Diet soda not a magic bullet for weight loss
BY KEITH ROACH, M.D.
DEAR DR. ROACH: My family members drink mega amounts of diet pop, including the kids, ranging from age 3 to age 10. All the adults have serious weight problems. They say they have to drink something besides water. What comments do you have? — A.H.
ANSWER: There remains a controversy about the effect of diet soda and nonsugar sweeteners on weight loss. Observational studies (those that correlate behaviors with outcomes) suggest that greater consumption of diet sodas is associated with a higher risk of obesity. There are several possible explanations for this, including that overweight people are more likely to drink diet soda to try to lose weight. However, there also is evidence that drinking diet soda increases appetite and changes the way we perceive taste.
Some interventional studies, generally considered the strongest evidence, have shown that people whose diet is changed to include diet sodas experience weight loss. Unfortunately, there is evidence of bias in these kinds of studies, possibly related to support by the industry.
Given that the information is unclear and even conflicting, I recommend a common-sense approach. If what you are doing isn’t working, you need to change it. If your family consumes large amounts of diet sodas and they have weight problems, changing from diet soda to water (or another unsweetened beverage, like tea or herbal beverages) may help.
By itself, though, it is probably not the answer. Losing weight requires a more comprehensive evaluation of the diet. Regular exercise is important as well. Even if a change to a healthier diet does not promote weight loss, it does help with many other issues, including risk of heart disease, cancer and diabetes.
DEAR DR. ROACH: Can you explain the purpose of taking fiber pills? I’ve heard some say they’re to relieve diarrhea, and others that they help with constipation. — J.K.
ANSWER: Fiber supplements help with both diarrhea and constipation. Fiber is not absorbable in our guts, so the fiber will pass through the gastrointestinal tract, taking fluid with it — which helps people with diarrhea to have less-watery stools. The increased bulk and water of the stool helps people with constipation, so fiber is a safe, first-line treatment for both mild diarrhea and constipation.
Fiber supplements have been thought to reduce cancer risk, but studies have shown that foods high in fiber are associated with lower cancer risk, while supplements are not. I recommend high-fiber foods as part of an overall healthy diet, but fiber supplements only for treatment of bowel symptoms.
Fiber supplements should always be taken with adequate water.
DEAR DR. ROACH: I am a Type 2 diabetic of 18 years, with pretty good blood sugar control at age 62. My last A1c was 7.3. A previous internist recommended that I take one baby aspirin per day. I discontinued this about two years ago because of minor bleeding issues, and have not restarted. I am very active and not a cardiac patient. Do I need to think about restarting? My current internist seems not to have a preference one way or the other. — B.B.
ANSWER: Different physicians will have different opinions, but for a person with a history of even a minor bleeding issue, most authorities would be likely to advise against it, despite the fact that aspirin has a modest benefit in people with diabetes. The benefit in reducing risk for a person without known heart blockages is small, and the risk of a serious bleeding event is probably higher than the benefit. Of course, the more serious the bleeding event, the more dangerous aspirin is.
Most people with diabetes should at least consider the use of a statin to prevent a first heart attack.