4 ms·

I'm not sure artificial sweeteners are good for anything. A 2019 meta analysis published in the British Medical Journal said, "Most health outcomes did not see

I'm not sure artificial sweeteners are good for anything. A 2019 meta analysis published in the British Medical Journal said, "Most health outcomes did not seem to have differences between the NSS (Non-sugar sweeteners) exposed and unexposed groups." - https://www.bmj.com/content/364/bmj.k4718 https://www.bmj.com/content/364/bmj.k4718 A few months ago, "WHO advises not to use non-sugar sweeteners for weight control in newly released guideline" - https://www.who.int/news/item/15-05-2023-who-advises-not-to-use-non-sugar-sweeteners-for-weight-control-in-newly-released-guideline https://www.who.int/news/item/15-05-2023-who-advises-not-to-... My guess is that things tasting sweet is part of the problem. For example: "Ingestion of these artificial sweeteners (AS) results in the release of insulin from pancreas which is mistaken for glucose (due to their sweet taste). This increases the levels of insulin in blood eventually leading to decreased receptor activity due to insulin resistance." - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014832/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014832/ And: "the role of sweet taste in energy intake and appetite regulation is controversial" - https://www.mdpi.com/2072-6643/6/9/3431 https://www.mdpi.com/2072-6643/6/9/3431

haldujai 3y ago
Respectfully, overstated conclusions you’re drawing from these limited studies. Ref[1]: Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality was limited; therefore, confidence in the reported results is limited. Ref[2] only states NSS should not be used in weight control due to a lack of long term evidence (I.e. if trying to achieve weight control there are better strategies, not necessarily a condemnation) as well as: Because the link observed in the evidence between NSS and disease outcomes might be confounded by baseline characteristics of study participants and complicated patterns of NSS use, the recommendation has been assessed as conditional, following WHO processes for developing guidelines. This signals that policy decisions based on this recommendation may require substantive discussion in specific country contexts, linked for example to the extent of consumption in different age groups. Ref[2]’s full WHO review article[5] is even more damning on the methodology. Pertinent to your arguments: The results suggest that, in the short term, NSS use may lead to small reductions in adiposity without any significant impact on cardiometabolic risk. There is suggestion of negative health effects with long-term use, but the evidence is ultimately inconclusive. Ref[3] is obviated by ref[2] and meaningless in isolation, reasons described in the 200 page WHO report. Ref[4] is theoretical about mechanisms and provides no empiric evidence of anything. Contrary to this hypothesis the WHO study elaborates on why the long-term observational studies are discordant with short-term RCTs and the gist is bias. [5] https://apps.who.int/iris/rest/bitstreams/1417548/retrieve https://apps.who.int/iris/rest/bitstreams/1417548/retrieve
- abainbridge 3y ago
  I guess the way I presented thoughts looked like I was saying NSS are bad for you. I don't have the evidence for that claim. But I don't think the balance of evidence is in favour of NSS either. I know you can cherry pick health studies to support any argument you like but I don't feel like I've done that. The WHO guidelines/study that we linked to is supposed to be a broad summary of the whole research area. The guidelines document doesn't recommend NSS for anything. It only recommends _against_ using them for things. > Ref[3] is obviated by ref[2] and meaningless in isolation, reasons described in the 200 page WHO report. Whereabouts? I couldn't find what you're referring to.
  - haldujai 3y ago
    > I guess the way I presented thoughts looked like I was saying NSS are bad for you. I don't have the evidence for that claim. But I don't think the balance of evidence is in favour of NSS either. Thanks for the clarification, my interpretation of your comment was that you were suggesting that NSS have harmful effects given the insulin discussion. I agree the evidence is neither for or against NSS harms. > I know you can cherry pick health studies to support any argument you like but I don't feel like I've done that. The WHO guidelines/study that we linked to is supposed to be a broad summary of the whole research area. The guidelines document doesn't recommend NSS for anything. It only recommends _against_ using them for things. Agree the WHO review is great and well done. The recommendation against use stems from conflicting evidence and a lack of evidence showing it has the beneficial effects thought to exist. Recommendations like this are generally made to avoid delaying positive interventions rather than a negative statement regarding said intervention. An analogy would be a position statement to not use bananas for the prevention of breast cancer. It doesn’t mean one shouldn’t eat bananas or that they’re bad for you, it’s just irrelevant and potentially harmful for this indication. Bananas may also still be good for you. > Whereabouts? I couldn't find what you're referring to. Apologies I was vague. What I mean is you went backwards down the levels of evidence pyramid. Once a good quality systematic review is cited it becomes unnecessary to cite substantially weaker evidence (retrospective observational study with self reporting) unless it presents new and compelling information that was not included in the study. Given the study type it’s low-quality and is non-contributory to the conclusions stated in the review. With respects to reasons described by WHO, I’m referring to the discussion and risks of bias sections. They quite extensively elaborate on the reasons observational studies are poor quality for this question and talks about reasons for conflicting findings between RCTs and observational studies.

