Aspartame?

[Apparition]

What's the deal? Everyone drinks diet coke but how good is it for you?
FDA approved it (as it did Bextra and Vioxx) but a lot of people complain of side effects when they drink it that go away when they stop or switch to regular coke. It seems everyday, there's new study coming out about some drug or food only to be contradicted a week later. Many of these studies are funded by corporations. Is there any source we can believe since private companies are out only to make money and FDA unreliable? The increase in some previously rare diseases makes one wonder...

And what's up with fruit that stays in perfect shape after several weeks? Aren't all natural things supposed to rot? No, I didn't just land from Mars. I know that virtually everything is processed. But where does it stop? It sucks that scientists and physicians are working so hard to fight disease when other people create it.

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[velo]

What's the deal? Everyone drinks diet coke but how good is it for you?
FDA approved it (as it did Bextra and Vioxx) but a lot of people complain of side effects when they drink it that go away when they stop or switch to regular coke. It seems everyday, there's new study coming out about some drug or food only to be contradicted a week later. Many of these studies are funded by corporations. Is there any source we can believe since private companies are out only to make money and FDA unreliable? The increase in some previously rare diseases makes one wonder...

Is pubmed really so hard to use?

here's the summery of a review article

"In this report the neurotoxicity of aspartame and its constituent amino acids aspartic acid and phenylalanine is reviewed. The adverse reactions ascribed to the consumption of aspartame-containing products, as reported in the U.S.A., are discussed and placed in perspective with the results of recent behavioural studies in humans and animals. The issue of common intake levels associated with proposed uses of aspartame is addressed. In brief, the following conclusions can be drawn: When aspartame is consumed at levels within the ADI-limit of 40 mg/kg body wt, there is no significant risk for an aspartate-induced neurotoxic effect in the brain. When aspartame is consumed at levels within the ADI-limit by normal subjects or persons heterozygous for phenylketonuria (PKU) the resultant plasma phenylalanine concentrations are practically always within the normal postprandial range; elevation to plasma concentrations commonly associated with adverse effects has not been observed. Persons suffering from phenylketonuria (PKU-homozygotes) on a phenylalanine-restricted diet should avoid consumption of aspartame. PKU-homozygotes on the (less strict) phenylalanine-liberalized diet should be made aware of the phenylalanine content of aspartame. In the available behavioural studies in humans with acute dosing, no adverse effects were observed. Long-term studies on behaviour and cognitive function in (sensitive) humans are lacking. Analyses of adverse reaction reports made by consumers in the U.S.A. have not yielded a specific constellation of symptoms clearly related to aspartame that would suggest a widespread public health hazard associated with aspartame use. Focussed clinical studies are now being carried out in the U.S.A.; the results should provide additional evidence concerning the interpretation of the reports on adverse reactions ascribed to aspartame. In the regulation of admitted uses for aspartame the possibility of intake levels exceeding the ADI-limit in some groups of consumers should be a point of attention."
http://www.ncbi.nlm.nih.gov/entrez/...t_uids=3291200&query_hl=1&itool=pubmed_DocSum

 

[Pontifex Maximus]

Its fine. Much ado about nothing.

 

[Keg]

Sweet-N-Low (saccharin) and Splenda (polychlorinated benzene rings) though, at least according to my toxicology teacher, are bad for you. So, according to him, stick with aspartame (Equal).

 

[Brickhouse]

everyone dies of something, why not diet coke?

 

[MEG@COOL]

everyone dies of something, why not diet coke?

Why not? Because life is too precious to forfeit to a can of soda. Your cavalier attitude towards life is unreal!!!! Gotta go smoke a cig now to calm my nerves.

 

[Rafa]

Screw sugar substitutes. I go with the real thing.

 

[Krazykritter]

First of all, Splenda is made of a sugar (dextrose) derived substance that is not absorbed across the mucosa and therefore is supposed to be the safest of all alternatives b/c you get the flavor w/out any byproducts.

Second, aspartame in normal quantities should also be safe unless you have PKU.

 

[Saluki]

The danger to you from aspartame is not well-established at all, as my friend with the pubmed article already pointed out. However, the dangers that sugary sodas provide to your teeth are well-known... I'd rather die a little bit younger, but not be wearing dentures...

 

[JimmyG]

The danger to you from aspartame is not well-established at all, as my friend with the pubmed article already pointed out. However, the dangers that sugary sodas provide to your teeth are well-known... I'd rather die a little bit younger, but not be wearing dentures...

Oh, this reminds me of my 5th grade science project...

Creepily, my mother had kept a lot of my baby teeth so I decided to soak the suckers in jars of coke, diet coke, sprite, etc. etc.... for maybe a month?? (5th grade was awhile back...)

I just remember pulling out that dark, icky brown tooth from the coke to this day...

 

[IAMS]

Ugh, I tried some low-carb icecream (sweetened with splenda). That stuff if horrble. It tore up my stomach, gave me the most horrific gas, and I couldn't sit right for a few days...

