Your Weekly Checkup: Artificially Sweetened Beverages and the Risks of Stroke and Dementia

“Your Weekly Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

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Being 10 pounds overweight and a coffee drinker, I try to avoid additional calories by using artificial sweeteners instead of sugar in my coffee. A recent publication has made me question the soundness of that choice.

In the journal Stroke, investigators of the Framingham Heart Study Offspring cohort studied 2,888 participants for new onset stroke and 1,484 participants for new onset dementia. They found that higher consumption of artificially sweetened soft drinks was associated with an almost three-fold increased ten-year risk of stroke, particularly ischemic stroke, and Alzheimer’s dementia. Consumption of sugary beverages or sugar-sweetened soft drinks were not associated with the risks of stroke or dementia. However, before concluding that sugary drinks are okay, consider the Nurses’ Health Study and Health Professionals Follow-Up Study. They reported that greater consumption of sugar- and artificially sweetened soft drinks was each independently associated with a higher risk of stroke. Also, too much sugar can be associated with diabetes, obesity, and metabolic dysfunction.

You should accept conclusions from these reports with some caution because they are observational studies, which prevents drawing definitive causal links between sugary and artificially sweetened beverage consumption and the risks of stroke and dementia. Also, in the first study, participants with diabetes—who would be more likely to develop stroke and dementia—consumed more artificially sweetened beverages, which could impact the conclusions.

Nevertheless, it would be wise to cut back on sugary and artificially sweetened beverages. While the non-caloric artificial sweeteners are so sweet they can be used in small amounts with little added caloric value and are thought to be excreted unchanged and therefore metabolically inert, there is increasing controversy whether that is true and whether they can alter the microflora in the GI tract and thus promote metabolic derangements in some people. Artificial sweeteners might even affect wildlife since they can pass non-degraded through wastewater treatment systems and are subsequently discharged to groundwater and surface waters.

There is a lot we can learn from nature. Consider the quote by Joan Dye Gussow, who wrote, “As for butter versus margarine, I trust cows more than chemists.” Whole, natural foods like chicken and fish, fresh salads, and nuts with a dash of red wine are to be preferred over processed foods that have been altered by food industry chemists. That includes artificially sweetened soft drinks and foods.