The WHO recently came out with a guidelineon artificial sweeteners and basically they discourage their use. and based on thescientific evidence that we have I suspect their overall logic is wrong. drama…. so we'llgo over the scientific evidence in a nutshell, I'll explain what I mean, of course, real quick,I have no conflicts of interest in this area, no checks from big sugar or big sweeteneror big anything, we're just going over the available scientific evidence and trying tofigure out what's most likely to be true. so there's basically two ways that you can study theeffect of a food or a product on human health, you can take a group of people and splitthem randomly and give half that food you're interested in or product and see what happens,that's called a randomized trial. the other way.
Is to ask a population of people how much of thatfood or product each person normally eats in their daily life and then follow them for years and seewhat happens to their health. and you can look for a connection between the intake of that productor food and their health outcomes. so that's called an observational study because you're notintervening, you're not changing anything, you're just observing. long story short, when we lookat the randomized trials that we have, in general they point to safety of artificial sweetenersand even some benefit, people who are randomized to the group adding artificial sweeteners orincreasing their intake of artificial sweeteners tend to show a reduction in body weight. sometrials even compare artificial sweeteners to water and overall it's pretty common to see nostatistically significant difference between them,.
Suggesting that artificial sweeteners are not justbetter than regular added sugar but even compared to water we don't see a clear superiority, atleast for these parameters that are reported, like weight loss. now, randomized trials aregreat, the problem is they're usually short, normally a few months, a year, two years ifwe're really lucky. and that's for many reasons, they are costly to run, they're logisticallycomplicated. also adherence. in a randomized trial you have to convince people to change theirdiet or their habit and there's only so long you can keep people on a change like that beforeyou lose your participants to adherence. now, the observational studies can be much longer,they can last decades, and this is where it gets interesting because in observational studiesoften people consuming more artificial sweeteners.
Tend to have higher risk of disease. higher riskof obesity than People consuming less artificial sweeteners. so in this graph the line in themiddle is the reference, the null if you will, so anything above the line is an increase in risk.also common to see higher risk of coronary heart disease and even higher risk of total death. sowe have this conundrum, we have this contradiction between the short term randomized data on one handand the long-term observational data on the other, and the WHO essentially erred on the side ofcaution and said the short-term benefit seen in the trials is trumped by these concerns comingfrom the long-term observational studies. now, this is debatable, some people argue thatthe randomized trials should get more weight because they're randomized, which everything elseheld equal is methodologically more robust, gets.
Rid of more confounders, other people agree withthe WHO and they think, yeah, the observational studies should be given preference because they'relonger. but here's the thing, there's a chance that these results from these observationalstudies are an artifact anyway. people who consume more artificial sweeteners often do thatto try to lose weight and to get healthier, so we might be seeing a higher risk in that populationbecause they're heavier and sicker to begin with, not because artificial sweeteners cause disease.this phenomenon is called reverse causation, when the direction of cause and effect is differentfrom what it might appear at first glance. now, the authors of the WHO guideline are completelyaware that this is a possibility, these people are not dumb, these are professional nutritionscientists who do this for a living, and in fact.
They mention this possibility in their report butthey still lean towards the observational studies mainly because the randomized trials tend to bemuch shorter. but what they pay less attention to is that there are other ways to look atobservational data, and more robust way ways, than this default analysis. for example, instead ofjust looking at people consuming more artificial sweeteners versus people consuming less, we canlook at specific alternatives. and the one that makes the most sense is regular added sugar, sofor example we might compare diet soda to regular soda, and we can do this for specific dosages,so let's say the health effect of one serving a day or one can a day of regular soda compared tothe health effect of one can a day of diet soda, and at the same time you can try to adjust for allthe other variables, things like BMI, presence of.
Diabetes, other dietary factors even, and so youcan try to isolate the effect of these products on health. so this is called a substitution analysis,precisely because it's looking at head-to-head two alternatives. and in general it's more robustthan just the default observational approach and it helps minimize some of this reverse causationrisk. and when we look at this type of analysis, the results change dramatically, we see lowerrisk of obesity comparing artificially sweetened products to regular sugar sweetened products, sofor example people drinking diet soda instead of regular soda. lower risk of heart disease,lower risk of total death. so none of these techniques are perfect, the randomized trialsalso aren't perfect, there's always a degree of of uncertainty, but in general a substitutionanalysis is a bit more compelling than a standard.
Observational study, and these results align withthe randomized trial results, suggesting benefits short term and long term of replacing sugarsweetened beverages and products with artificially sweetened products. so this is why I lean towardsartificial sweeteners are probably beneficial, at least compared to regular added sugars. if theevidence in the future continues to support this, continues to mount in that direction, probablywhat's going to happen is the WHO is going to change its guidelines. if on the other handevidence starts pointing to more concerns of artificial sweeteners and suggesting that,no, they're just as bad as added sugar, then I'm going to change my views, that's how scienceworks, views follow evidence. now, in a perfect world we would just run a massive randomizedtrial with a million people over 20 years,.
Right? and just nail this. in reality that'salmost impossible, we'll probably never have that, so we have to make educated decisions with theinformation we have. now, very interestingly, as we were preparing this video a new trial came out,and this is one of the larger ones that we have, a year of followup, almost 500 participants,and they were all overweight before the trial, they were all placed on a weight lossprogram and then they were randomly split, half of them were told to replace some of theregular soda that they drank with water and the other half with artificially sweetened drinkslike diet soda. and both groups lost weight, and if anything the group on the artificiallysweetened replacement lost a bit more weight, 7.5 versus 6 kilos lost over the course of theyear. and this is possibly because the sweetness.
Of the artificial sweetener satisfied them a bitmore so they ate a little bit less on the side than the guys who just replaced it with water. andso basically the results of this new trial align with the evidence we had before. now, in theirdefense, the WHO committee makes some really good points in their report, for example they point outthat artificial sweeteners, non-sugar sweeteners, aren't the only way to reduce added sugarsin the diet, fruit is also an option, or unsweetened food and drinks. so they're referringto things like water and tea for example. yeah, those are perfectly valid options. another goodpoint they make, that just replacing free sugars with artificial sweeteners, for example swappingsoda with diet soda, by itself is not going to massively overhaul the overall quality of thediet because we're still eating a highly processed.
Product. that's a good point, I agree that overalldietary quality is of paramount importance, but the question is, in terms of public healthand, implementation, how do we get people there. right? how do we get a population that eats a veryunhealthy diet to move in that direction? cuz it's easy for me to talk, I don't consume diet soda.I don't consume regular soda either. so I don't feel any need for these products, but I'm notthe target audience, the question is, somebody who consumes a lot of regular soda, two, three,four cans a day, and who finds it difficult, who finds it impractical to simply transition towater or tea, who's not going to stick with that, if diet soda helps them cut back, is that apositive move or not health-wise? and most of the evidence we have suggests that it is, so we canexplain that science, we can explain the different.
Factors without necessarily encouraging a dietof junk food. so hopefully that gives you some information to make your own educated decisions,here's a lot more on artificial sweeteners and here are some general tips to ditch the refinedsugars. check those out, I'll meet you over there