Didn't they once say Nutrasweet was safe before they found out it was carcinogenic?

 

[Apparition]

Is pubmed really so hard to use?

here's the summery of a review article

"In this report the neurotoxicity of aspartame and its constituent amino acids aspartic acid and phenylalanine is reviewed. The adverse reactions ascribed to the consumption of aspartame-containing products, as reported in the U.S.A., are discussed and placed in perspective with the results of recent behavioural studies in humans and animals. The issue of common intake levels associated with proposed uses of aspartame is addressed. In brief, the following conclusions can be drawn: When aspartame is consumed at levels within the ADI-limit of 40 mg/kg body wt, there is no significant risk for an aspartate-induced neurotoxic effect in the brain. When aspartame is consumed at levels within the ADI-limit by normal subjects or persons heterozygous for phenylketonuria (PKU) the resultant plasma phenylalanine concentrations are practically always within the normal postprandial range; elevation to plasma concentrations commonly associated with adverse effects has not been observed. Persons suffering from phenylketonuria (PKU-homozygotes) on a phenylalanine-restricted diet should avoid consumption of aspartame. PKU-homozygotes on the (less strict) phenylalanine-liberalized diet should be made aware of the phenylalanine content of aspartame. In the available behavioural studies in humans with acute dosing, no adverse effects were observed. Long-term studies on behaviour and cognitive function in (sensitive) humans are lacking. Analyses of adverse reaction reports made by consumers in the U.S.A. have not yielded a specific constellation of symptoms clearly related to aspartame that would suggest a widespread public health hazard associated with aspartame use. Focussed clinical studies are now being carried out in the U.S.A.; the results should provide additional evidence concerning the interpretation of the reports on adverse reactions ascribed to aspartame. In the regulation of admitted uses for aspartame the possibility of intake levels exceeding the ADI-limit in some groups of consumers should be a point of attention."
http://www.ncbi.nlm.nih.gov/entrez/...t_uids=3291200&query_hl=1&itool=pubmed_DocSum

I'm aware of this research but I've encountered a lot of people who experience adverse effects after consuming diet coke. Not talking about death, just feeling bad after drinking. Things are pulled off the market all the time after initial research proves them harmless. I drink mostly coffee and red bull for energy. Diet coke, when I drink more than a can, has a strange effect on me. That's why I looked it up.

 

[TracksuitsRock]

Oh, this reminds me of my 5th grade science project...

Creepily, my mother had kept a lot of my baby teeth so I decided to soak the suckers in jars of coke, diet coke, sprite, etc. etc.... for maybe a month?? (5th grade was awhile back...)

I just remember pulling out that dark, icky brown tooth from the coke to this day...

This is the literally the best story ever (don't you think indo?)
But seriously it's hilarious
and so gross!!!

 

[thatguyagain]

.

 

[velo]

I'm aware of this research but I've encountered a lot of people who experience adverse effects after consuming diet coke. Not talking about death, just feeling bad after drinking. Things are pulled off the market all the time after initial research proves them harmless. I drink mostly coffee and red bull for energy. Diet coke, when I drink more than a can, has a strange effect on me. That's why I looked it up.

yeah those are called anecdotal examples. People "feel bad" all the time and they attribute it to all sorts of things--sometimes they're right, sometimes not. If you're going to be a physician you need to learn to form opinions based on the strongest available evidence, the risk/benifit, and not fickle media reports and anecdotes. In this case the current evidence indicates that there is no proven risk in normal healthy people consuming aspartame. We should temper this position with the knowledge that long-term cognitive studies are lacking and results of additional focused clinical studies are pending--however artificial sweeteners have been around for a while and to date there is no good evidence of adverse reactions associated with them.

We do, on the other hand, have good evidence for the risk associated with consuming pounds of refined sugar. Do you know how much 40g of sugar is? Measure it out sometime, its amazing they can even get that much to stay in solution in a 12oz can. Obesity, diabetes, vascular disease...when patients come in saying they drink 2liters of mountain dew a day I have no reservations about suggesting they switch to diet.

 

[slmsmith]

Sweet-N-Low (saccharin) and Splenda (polychlorinated benzene rings) though, at least according to my toxicology teacher, are bad for you. So, according to him, stick with aspartame (Equal).

actually, the cancer warning labels were recently (past 2 years or so) removed from the saccharin packages. it was discovered that saccharin was not carcinogenic and that the original studies regarding its safety were flawed. so it seems it might be safe after all. although, i think that sugar consumed in moderation is probably the safest option for the non-diabetic population.

as for aspartame, i really think that the jury is still out on this one. the posted pubmed abstract doesn't account for a lot of other studies that report that aspartame is related to memory loss, headaches, agressive behavior, etc. in humans and teratogenicity in rodents. also, research indicates that aspartame, when heated to high temperatures, can convert to formaldehyde and dkp. again, it's hard to say how safe any of these sugar substitutes really are...

