Frequent Diet Soda Intake Linked to Fourfold Increased Dementia Risk

 Has your competent? doctor and hospital managed to remove ALL soda from the  hospital? Not just diet soda?

soda (11 posts to September 2011)

Frequent Diet Soda Intake Linked to Fourfold Increased Dementia Risk

Frequent consumption of diet soda has been tied to an increased risk for dementia, although the association may be mediated by certain physical conditions.

New findings from the Northern Manhattan Study (NOMAS) showed a fourfold increased dementia risk among dementia-free individuals who consumed more than one diet soda per day. In addition, the increased risk was found in individuals who were White or Black but not Hispanic. 

However, after excluding participants with either diabetes or obesity, this association was no longer significant. 

“I think the takeaway message for clinicians is that we need more research to better understand the association of soda consumption with neurological health,” corresponding author Hannah Gardener, ScD, Department of Neurology, University of Miami Miller School of Medicine, Miami, told Medscape Medical News.

Still, she added that the study adds to previous research showing that drinking diet soda “is not very healthy, and consuming more of it is not an effective way to decrease cardiometabolic risk,” Gardener said.

The findings were published online on January 6 in the Journal of Alzheimer’s Disease.

The History of the Soda-Dementia Link

Soda consumption is linked to vascular risk, but little is known about its potential association with dementia. 

A prospective 2017 study published in Stroke showed an increased incidence of both stroke and dementia among participants who consumed artificially sweetened beverages, including diet soda — but not among those who consumed sugar-sweetened beverages.

On the other hand, a meta-analysis published in 2022 showed a link between cognitive disorders and sugar-sweetened beverages — but not with artificially sweetened beverages. 

The investigators wanted to assess these associations in a population-based cohort, deciding to analyze data from the longitudinal NOMAS project.

The analysis included 947 adults without dementia at baseline. Participants at the start of the study had a mean age of 64 years; 59% were women, 64% Hispanic, 18% Black, and 16% White. 

A variation of the Block-National Cancer Center Institute food-frequency questionnaire was used to determine consumption of both regular and diet soda. Among participants, 4.8% consumed regular soda more than once per day, and 2.3% consumed diet soda more than once per day.

Dementia was diagnosed using neuropsychological and functional testing, with 20% of participants developing the condition over the follow-up period.

Reverse Causation?

Diet soda consumption was linked to a significantly increased risk for dementia, with an adjusted incidence rate ratio (aIRR) of 1.39 per soda per day after accounting for demographic and vascular risk factors.

Those who consumed more than one diet soda per day had an even greater risk for dementia than those who drank one or fewer diet sodas per day (aIRR, 4.15; P = .001).

Diet soft drink consumption was also associated with a greater risk for dementia in non-Hispanic White and Black individuals but not in Hispanic individuals. 

Although the investigators had hypothesized that regular soda consumption would also be linked to increased risk for dementia, they found no significant association. Still, they did observe a “nonstatistically significant trend” (unadjusted P = .07).

Interestingly, sensitivity analyses showed that the link between higher consumption of diet soda and increased dementia risk “was not apparent after excluding those with obesity or diabetes, highlighting a potential for reverse causation,” the researchers reported.

“Further study is needed into the impacts of obesity and diabetes,” they added. 

Gardener noted that the study did not assess how long the participants had been drinking soft drinks, or whether or when they switched from regular sodas to diet versions.

“Were they increasing their consumption of diet sodas in an effort to control their metabolic risk factors — to consume fewer calories or to control their blood sugar? We really need more research to better understand if this association that we and other researchers have seen is causal,” she said.

No Definitive Answer

Commenting for Medscape Medical News, Matthew P. Pase, PhD, a professor of neurology in the School of Psychological Sciences at Monash University in Melbourne, Australia, said it was notable that the current findings closely resembled those from his 2017 Stroke paper, one of the first major studies to examine these associations, despite being conducted nearly nine years ago.

He also pointed out similar limitations in both papers, including the fact that consumption data were collected at the same timepoint and that it was difficult to tease out whether physical conditions, such as obesity and diabetes, may play a role in the diet soda-dementia association.

“It’s just a quick snapshot. We don’t know what these people were doing 5 or 10 or 30 years ago. It’s difficult to [assess] that, but I think that’s what’s needed in order to be able to really tease out the ‘chicken or the egg’ question,” he said. 

Pase added that it makes one wonder whether the association was only there because the individuals who drank diet drinks were already unhealthy

Overall, “I actually don’t think there’s a strong message yet for clinicians,” he said. 

If a patient raises the topic, “it might be best to say that the science is a bit mixed currently, and it makes it hard to make a conclusion one way or the other,” Pase said. 

Partial results were presented previously at the 2024 Alzheimer's Association International Conference in Philadelphia, Pennsylvania

NOMAS was funded by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging. One investigator reported receiving royalties from Wolters Kluwer, Inc. for a writing project on vascular dementia. Gardener, Pase, and the other investigators reported no relevant financial relationships.

Brews, Bubbles, & Booze: Stroke Risk and Patients’ Favorite Drinks

 For me coffee is reducing my risk of dementia and Parkinsons. Alcohol is doing the same by increasing my social connections exponentially. Much more important to me than these possible risks. I'm not medically trained, so don't listen to me. Just ask your competent? doctor EXACTLY where I'm wrong, you'll get sputtering.

