A new systematic review and meta-analysis suggests that swapping out sugar-sweetened beverages (SSBs) for low- and no-calorie sweetened beverages (LNCSBs) may support modest weight loss and improve certain cardiometabolic factors.
The study found that LNCSBs offer similar benefits to water, the standard substitution recommended by health authorities.
Key findings:
- Replacing SSBs with LNCSBs was linked to modest reductions in body weight, BMI, body fat percentage, and liver fat over 3 months.
- Water substitution showed no significant improvement in weight loss or cardiometabolic factors compared to SSBs, though trends favored water.
- LNCSBs as a swap for water showed no differences except slightly lower A1C with water and lower systolic blood pressure with LNCSBs.
- There was no evidence that LNCSBs cause harm when substituted for SSBs or water over 3 months.
Source: JAMA Netw Open. 2022
The Role of Sugary Drinks in Obesity and Diabetes
SSBs like soda, fruit drinks, sports drinks, and sweetened teas and coffees are the largest source of added sugars in the American diet.
Higher intake of sugary drinks is tied to excessive calorie consumption, weight gain, type 2 diabetes, heart disease, fatty liver disease, gout, and kidney stones.
Public health authorities including the CDC, American Heart Association, and diabetes organizations universally recommend limiting intake of added sugars to less than 10% of total calories.
For an average 2000 calorie diet, that equates to about 50 grams or 12 teaspoons of added sugar per day.
A 12-ounce can of soda packs around 40 grams of sugar, nearly maxing out the daily limit in one serving.
Given the harms of excess sugar, national dietary guidelines in the U.S., Canada, and elsewhere advise swapping out SSBs for water.
Some groups like the American Heart Association say low-calorie sweeteners (LCSs) may be an acceptable alternative for habitual SSB drinkers trying to reduce sugar and calories.
But concerns have emerged that LCSs may disrupt metabolism and appetite regulation, fueling rather than fighting obesity.
Examining the Impact of Low-Calorie Sweetened Beverages
To clarify the role of LNCSBs, an international team conducted a systematic review and meta-analysis of randomized controlled trials comparing intake of LNCSBs, SSBs, and water.
The study sought to assess three specific switches:
- Replacing SSBs with LNCSBs
- Replacing SSBs with water (standard substitution)
- Replacing water with LNCSBs
In total, 17 trials with over 1700 mostly overweight and obese adults were included.
Nearly 80% were women, and the average participant age was 33 years.
Study durations ranged from 3 weeks to 1 year, with a median of 12 weeks.
Most studies were conducted in Europe and North America.
LNCSBs Linked to Modest Improvements in Weight and Metabolic Factors
When LNCSBs were substituted for SSBs:
- Body weight decreased by about 1 kg (2.2 lbs)
- BMI dropped by 0.3 kg/m2
- Body fat percentage declined by 0.6%
- Liver fat content was moderately reduced
Though not statistically significant, switching to LNCSBs also trended toward improvements in waist circumference, blood sugar levels, insulin resistance, blood pressure, and blood lipids like triglycerides and HDL cholesterol.
No changes were observed when SSBs were swapped for water, though markers again trended in a favorable direction.
Replacing water with LNCSBs showed no differences except slightly lower A1C with water and lower systolic blood pressure with LNCSBs.
Overall, the meta-analysis indicates that LNCSBs offer comparable benefits to water for weight management and metabolic health when substituted for SSBs.
Neither replacement appeared to cause harm based on the intermediate markers examined over 3 months.
LNCSBs: A Viable Alternative to Water for Reducing Sugar Intake
Though water remains the gold standard, the findings suggest LNCSBs are an acceptable short-term alternative to cut sugars and calories from SSBs.
This is especially true for habitual soda drinkers who struggle to replace sugary beverages with only water.
LNCSBs provide the sweet taste these individuals crave without the high calories and blood sugar spike.
For overweight and obese adults at risk for diabetes, incorporating LNCSBs in place of sugary drinks could support modest weight loss and improvements in metabolic factors tied to chronic disease.
More long-term studies are still needed to determine if using LNCSBs has enduring benefits for hard clinical outcomes like heart attacks, strokes, and mortality.
But over 3 months, LNCSBs appear a safe substitute for SSBs and water for those trying to reduce sugar and lose weight.
LNCS Cautions and Considerations
A few words of caution regarding low- and no-calorie sweeteners:
- LNCSBs are not a magic bullet for weight loss. Reducing overall calories and increasing physical activity remain critical.
- Variety is key – rotate different LNCSBs to prevent taste fatigue.
- Focus on whole foods first before relying on highly processed LNCSBs for your daily water intake.
- Avoid compensating for the lower calories in LNCSBs by eating more calories elsewhere.
- LNCSBs alone are unlikely to improve metabolic health – decreasing sugary foods and beverages as a whole is important.
The Bottom Line: Diet Beverages
For those struggling to give up sugary sodas and teas, incorporating some LNCSBs may support moderate weight loss and metabolic improvements over 3 months when consumed instead of SSBs.
LNCSBs appear equally beneficial to water in the short term.
But long-term data are still limited.
More research is underway to clarify if LNCSBs have lasting benefits for weight management and chronic disease prevention.
References
- Study: Association of low and no calorie sweetened beverages as a replacement for sugar-sweetened beverages with body weight and cardiometabolic risk
- Authors: Nema D. McGlynn et al. (2022)