 

[Apparition]

If you're going to be a physician you need to learn to form opinions based on the strongest available evidence, the risk/benifit, and not fickle media reports and anecdotes.

Then there's always the rare physician/researcher who notices something others don't, and changes the facts. I think it's important to listen to anecdotes.

 

[Apparition]

We do, on the other hand, have good evidence for the risk associated with consuming pounds of refined sugar. Do you know how much 40g of sugar is? Measure it out sometime, its amazing they can even get that much to stay in solution in a 12oz can. Obesity, diabetes, vascular disease...when patients come in saying they drink 2liters of mountain dew a day I have no reservations about suggesting they switch to diet.

Yet these foods that contribute to much of heart disease are approved by FDA.

 

[velo]

Then there's always the rare physician/researcher who notices something others don't, and changes the facts. I think it's important to listen to anecdotes.

After reviewing the evidence, identifying real areas of possible controversey, and proving themselves right experimentally with well designed studies--yes. After chasing anecdotes of mild, non-specific, "adverse reactions" in a substance that is widely used by the general population--no.

It's important to be critical and vigilant--but there is a fine line between an appropriate degree of suspician and irrational mistrust. You can play this game with ANYTHING, (the studies show its safe but is it really?) but at the end of the day you need to have a position. When patients ask you "is diet soda safe?" you need to give an answer and even though they won't ask about the evidence supporting your position, they trust you and you have a professional obligation to be providing an informed opinion. I looked around the literature again and the evidence I see shows it to be safe in the general population--I havn't seen anyone present anything to contradict that.

If you go with the weight of the evidence you'll be right 99/100 times. If you look at the weight of the evidence and also consider conflicting studies with an appropriate degree of suspicion you'll be right 999/1000 times. If, as you're doing, you bet that "this time" will be that 1 time out of 1000 without any real evidence to support you then you're just a conspiracy theorist...and you're wrong 999/1000.

 

[velo]

Yet these foods that contribute to much of heart disease are approved by FDA.

You now don't trust the FDA because they approved sugar?

Are you familiar with the expression "the dose makes the poison"? The FDA approved aspartame with an acceptable daily intake (ADI) of 50mg/kg. At this level aspartame has repeatedly been shown to be safe. Studies also show that even the 90th percentile of aspartame consumers in the USA do not exceed 10mg/kg.

Now you claim that the FDA is not to be trusted because they approve of simple carbohydrates--one of the bodies principle sources of energy--which in excess can cause obseity, diabetes, CAD, etc etc. sigh. Ask yourself this question--the FDA approves aspartame, sugar, and aspirin to name a few things. Does the FDA approve of people eating enough sugar to cause chronic disease? Taking a whole bottle of aspirin? Taking in 1000mg/kg aspartame?

mull that one over big guy

 

[cardsurgguy]

people give me a hard time about aspartame all the time since I drink an extremely high volume of diet soda (we're talking really high here, to the point of an equivalent amount greater than a dozen cans per day)

To the OP: You cite anectodal (sp?) evidence by saying others and yourself have experienced negative effects about aspartamse
As I'm sure you know, anectodal evidence is horrible evidence, since it's so unreliable
For example, placebo effect: if someone may already be skeptical about anything not from the Earth b/c they are one of these natural people, then they will probably have a higher chance of reporting negative feelings after diet soda

I don't feel any negative feelings after diet soda. And remember, I drink a HUGE amount. One person says one thing, another says another. It doesn't mean a thing.

As others have said, the scientific data says there is no significant risk
I've researched this intensely to have rebuttals b/c people give me so much crap over this

As for people who say that aspartame eventually splits up in the body and methanol is produced (which could be a concern since methanol is toxic), studies mostly show that the increase in serum methanol concentration is negligible
Have you had a glass of orange juice today? If so, you've just given your body more methanol than, if I remember correctly, over 50 times that amount of diet soda according to one study in particular.

Also, as for aspartame and cancer. The links that have been found between the two have been found injected rats with concentrations of aspartame that are so far beyond what is physiologically possible for a human to consume. It would be the equivalent of a human being drinking a swimming pool of diet soda every day.
Simply stupid to draw a conclusion from this because ANYTHING in high enough concentrations is fatal. Most vitamins which are great for health will kill you in high enough concentrations.


I would argue aspartame can be of public health benefit and should be encouraged to be drunk.
Many studies show aspartame is an appetite suppressant. One study posed an interesting question, imagine if aspartame consumption causes a mere 4-5% decline in total calories consumed per day by the average person.

Can you imagine the health benefits for the population this would have!! The biggest problem is obesity in our country by far. A 4-5% decrease in calories ingested per day would be amazing for the health of our population. That alone would probably cause a huge decline in the amount of chronic diseases.

It's about time we stop wasting time worrying about aspartame and stop giving people who drink a lot of diet soda a hard time...


