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From the linked study, "These findings of positive associations between artificial sweetener intakes and increased T2D risk strengthen the evidence that these a

From the linked study, "These findings of positive associations between artificial sweetener intakes and increased T2D risk strengthen the evidence that these additives may not be safe sugar alternatives." This is news to me. I was under the impression that: 1) artificial sweeteners were a safe substitute for sugar for people with diabetes and 2) diabetes came from excess sugar consumption which wasn't a problem with artificial sweeteners.

kwhitefoot 2y ago
Sugar does more than one thing. It's mere presence triggers hormone related actions in the body and its energy content is what the reaction is supposed to deal with. If a sweetener behaves like sugar as far as taste is concerned, that is it fools one part of your body into reacting as though it is sugar, it seems plausible that it might also fool other parts of the system.
watwut 2y ago
There is type of diabetes that is simply hereditary and that is all there is to it. It is not rare. Then there is also pregnancy diabetes that comes and goes with pregnancy (they make routine test for it). Not all diabetes is from sugar.
- deleted 2y ago
  [deleted]
- epcoa 2y ago
  > There is type of diabetes that is simply hereditary and that is all there is to it. This is a common misconception. Type 1 diabetes cases are more often acquired with no family history, there are some genetic associations but it is actually less strong than Type 2 (insulin resistance/diet related diabetes) where family history is a substantial risk factor. Pregnancy (gestational) diabetes isn’t just pregnancy related either as it is more likely in those with metabolic syndrome/obesity and is associated with type 2 as well, so it is also partially diet related. > Not all diabetes is from sugar. I would go further and just say no diabetes is “from sugar”, it’s just a completely uselessly simplistic way of looking at it (I know this was in response to GP comment). It’s not like low carb diets even prevent some people from getting type 2. Type 2 diabetes is a disease of acquired insulin resistance for which excessive consumption of high glycemic index food (eg processed food with high sugar content) is a major risk factor, but not the only one.
  - shepherdjerred 2y ago
    Do we know if type 2 diabetes itself is actually hereditary, or is it possible that the genetic component makes individuals eat more sugar which causes type 2 diabetes?
    - worik 2y ago
      Or it is possible that dietary habits are taken up from your cultural environment I see that, but I have not made a study
- throwawaymaths 2y ago
  Iirc diabetes is technically "sugar in the pee" so all diabetes must be linked to some sugar metabolism at some point.
  - epcoa 2y ago
    It’s an interesting bit of ancient word and medicine trivia but it isn’t terribly elucidating about the mechanism or course of diabetes in modern times. Your body always has some glucose metabolism going, even if you’re in ketosis, etc there’s always “sugar metabolism” - your blood glucose doesn’t drop to 0 unless you’re dead. It’s simply not a useful abstraction to link sugar consumption to diabetes as implied by the GP. And ultimately diabetes is defined as a condition of dysregulation of sugar in the blood. In fact, these days most well cared for people with controlled diabetes don’t have sugar in the pee unless they’re taking a medication specifically to put it there. Also if you want your mind blown and why you can’t diagnose based on etymology alone (at least not without a sense of humor) - lookup “diabetes insipidus”. Literally means “sweet pee that isn’t sweet”. The historic reason is that excessive urination is common to both.
  - zadokshi 2y ago
    Yes, but from an education perspective it’s probably hurting more people than it helps to use this terminology. It’s better to label the true source of the problem, rather than reduce the blame to “sugar”
McP 2y ago
Yes it is new. The WHO only changed their guidance about a year ago [1]. Still, as far as I know the evidence is only associational. From the paper the article links to: "Potential for reverse causality cannot be eliminated". [1] 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-...
- shepherdjerred 2y ago
  So it sounds like artificial sugars can actually cause diabetes? That's unfortunate. Occasionally I drink Coke Zero as an alternative to Coke, but perhaps I should start replacing that with unsweetened seltzer water like La Croix.
  - worik 2y ago
    Water. On its own. It's what I drink
    - shepherdjerred 2y ago
      I already drink more than enough water; I enjoy drinking _something_ while studying.
  - kevinmchugh 2y ago
    An occasional pop, sugar or no, isn't going to cause diabetes.
  - amanaplanacanal 2y ago
    Or, just as likely, diabetics are more likely to use artificial sweeteners.
  - Pomfers 2y ago
    No, the "Potential for reverse causality cannot be eliminated" means that instead of artificial sweeteners causing diabetes, causality can be reversed: Diabetes causes the intake of artificial sweeteners. All these studies just show an association, but can not prove the direction of causality. For whatever reason, the idea that diabetic and overweight people deliberately seek out zero sugar sweeteners so that they can enjoy sweetness without making their situation worse just doesn't seem like a plausible explanation to them. Personally, if you can't definitively prove something is bad for you after 45+ years of research, I just don't care anymore. People can occasionally drink Coke regular without issue, I wouldn't be worried. Most of the time, diabetes is not caused by merely occasional consumption of sugars.
m463 2y ago
There are some studies showing some artificial sweeteners raise blood glucose, just like sugar.
ayakang31415 2y ago
Is the association correlation or causation? Because that is very important. People with higher BMI (thus higher risk of diabetes) tend to be self conscious about their diet, they might consume more artificial sweeteners than healthy individuals. They can be already diabetic to begin with before artificial sweetener was consumed frequently.
Der_Einzige 2y ago
I don’t buy this at all! Zero calorie sweeteners by definition cannot cause insulin responses. I can easily verify this by using my families blood glucose monitors before and after I’ve had a diet soda. I’ve done this several times and I have zero increase in blood glucose levels from a Diet Coke. It actually goes down since time passes between me starting the drink and finishing it. The obsession from even purportedly good doctors with trying to find reasons to vilify anything that might taste good while not spiking glycemic loads is horrifying to witness. I’m extremely upset, especially as someone with two diabetic parents and a history of diabetes. Both parents are diabetic because they’re fat as hell.
- Jensson 2y ago
  > It actually goes down That is what you expect if you raise your insulin, insulin reduce blood glucose, so if the sweetener increased insulin without adding sugar then it reduces blood glucose. > goes down since time passes between me starting the drink and finishing it. Blood sugar levels are stable unless you eat sugar, they don't go down over time, unless you do something to add insulin to make it go down or add sugar to make it go up. Here it sounds like you adding insulin when drinking that and thus making it go down.
  - Der_Einzige 2y ago
    Diet soda using a zero calorie sweetener has an insulin index and glycemic index of zero. You’re just wrong.
    - Jensson 2y ago
      You are making the strong statements here, not me, I'm just saying your evidence there wasn't enough to support your strong statements. If you have more evidence such as the insulin index being zero, you should have brought that up. If the insulin index is 0 then per definition it doesn't increase insulin, yes, but the glycemic index being 0 doesn't say it about insulin, as your post suggest, so your post was definitely wrong. I was not wrong pointing out that your post was wrong.
Pomfers 2y ago
Your impressions 1 and 2 can both be correct, and there still be an association between artificial sweeteners and type 2 diabetes. It has been shown for decades that this association exists, it's establishing cause, and causal direction that's hard. Does consuming artificial sweeteners cause diabetes? Or does having diabetes cause the consuming of artificial sweeteners?
GrantMoyer 2y ago
Exccess calorie consumption and resulting obesity can cause diabetes. Consuming too much sugar is one way to consume too many calories, but so is too much starch, or too much fats, or (perhaps most commonly) too much food in general.