haldujai 3y ago

Respectfully, overstated conclusions you’re drawing from these limited studies. Ref[1]: Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality was limited; therefore, confidence in the reported results is limited. Ref[2] only states NSS should not be used in weight control due to a lack of long term evidence (I.e. if trying to achieve weight control there are better strategies, not necessarily a condemnation) as well as: Because the link observed in the evidence between NSS and disease outcomes might be confounded by baseline characteristics of study participants and complicated patterns of NSS use, the recommendation has been assessed as conditional, following WHO processes for developing guidelines. This signals that policy decisions based on this recommendation may require substantive discussion in specific country contexts, linked for example to the extent of consumption in different age groups. Ref[2]’s full WHO review article[5] is even more damning on the methodology. Pertinent to your arguments: The results suggest that, in the short term, NSS use may lead to small reductions in adiposity without any significant impact on cardiometabolic risk. There is suggestion of negative health effects with long-term use, but the evidence is ultimately inconclusive. Ref[3] is obviated by ref[2] and meaningless in isolation, reasons described in the 200 page WHO report. Ref[4] is theoretical about mechanisms and provides no empiric evidence of anything. Contrary to this hypothesis the WHO study elaborates on why the long-term observational studies are discordant with short-term RCTs and the gist is bias. [5] https://apps.who.int/iris/rest/bitstreams/1417548/retrieve https://apps.who.int/iris/rest/bitstreams/1417548/retrieve

abainbridge 3y ago
I guess the way I presented thoughts looked like I was saying NSS are bad for you. I don't have the evidence for that claim. But I don't think the balance of evidence is in favour of NSS either. I know you can cherry pick health studies to support any argument you like but I don't feel like I've done that. The WHO guidelines/study that we linked to is supposed to be a broad summary of the whole research area. The guidelines document doesn't recommend NSS for anything. It only recommends _against_ using them for things. > Ref[3] is obviated by ref[2] and meaningless in isolation, reasons described in the 200 page WHO report. Whereabouts? I couldn't find what you're referring to.
- haldujai 3y ago
  > I guess the way I presented thoughts looked like I was saying NSS are bad for you. I don't have the evidence for that claim. But I don't think the balance of evidence is in favour of NSS either. Thanks for the clarification, my interpretation of your comment was that you were suggesting that NSS have harmful effects given the insulin discussion. I agree the evidence is neither for or against NSS harms. > I know you can cherry pick health studies to support any argument you like but I don't feel like I've done that. The WHO guidelines/study that we linked to is supposed to be a broad summary of the whole research area. The guidelines document doesn't recommend NSS for anything. It only recommends _against_ using them for things. Agree the WHO review is great and well done. The recommendation against use stems from conflicting evidence and a lack of evidence showing it has the beneficial effects thought to exist. Recommendations like this are generally made to avoid delaying positive interventions rather than a negative statement regarding said intervention. An analogy would be a position statement to not use bananas for the prevention of breast cancer. It doesn’t mean one shouldn’t eat bananas or that they’re bad for you, it’s just irrelevant and potentially harmful for this indication. Bananas may also still be good for you. > Whereabouts? I couldn't find what you're referring to. Apologies I was vague. What I mean is you went backwards down the levels of evidence pyramid. Once a good quality systematic review is cited it becomes unnecessary to cite substantially weaker evidence (retrospective observational study with self reporting) unless it presents new and compelling information that was not included in the study. Given the study type it’s low-quality and is non-contributory to the conclusions stated in the review. With respects to reasons described by WHO, I’m referring to the discussion and risks of bias sections. They quite extensively elaborate on the reasons observational studies are poor quality for this question and talks about reasons for conflicting findings between RCTs and observational studies.