Case in point
(this is absolutely HILARIOUS and illustrates how RIDICULOUS people are with aspartame)

At one of my jobs this past summer, a woman saw me with a whole bunch of diet soda bottles in a plastic bag after a full day of work.

Remember, I said I drink an ungodly amount of diet soda, so she, as is usually the case when people first see how much I drink, reacted with utter shock and horror at how much I drink.

She preceded to tell me I shouldn't drink so much. Aspartame isn't natural, who knows what it does to you, bla bla bla

She knows somebody who is a biochemist PhD who told her that he doesn't allow aspartame in his house since he thinks its bad for you.

She kept telling me it was a health risk...


Oh yeah, let me mention one more thing...

This woman was about 5'5"-5'6" and I would guess a little over 300 lbs!!!!!!!!!!!

AND SHE IS GIVING ME A HARD TIME ABOUT ASPARTAME!!!!

I'm still amazed at this...

 

[tigress]

I still drink diet soda, but not very often. Most of the research I've read doesn't show any problems with it (as the review article abstract posted says). For one thing, in order to reach the ADI-limit of 40 mg/kg body weight you'd have to drink something like 60 cans of soda in one sitting.

Anyway, there is some interesting research out there. Here's one abstract:

Synergistic Interactions Between Commonly Used Food Additives in a Developmental Neurotoxicity Test.

Lau K, McLean WG, Williams DP, Howard CV.

Developmental Toxicopathology Unit, Department of Human Anatomy & Cell Biology, University of Liverpool, Sherrington Buildings, Liverpool L69 3GE, UK; Department of Pharmacology & Therapeutics, University of Liverpool, Sherrington Buildings, Liverpool L69 3GE, UK.

Exposure to non-nutritional food additives during the critical development window has been implicated in the induction and severity of behavioural disorders such as attention deficit hyperactivity disorder (ADHD). Although the use of single food additives at their regulated concentrations is believed to be relatively safe in terms of neuronal development, their combined effects remain unclear. We therefore examined the neurotoxic effects of four common food additives in combinations of two (Brilliant Blue and L-glutamic acid, Quinoline Yellow and aspartame) to assess potential interactions. Mouse NB2a neuroblastoma cells were induced to differentiate and grow neurites in the presence of additives. After 24 h, cells were fixed and stained and neurite length measured by light microscopy with computerised image analysis. Neurotoxicity was measured as an inhibition of neurite outgrowth. Two independent models were used to analyse combination effects: effect additivity and dose additivity. Significant synergy was observed between combinations of Brilliant Blue with L-glutamic acid, and Quinoline Yellow with aspartame, in both models. Involvement of N-methyl-D-aspartate (NMDA) receptors in food additive-induced neurite inhibition was assessed with a NMDA antagonist, CNS-1102. L-glutamic acid- and aspartame-induced neurotoxicity was reduced in the presence of CNS-1102; however the antagonist did not prevent food colour-induced neurotoxicity. Theoretical exposure to additives was calculated based on analysis of content in foodstuff, and estimated percentage absorption from the gut. Inhibition of neurite outgrowth was found at concentrations of additives theoretically achievable in plasma by ingestion of a typical snack and drink. In addition, Trypan Blue dye exclusion was used to evaluate the cellular toxicity of food additives on cell viability of NB2a cells; both combinations had a straightforward additive effect on cytotoxicity. These data have implications for the cellular effects of common chemical entities ingested individually and in combination.

I'm not sure that really means anything in vivo, but it's worth thinking about I guess. Here's another:

The effect of aspartame metabolites on human erythrocyte membrane acetylcholinesterase activity.

Tsakiris S, Giannoulia-Karantana A, Simintzi I, Schulpis KH.

Department of Experimental Physiology, Medical School, University of Athens, Greece. [email protected]

Studies have implicated aspartame (ASP) with neurological problems. The aim of this study was to evaluate acetylcholinesterase (AChE) activity in human erythrocyte membranes after incubation with the sum of ASP metabolites, phenylalanine (Phe), methanol (met) and aspartic acid (aspt), or with each one separately. Erythrocyte membranes were obtained from 12 healthy individuals and were incubated with ASP hydrolysis products for 1 h at 37 degrees C. AChE was measured spectrophotometrically. Incubation of membranes with ASP metabolites corresponding with 34 mg/kg, 150 mg/kg or 200 mg/kg of ASP consumption resulted in an enzyme activity reduction by -33%, -41%, and -57%, respectively. Met concentrations 0.14 mM, 0.60 mM, and 0.80 mM decreased the enzyme activity by -20%, -32% or -40%, respectively. Aspt concentrations 2.80 mM, 7.60 mM or 10.0 mM inhibited membrane AChE activity by -20%, -35%, and -47%, respectively. Phe concentrations 0.14 mM, 0.35 mM or 0.50mM reduced the enzyme activity by -11%, -33%, and -35%, respectively. Aspt or Phe concentrations 0.82 mM or 0.07 mM, respectively, did not alter the membrane AChE activity. It is concluded that low concentrations of ASP metabolites had no effect on the membrane enzyme activity, whereas high or toxic concentrations partially or remarkably decreased the membrane AChE activity, respectively. Additionally, neurological symptoms, including learning and memory processes, may be related to the high or toxic concentrations of the sweetener metabolites.