kwhitefoot 2y ago

Sugar does more than one thing. It's mere presence triggers hormone related actions in the body and its energy content is what the reaction is supposed to deal with. If a sweetener behaves like sugar as far as taste is concerned, that is it fools one part of your body into reacting as though it is sugar, it seems plausible that it might also fool other parts of the system.

watwut 2y ago

There is type of diabetes that is simply hereditary and that is all there is to it. It is not rare. Then there is also pregnancy diabetes that comes and goes with pregnancy (they make routine test for it). Not all diabetes is from sugar.

deleted 2y ago
[deleted]
epcoa 2y ago
> There is type of diabetes that is simply hereditary and that is all there is to it. This is a common misconception. Type 1 diabetes cases are more often acquired with no family history, there are some genetic associations but it is actually less strong than Type 2 (insulin resistance/diet related diabetes) where family history is a substantial risk factor. Pregnancy (gestational) diabetes isn’t just pregnancy related either as it is more likely in those with metabolic syndrome/obesity and is associated with type 2 as well, so it is also partially diet related. > Not all diabetes is from sugar. I would go further and just say no diabetes is “from sugar”, it’s just a completely uselessly simplistic way of looking at it (I know this was in response to GP comment). It’s not like low carb diets even prevent some people from getting type 2. Type 2 diabetes is a disease of acquired insulin resistance for which excessive consumption of high glycemic index food (eg processed food with high sugar content) is a major risk factor, but not the only one.
- shepherdjerred 2y ago
  Do we know if type 2 diabetes itself is actually hereditary, or is it possible that the genetic component makes individuals eat more sugar which causes type 2 diabetes?
  - worik 2y ago
    Or it is possible that dietary habits are taken up from your cultural environment I see that, but I have not made a study
throwawaymaths 2y ago
Iirc diabetes is technically "sugar in the pee" so all diabetes must be linked to some sugar metabolism at some point.
- epcoa 2y ago
  It’s an interesting bit of ancient word and medicine trivia but it isn’t terribly elucidating about the mechanism or course of diabetes in modern times. Your body always has some glucose metabolism going, even if you’re in ketosis, etc there’s always “sugar metabolism” - your blood glucose doesn’t drop to 0 unless you’re dead. It’s simply not a useful abstraction to link sugar consumption to diabetes as implied by the GP. And ultimately diabetes is defined as a condition of dysregulation of sugar in the blood. In fact, these days most well cared for people with controlled diabetes don’t have sugar in the pee unless they’re taking a medication specifically to put it there. Also if you want your mind blown and why you can’t diagnose based on etymology alone (at least not without a sense of humor) - lookup “diabetes insipidus”. Literally means “sweet pee that isn’t sweet”. The historic reason is that excessive urination is common to both.
- zadokshi 2y ago
  Yes, but from an education perspective it’s probably hurting more people than it helps to use this terminology. It’s better to label the true source of the problem, rather than reduce the blame to “sugar”

