is clear: the vaccines are strongly implicated in myocarditis, pericarditis, strokes, heart attacks, and death. Stop doing PR work for Big Pharma.
I did exactly that, weaned myself off, after I hit 40 and my weight ballooned from 140-ish to 170, just as my parents had warned me. I still have a rare sugar treat, maybe 3 to 5 times a year.
I find that a half packet of saccharin boosts the sweetness of sugar quite a lot without leaving the saccharine aftertaste, so that might be an avenue to pursue. I don't know if the sweetness sensation ends up causing insulin resistance, but that's possible.
The article should have begun with "What they found was a rather modest increase in cardiovascular events among those who consumed artificial sweeteners. Indeed, it barely reached statistical significance for the composite measure:" At that point the article should have ended before the good doctor damned Diet Coke because he didn't like the taste. The article is mostly piffle.
No, that would be a stupid and intellectually dishonest approach toward writing the article.
The taste is bad. Objectively. Like alcohol. Until it is acquired. His point is that it is rational to choose to consume unhealthy substances if they taste good. Choosing to acquire a taste for health-neutral substances because they are "healthy" ... less rationale.
(If the doctor had said .. these are delicious but very bad for you ... that is when I would have ended the article so I could go out and stock up on them while they are still legal).
This comment makes even less sense than the one from Wayner.
I certainly say agree with your view on refined sugar and starch: it’s important that medical professionals can be honest about how unnecessary and often harmful so many of these foods are when consumed regularly in the diet.
I’m less certain about the impact of artificial sweeteners. Without a doubt swapping refined sugar for sweeteners lowers both the total calories and amount of refined sugars in the diet, which is of plausible benefit.
In contrast, any negative health effects of artificial sweeteners is largely speculative. None of the basic research studies demonstrate a definitive mechanism. And the data in these associative epidemiology studies is simply not that convincing.
Take this study for instance. The trial protocol lists 16 (sixteen!) different primary endpoints: https://clinicaltrials.gov/ct2/show/NCT03335644
Whereas the main findings of this paper refer to just one of those primary endpoints (“CVD”), and the selection of artificial sweeteners is not even included in the trial protocol (because they collected data on many different foods).
Statistically this type of study design is largely a “fishing expedition” which is prone to produce a lot of random “statistically significant” effects. I just don’t see how you can get around the multiple comparisons issue when the authors can mine such a vast data set and there are literally thousands of possible comparisons that are eligible and there is no one policing how they are adjusting for this statistically.
So artificial sweeteners might be a problem, but I don’t currently see a plausible reason why they are worse than straight up pure sugar. And, it doesn’t really matter how many epidemiology studies people publish, the data simply point to the reason why we use RCTs in the first place: the ability to differentiate random effects from real ones.
'I’m less certain about the impact of artificial sweeteners. Without a doubt swapping refined sugar for sweeteners lowers both the total calories and amount of refined sugars in the diet, which is of plausible benefit.'
I think that's an important point. Whatever the doctor's opinion on the matter, I think unsweetened coffee is an abomination, but where I used to dump sugar into my morning cups, now I dump Splenda.
I suspect I'm better off. The choice isn't between artificial sweeteners and nothing; it's between artificial sweeteners and sugar in some form.
Then too, other effects aside, there's the matter of calories; I could stand to lose some weight, and using Splenda in my coffee removes a good 100-200 calories a day from my diet.
At this point, I ignore epidemiological findings unless they're compelling on their face. Like smokers = 20x more lung cancer vs. non-smokers. Or that 80-year-olds die of Covid 1,000x more frequently than toddlers.
1.09 increased relative risk on an epidemiological survey.,...just doesn't move the needle for me. I'm sure you're familiar with the Ioannides paper that showed pretty much every ingredient in popular cookbooks is "associated" with one type of cancer or another? That's how I filter these kinds of results.
To talk out of the other side of my mouth for a moment: who needs research to tell them Diet Coke probably isn't awesome?
Perfect statistical conclusions. I always figured 10x as statistically significant for disease projections.
The problems with this study are numerous, the lack of any sort of control group actually throws any sort of generalizing conclusions of this study into serious doubt, when you don't know the baseline incidence of the measured cardiac and brain incidents among the target group, makes any conclusion of any sort of causal inference impossible, unreliable and inaccurate. The next problem is the self-report of the amount of artificial sweetener that the people ingested per time point. This is the biggest potential bias in these kinds of epidemiology studies. The problems with inaccurate and biased memories and social desirable responses are very serious. Combine this with the statistical fishing expedition that these multivariate study designs tend to be, and I would not call this study a strong one. This is just the typical problematic study design that has proved why double-blind trials are so important (as Zach has also stated in the comment section). And a change in the microbiome, any kind of ingested food or change in the diet changes the microbiome, and without knowing if these changes are an actual problem, it means nothing of importance. Without any actual double-blind trials of sufficient statistical power and time, I would not trust any of the conclusions based on a body of evidence that is just a sand castle that is waiting to dry up and become loose sand. These kinds of studies have incited numerous justified critiques over the years and is why nutrition science is not trusted and is the social psychology of the medical sciences when it comes to unreliable and irreproducible results (and I think considering the improvements in social psychology over the years, that social psych is even better off).
Nice try! Pretty clever: artificial sweeteners. I saw a similar article blaming cardiac issues in young people on herbal supplements. How about being honest? The most significant event in Americans’ lives in the last two plume years is Covid, and more specially, the mRNA jab that over two thirds of America has undergone. The published data is clear: the vaccines are strongly implicated in myocarditis, pericarditis, strokes, heart attacks, and death. Stop doing PR work for Big Pharma.
Correlation is not causation.
The doc needs to go back to school and study statistics and clinical study design.
People may choose an artificial sweetner because of other health concerns - so the underlying health problem could be a factor.
Sugar has to be much worse than any substitute, due to diabetes.
I don't have diabetes. Do you? I stick to high fructose corn syrup.
Should have scanned for all diseases, especially cancers.
I did exactly that, weaned myself off, after I hit 40 and my weight ballooned from 140-ish to 170, just as my parents had warned me. I still have a rare sugar treat, maybe 3 to 5 times a year.
I find that a half packet of saccharin boosts the sweetness of sugar quite a lot without leaving the saccharine aftertaste, so that might be an avenue to pursue. I don't know if the sweetness sensation ends up causing insulin resistance, but that's possible.