Again, it's difficult to get toxic concentrations in your blood. You'd have to drink diet soda AND eat aspartame candies and cookies all day long non-stop, I think.

So I guess it comes down to my initial philosophy: everything in moderation

 

[tigress]

Here's another interesting one I found

Possible analgesic and anti-inflammatory interactions of aspartame with opioids and NSAIDs.

Sharma S, Jain NK, Kulkarni SK.

Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160 014, India.

The purpose of the present study was to investigate analgesic and anti-inflammatory properties of aspartame, an artificial sweetner and its combination with various opioids and NSAIDs for a possible synergistic response. The oral administration of aspartame (2-16mg/kg, po) significantly increased the pain threshold against acetic acid-induced writhes in mice. Co-administration of aspartame (2mg/kg, po) with nimesulide (2 mg/kg, po) and naproxen (5 mg/kg, po) significantly reduced acetic acid-induced writhes as compared to effects per se of individual drugs. Similarly when morphine (1 mg/kg, po) or pentazocine (1 mg/kg, po) was co-administered with aspartame it reduced the number of writhes as compared to their effects per se. Aspartame (4,8,16 mg/kg, po) significantly decreased carrageenan-induced increase in paw volume and also reversed the hyperalgesic effects in rats in combination with nimesulide (2 mg/kg, po).The study indicated that aspartame exerted analgesic and anti-inflammatory effects on its own and have a synergistic analgesic response with conventional analgesics of opioid and non-opioid type, respectively.

So maybe we should all be drinking small amounts of aspartame! Heck, we now tout the role of inflammation in everything from heart disease to neurological disease, right?

 

[tigress]

Oh, I also want to comment on the OP's inclusion of Vioxx. For one thing, if I needed Vioxx right now I would take it. I don't have any heart risk, so I wouldn't worry. For another thing, the FDA approved it based on the information they had available to them. Merck withheld information which could have been damning from the FDA. So if you're going to blame somebody, don't make it the FDA.

Oh, and this is also interesting, though it's again more anecdotal. Regular soda is worse, in my opinion, than diet, because of the extremely high sugar content. (Of course, risks to bone and tooth mineralization are another significant issue with soda -- a good reason not to drink too much of any type, especially if you're a woman.) But I've read that some people actually have an insulin response to drinking diet sodas, simply from the taste of the sweetness, which can lead to weight gain. One doctor I know, who specializes in nutrition, says she had a patient lose 12 pounds in two months by doing nothing other than avoiding his daily diet sodas. (It is a minority of people who have this effect, apparently, but it's interesting.)

So there are plenty of health reasons for avoiding soda of all types. You don't have to get into pseudo-scientific or even scientific risks of aspartame to find reasons for that. Like I said earlier, I drink diet soda every so often and I don't worry about it. But I wouldn't drink it every day (or no more than 1 can a day, though I drink much less than that), and I'd never give it to my children more than once a week -- not because of aspartame, but for other health reasons.

 

[TracksuitsRock]

But I've read that some people actually have an insulin response to drinking diet sodas, simply from the taste of the sweetness, which can lead to weight gain.

This is interesting. Kind of a naive question but I wonder how these people gain weight with an insulin response when the artificial sweetener is not able to be absorbed/utilized by the body? I would think there would be nothing to store? Or is it that they are also eating/drinking other, digestable, sugars at the same time and this is what the insulin puts away?

edit: or does it trigger a sustained insulin response so that their insulin level is always naturally higher?

 

[velo]

This is interesting. Kind of a naive question but I wonder how these people gain weight with an insulin response when the artificial sweetener is not able to be absorbed/utilized by the body? I would think there would be nothing to store? Or is it that they are also eating/drinking other, digestable, sugars at the same time and this is what the insulin puts away?

edit: or does it trigger a sustained insulin response so that their insulin level is always naturally higher?

no its not a naive question as the assertion, if true, isn't consistant with our current understanding of the mechanism of insulin release. I'd be very hesitant to believe that without seeing the article for myself.

 

[DocKnock]

Very interesting indeed surrounding the insulin path.

 

[tigress]

no its not a naive question as the assertion, if true, isn't consistant with our current understanding of the mechanism of insulin release. I'd be very hesitant to believe that without seeing the article for myself.

Like I said in my post, this was anecdotal, since I heard it from a doctor I respect. She also writes it in her book (about a patient losing 12 pounds in 2 months just by dropping diet soda).