McP 2y ago

Yes it is new. The WHO only changed their guidance about a year ago [1]. Still, as far as I know the evidence is only associational. From the paper the article links to: "Potential for reverse causality cannot be eliminated". [1] 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-...

shepherdjerred 2y ago
So it sounds like artificial sugars can actually cause diabetes? That's unfortunate. Occasionally I drink Coke Zero as an alternative to Coke, but perhaps I should start replacing that with unsweetened seltzer water like La Croix.
- worik 2y ago
  Water. On its own. It's what I drink
  - shepherdjerred 2y ago
    I already drink more than enough water; I enjoy drinking _something_ while studying.
- kevinmchugh 2y ago
  An occasional pop, sugar or no, isn't going to cause diabetes.
- amanaplanacanal 2y ago
  Or, just as likely, diabetics are more likely to use artificial sweeteners.
- Pomfers 2y ago
  No, the "Potential for reverse causality cannot be eliminated" means that instead of artificial sweeteners causing diabetes, causality can be reversed: Diabetes causes the intake of artificial sweeteners. All these studies just show an association, but can not prove the direction of causality. For whatever reason, the idea that diabetic and overweight people deliberately seek out zero sugar sweeteners so that they can enjoy sweetness without making their situation worse just doesn't seem like a plausible explanation to them. Personally, if you can't definitively prove something is bad for you after 45+ years of research, I just don't care anymore. People can occasionally drink Coke regular without issue, I wouldn't be worried. Most of the time, diabetes is not caused by merely occasional consumption of sugars.

m463 2y ago

There are some studies showing some artificial sweeteners raise blood glucose, just like sugar.

ayakang31415 2y ago

Is the association correlation or causation? Because that is very important. People with higher BMI (thus higher risk of diabetes) tend to be self conscious about their diet, they might consume more artificial sweeteners than healthy individuals. They can be already diabetic to begin with before artificial sweetener was consumed frequently.

Der_Einzige 2y ago

I don’t buy this at all! Zero calorie sweeteners by definition cannot cause insulin responses. I can easily verify this by using my families blood glucose monitors before and after I’ve had a diet soda. I’ve done this several times and I have zero increase in blood glucose levels from a Diet Coke. It actually goes down since time passes between me starting the drink and finishing it. The obsession from even purportedly good doctors with trying to find reasons to vilify anything that might taste good while not spiking glycemic loads is horrifying to witness. I’m extremely upset, especially as someone with two diabetic parents and a history of diabetes. Both parents are diabetic because they’re fat as hell.

Jensson 2y ago
> It actually goes down That is what you expect if you raise your insulin, insulin reduce blood glucose, so if the sweetener increased insulin without adding sugar then it reduces blood glucose. > goes down since time passes between me starting the drink and finishing it. Blood sugar levels are stable unless you eat sugar, they don't go down over time, unless you do something to add insulin to make it go down or add sugar to make it go up. Here it sounds like you adding insulin when drinking that and thus making it go down.
- Der_Einzige 2y ago
  Diet soda using a zero calorie sweetener has an insulin index and glycemic index of zero. You’re just wrong.
  - Jensson 2y ago
    You are making the strong statements here, not me, I'm just saying your evidence there wasn't enough to support your strong statements. If you have more evidence such as the insulin index being zero, you should have brought that up. If the insulin index is 0 then per definition it doesn't increase insulin, yes, but the glycemic index being 0 doesn't say it about insulin, as your post suggest, so your post was definitely wrong. I was not wrong pointing out that your post was wrong.

Pomfers 2y ago

Your impressions 1 and 2 can both be correct, and there still be an association between artificial sweeteners and type 2 diabetes. It has been shown for decades that this association exists, it's establishing cause, and causal direction that's hard. Does consuming artificial sweeteners cause diabetes? Or does having diabetes cause the consuming of artificial sweeteners?

GrantMoyer 2y ago

Exccess calorie consumption and resulting obesity can cause diabetes. Consuming too much sugar is one way to consume too many calories, but so is too much starch, or too much fats, or (perhaps most commonly) too much food in general.