I quickly checked to see if I could find any papers. It looks like there was an indication at some point that this was true, but newer research (like from the past year, after I heard this and after the book was published) shows it probably isn't true. Then again, this doctor has said it's only in a subset of people, and the studies are done on healthy subjects. I'm not going to simply dismiss the claim yet. And, since a huge number of researchers seem to have taken this seriously enough to study it and publish papers on it (just do a search), I would suggest that it's not completetely inconsistent with our current understanding of the mechanism of insulin release.

In any case, it's not my claim. I have no stake in it being true or not true. My other reasons for not drinking soda are better established (bone and teeth mineralization, for example). And I already knew this was an anecdotal claim. Maybe I'll ask this doctor (well, get my mother to ask her, since she doesn't live near me) about what she says.

edit: This post is very defensive. I suppose I was trying to make it clear that the claim was not my own. Somehow I was threatened by the suggestion that it isn't consistent with the mechanism of insulin release, I guess. I don't know. Silly me.

 

[TracksuitsRock]

edit: This post is very defensive. I suppose I was trying to make it clear that the claim was not my own. Somehow I was threatened by the suggestion that it isn't consistent with the mechanism of insulin release, I guess. I don't know. Silly me.

Yeah, no need to be defensive (at least with me). I am genuinely just interested in thinking about the process. I think a lot of good research begins with anecdotal evidence (especially if you think back on the history of medicine) and so this kind of questioning and discussion process is what I hope I am just beginning in medicine.

 

[velo]

Like I said in my post, this was anecdotal, since I heard it from a doctor I respect. She also writes it in her book (about a patient losing 12 pounds in 2 months just by dropping diet soda).

I quickly checked to see if I could find any papers. It looks like there was an indication at some point that this was true, but newer research (like from the past year, after I heard this and after the book was published) shows it probably isn't true. Then again, this doctor has said it's only in a subset of people, and the studies are done on healthy subjects. I'm not going to simply dismiss the claim yet. And, since a huge number of researchers seem to have taken this seriously enough to study it and publish papers on it (just do a search), I would suggest that it's not completetely inconsistent with our current understanding of the mechanism of insulin release.

I agree with you that there are reasons not to drink diet soda (mostly dental) and you can argue about the psychological ramifications of always consuming "sweet" things. I think diet soda, along with pretty much everything, should be consumed in moderation.

I didn't mean to attack you, but this is a perfect example of "old" medical practice. An elder, respected, no doubt very good physician says something and a younger colleague takes it as fact. The older physician's view is probably based on anecdotal evidence and experience which can be very useful--but is also far less powerful evidence than controlled studies.

We should be striving to practice evidence-based medicine whenever possible. To rely less on traditional practice and hand-me-down wisdom and more on large, valid, well-designed studies for clinical practice and bench research with strong, valid methodology for understanding of pathophysiology.

I'm sure the patient your mentor saw did lose 12 lbs, and maybe they lost it just by stopping diet soda. But with no control, a sample size of 1, and all the bias that could have lead to this observation (recall, observational, selection) its nothing to hang your hat on. Its certainly nothing to use to conclude that aspartame induces insulin release.

The fact that that assertion was studied can't be used as an argument that the assertion is valid. Its just as easily possible that it was studied because it goes against what we know about insulin release. As far as we know, insulin is released by beta cells in the islets of langerhans when increasing levels of blood glucose cause an increase in glucose levels within the beta cells (entering through a non-insulin sensitive glut2 transporter). The glucose is metabolized leading to an increase in the ATP/ADP ratio and activates a ATP sensitive K-channel. The K flux hyperpolarizes the cell, which results in a signaling cascade ultimately ending with the fusion of insulin containing vessicles.

So its not just glucose, but the metabolism of glucose that leads to insulin release. Given that fact, it would be interesting to work out how aspartame causes insulin release...unless it has some sulfonylurea-type quality and can bind to K-channels, or somewhere else along the pathway, OR unless it somehow causes the release of glucose from liver/kidney...OR increased absorption from the gut.

At any rate, the claim doens't make immediate intuitive sense, so before we start saying its true we should really have some strong basic science to back it up. The days of simple hypothesizing are over--nowadays you need to back up your claims with evidence.

 

[TracksuitsRock]

jeez, no wonder she's feeling defensive

I don't think she ever claimed this story was the golden truth, just adding something she had heard to the mix. I think you might have inferred much more to it than there was.

 

[Apparition]

At any rate, the claim doens't make immediate intuitive sense, so before we start saying its true we should really have some strong basic science to back it up. The days of simple hypothesizing are over--nowadays you need to back up your claims with evidence.

I like the appearance of "intuitive sense" and "you need to back up your claims with evidence" in this paragraph.

 

[drmota]

I don't feel any negative feelings after diet soda. And remember, I drink a HUGE amount. One person says one thing, another says another. It doesn't mean a thing.

i'm sorry but this is dead wrong. drugs/chemicals etc all have a different effect on different people. if diet soda doesn't affect you, so be it, but you're only one person. and the effects probably wouldn't be immediately evident but would come after years of drinking. my friends grandmother has been smoking a pack of cigs a day for over 60 years (she's in her 80s) and she's in perfect health and her lungs work at full capacity. does that mean smoking cigs don't harm your health? no. one person says one thing, another says another. doesn't mean a thing, huh?
-mota

 

[tigress]

I didn't mean to attack you, but this is a perfect example of "old" medical practice. An elder, respected, no doubt very good physician says something and a younger colleague takes it as fact. The older physician's view is probably based on anecdotal evidence and experience which can be very useful--but is also far less powerful evidence than controlled studies.
...
So its not just glucose, but the metabolism of glucose that leads to insulin release. Given that fact, it would be interesting to work out how aspartame causes insulin release...unless it has some sulfonylurea-type quality and can bind to K-channels, or somewhere else along the pathway, OR unless it somehow causes the release of glucose from liver/kidney...OR increased absorption from the gut.

Actually, the doctor I'm referring to is young. She's highly respected in her community and graduated first in her class from medical school. She lives where I grew up, and my mother is on the board of an nonprofit with her, which is how I know her. She also wrote a book for laypeople about her personal understanding of the ideal diet.

Her claim was not based on anecdotal evidence with a sample size of 1. As I said, earlier research seemed to show that there WAS an insulin response after ingestion of aspartame. More recent research has cast doubt on that. So her claim was based on both current research and anecdotal evidence with a much larger sample size, one of which she used as an example.

The most recent directly relevant study I found was from this past November and used fMRI. It suggested that it is not in fact only the metabolism of glucose that triggers the insulin response:

Functional magnetic resonance imaging of human hypothalamic responses to sweet taste and calories.

Smeets PA, de Graaf C, Stafleu A, van Osch MJ, van der Grond J.

Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands. [email protected]

BACKGROUND: Evidence exists that beverages do not trigger appropriate anticipatory physiologic responses, such as cephalic phase insulin release. Therefore, it is of interest to elucidate the food properties necessary for triggering adaptive responses. Previously, we found a prolonged dose-dependent decrease in the hypothalamic functional magnetic resonance imaging signal after ingestion of a glucose solution. OBJECTIVES: The aims of the present study were to measure the effects of sweet taste and energy content on the hypothalamic response to glucose ingestion and to measure the concomitant changes in blood glucose and insulin concentrations. DESIGN: Five healthy, normal-weight men participated in a randomized crossover design trial. The subjects were scanned 4 times for 37 min on separate days with functional magnetic resonance imaging. After 7 min, they ingested 1 of the following 4 stimuli (300 mL of each): water (control), a glucose solution, an aspartame (sweet taste) solution, or a maltodextrin (nonsweet carbohydrate) solution. RESULTS: Glucose ingestion resulted in a prolonged and significant signal decrease in the upper hypothalamus (P < 0.05). Water, aspartame, and maltodextrin had no such effect. Glucose and maltodextrin ingestions resulted in similar increases in blood glucose and insulin concentrations. However, only glucose triggered an early rise in insulin concentrations. Aspartame did not trigger any insulin response. CONCLUSIONS: Our findings suggest that both sweet taste and energy content are required for a hypothalamic response. The combination of sweet taste and energy content could be crucial in triggering adaptive responses to sweetened beverages.

 

[velo]

The most recent directly relevant study I found was from this past November and used fMRI. It suggested that it is not in fact only the metabolism of glucose that triggers the insulin response:

I'm really not trying to be on the attack here, but the study you quoted, in its abstract, said: "Aspartame did not trigger any insulin response." And only the carbohydrates that caused similar rises in plasma glucose resulted in insulin release. I'm confused as to what you're trying to prove with this.

The fact that she is well-respected, smart, a good doctor, etc is exactly my point. All to often misinformation is spread by quoting good doctor's thoughts and opinions as fact.

 

[velo]

I like the appearance of "intuitive sense" and "you need to back up your claims with evidence" in this paragraph.

is that so? What do you like about it? I'm asserting that if something is contrary to the existing physiological knowledge, which is based on volumes of research and data, it is held under greater scrutiny.

 

[tigress]

I'm really not trying to be on the attack here, but the study you quoted, in its abstract, said: "Aspartame did not trigger any insulin response." And only the carbohydrates that caused similar rises in plasma glucose resulted in insulin release. I'm confused as to what you're trying to prove with this.

The fact that she is well-respected, smart, a good doctor, etc is exactly my point. All to often misinformation is spread by quoting good doctor's thoughts and opinions as fact.

Did you even read what I said? I said that when she made her assertion, the current research suggested that aspartame did indeed trigger an insulin response. I then went on to say that CURRENT research suggests otherwise (although I'd be interested to see a bigger study, including overweight people). What was I trying to prove with the abstract? Exactly what I said -- you suggested that the metabolism of glucose is what causes the insulin response, and I said the study "suggested that it is not in fact only the metabolism of glucose that triggers the insulin response," as indicated by the bolded sentences. Therefore it is not a wild idea to consider the possibility of aspartame reproducing this response.

I also never presented this information as fact. Go back and read my original post. I presented it as an interesting possibility that I had read about, and said that I had heard something from a doctor.

 

[velo]

Did you even read what I said? I said that when she made her assertion, the current research suggested that aspartame did indeed trigger an insulin response. I then went on to say that CURRENT research suggests otherwise (although I'd be interested to see a bigger study, including overweight people). What was I trying to prove with the abstract? Exactly what I said -- you suggested that the metabolism of glucose is what causes the insulin response, and I said the study "suggested that it is not in fact only the metabolism of glucose that triggers the insulin response," as indicated by the bolded sentences. Therefore it is not a wild idea to consider the possibility of aspartame reproducing this response.

I also never presented this information as fact. Go back and read my original post. I presented it as an interesting possibility that I had read about, and said that I had heard something from a doctor.

Ok lets not get emotional, I think we might just have a simple miscommunication--I'm concerned by the way we're throwing the words "release" and "response" around.

Understand that what I am saying is that it seems to me unlikely that aspartame, or any non-carbohydrate (save something pharmacological like sulfonylurea), would cause insulin release--meaning the beta cells in the pancreas release insulin into the bloodstream. What you're talking about is an fMRI study about changes in hypothalamic activity in response to sugar and sweet things. If you'll read my earlier posts I already agreed with you that there may be psychological effects inherent in always consuming sweets--whether they have calories or not. But it seems your posts have been claiming changes in insulin levels--that's pancreas, not brain.

I'm concerned by the tone this discussion is taking on, maybe this will clear things up.

 

[MrBurns10]

Why am I still reading this thread?

I heart diet coke, and diet dr. pepper is good, too. diet cheerwine (for those carolinians) is terrible, though. my contribution to this thread!

 

[BooMed]

Eh, I think all soda is disgusting anyway. I'll eat my calories, thank you very much.

 

[Dr Trek 1]

You guys need to stick with unsweetened ice tea. You can even brew up some decaff if you wish. Not many will argue that tea is not bad for you.

In terms of the whole insulin debate, I've actually read that caffeinne causes insulin secretion. Anyone hear this?

 

[OSUdoc08]

What's the deal? Everyone drinks diet coke but how good is it for you?
FDA approved it (as it did Bextra and Vioxx) but a lot of people complain of side effects when they drink it that go away when they stop or switch to regular coke. It seems everyday, there's new study coming out about some drug or food only to be contradicted a week later. Many of these studies are funded by corporations. Is there any source we can believe since private companies are out only to make money and FDA unreliable? The increase in some previously rare diseases makes one wonder...

And what's up with fruit that stays in perfect shape after several weeks? Aren't all natural things supposed to rot? No, I didn't just land from Mars. I know that virtually everything is processed. But where does it stop? It sucks that scientists and physicians are working so hard to fight disease when other people create it.

I don't drink diet coke.

It causes cancer and erodes the lining of your esophagus.

It also tastes terrible.

I lost 50 lbs by cutting desserts and sodas out of my diet anyway.

Drink tea & water.

 

[Dr Trek 1]

I can't stand Diet Coke. Diet Pepsi is way better

 

[velo]

In terms of the whole insulin debate, I've actually read that caffeinne causes insulin secretion. Anyone hear this?

:bangs head against wall:

 

[OSUdoc08]

You guys need to stick with unsweetened ice tea. You can even brew up some decaff if you wish. Not many will argue that tea is not bad for you.

In terms of the whole insulin debate, I've actually read that caffeinne causes insulin secretion. Anyone hear this?

That's funny.

No.

 

[Dr Trek 1]

Ok I'm sorry if the whole caffeinne thing has been discussed already or something- I haven't read every post on this thread.

I actually remember reading that as an explaination to some orgo question on a practice MCAT. Ah well- goes to show you how dependable Kaplan explainations are for the real world,

 

[Rafa]

My three favorite (and most frequently consumed) beverages are water, vitamin D milk, and snapple.

 

[Dr Trek 1]

My three favorite (and most frequently consumed) beverages are water, vitamin D milk, and snapple.

I also like Snapple, however I would get fat if I consumed that much sugar so I stick with the Diet variety, so I'm back to square one.

Watch out for milk. The chemicals used to treat cows today make milk a bit harmful, or so I've read.

 

[OSUdoc08]

I also like Snapple, however I would get fat if I consumed that much sugar so I stick with the Diet variety, so I'm back to square one.

Watch out for milk. The chemicals used to treat cows today make milk a bit harmful, or so I've read.

Not to mention the fact that it is full of fat & lactose and it exacerbates allergic rhinitis

 

[bubbleyum]

splendaaaaaaaaaaa