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

Parkinson’s Disease May Have Link to Stroke March 2017

And the prevention possibilities here:

How coffee protects against Parkinson’s Aug. 2014  

Coffee May Lower Your Risk of Dementia Feb. 2013

Coffee drinkers rejoice! Drinking coffee could lower the risk of Alzheimer’s disease 

And this: Coffee's Phenylindanes Fight Alzheimer's Plaque December 2018

10+ years for your competent? doctor to come up with EXACT AMOUNTS OF COFFEE TO DRINK DAILY. Your incompetent doctors didn't do that, did they?

 And the benefits were not from caffeine as earlier research proved.

Benefits Aren't Just From Caffeine December 2018

The latest here:

Brews, Bubbles, & Booze: Stroke Risk and Patients’ Favorite Drinks

A growing body of research explores the link between stroke risk and regular consumption of coffee, tea, soda, and alcohol. This research roundup reviews the latest findings, highlighting both promising insights and remaining uncertainties to help guide discussions with your patients.

Coffee and Tea: Good or Bad? 

In the INTERSTROKE study, high coffee consumption (> 4 cups daily) was associated with an significantly increased risk for all strokes (odds ratio [OR], 1.37) or ischemic stroke (OR, 1.31), while low to moderate coffee had no link to increased stroke risk. In contrast, tea consumption was associated with lower odds of all stroke (OR, 0.81 for highest intake) or ischemic stroke (OR, 0.81). 

I'm doing a 12 cup pot of coffee a day to lessen my chance of dementia and Parkinsons. Tell me EXACTLY how much coffee to drink for that and I'll change. Yep, that is a lot more than the 400mg. limit. I think I'm in this category:  I never get the jitters or flushed skin.

Genetics determine how much coffee you can drink before it goes wrong

In a recent UK Biobank study, consumption of coffee or tea was associated with reduced risk for stroke and dementia, with the biggest benefit associated with consuming both beverages. 

Specifically, the investigators found that individuals who drank two to three cups of coffee and two to three cups of tea per day had a 30% decrease in incidence of stroke and a 28% lower risk for dementia vs those who did not.

A recent systematic review and dose-response meta-analysis showed that each daily cup increase in tea was associated with an average 4% reduced risk for stroke and a 2% reduced risk for cardiovascular disease (CVD) events. 

The protective effect of coffee and tea on stroke risk may be driven, in part, by flavonoids, which have antioxidant and anti-inflammatory properties, as well as positive effects on vascular function.

“The advice to patients should be that coffee and tea may protect against stroke, but that sweetening either beverage with sugar probably should be minimized,” Cheryl Bushnell, MD, MHS, of Wake Forest University School of Medicine in Winston-Salem, North Carolina, and chair of the American Stroke Association 2024 Guideline for the Primary Prevention of Stroke, told Medscape Medical News. 

Taylor Wallace, PhD, a certified food scientist, told Medscape Medical News, “most people should consume a cup or two of unsweetened tea per day in moderation for cardiometabolic health. It is an easy step in the right direction for good health but not a cure-all.”

When it comes to coffee, adults who like it should drink it “in moderation — just lay off the cream and sugar,” said Wallace, adjunct associate professor at George Washington University, Washington, DC, and Tufts University, Boston, Massachusetts.

“A cup or two of black coffee with low-fat or nonfat milk with breakfast is a healthy way to start the day, especially when you’re like me and have an 8-year-old that is full of energy!” Wallace said. 

The Skinny on Soda

When it comes to sugar-sweetened and diet beverages, data from the Nurses’ Health Study and Health Professionals Follow-Up Study, showed a 16% increased risk for stroke with one or more daily servings of sugar-sweetened or low-calorie soda per day (vs none), independent of established dietary and nondietary cardiovascular risk factors. 

I never do soda, way too dangerous.

In the Women’s Health Initiative Observational Study of postmenopausal women, a higher intake of artificially-sweetened beverages was associated with increased risk for all stroke (adjusted hazard ratio [aHR], 1.23), ischemic stroke (aHR, 1.31), coronary heart disease (aHR, 1.29) and all-cause mortality (aHR, 1.16). 

In the Framingham Heart Study Offspring cohort, consumption of one can of diet soda or more each day (vs none) was associated with a nearly threefold increased risk for stroke and dementia over a 10-year follow-up period. 

A separate French study showed that total artificial sweetener intake from all sources was associated with increased overall risk for cardiovascular and cerebrovascular disease.

However, given the limitations of these studies, it’s hard to draw any firm conclusions, Wallace cautioned. 

“We know that sugar-sweetened beverages are correlated with weight gain and cardiometabolic dysfunction promotion in children and adults,” he said. 

Yet, “there really isn’t any convincing evidence that diet soda has much impact on human health at all. Most observational studies are mixed and likely very confounded by other diet and lifestyle factors. That doesn’t mean go overboard; a daily diet soda is probably fine, but that doesn’t mean go drink 10 of them every day,” he added. 

Alcohol: Moderation or Abstinence?

Evidence on alcohol use and stroke risk have been mixed over the years. For decades, the evidence was suggestive that a moderate amount of alcohol daily (one to two drinks in men and one drink in women) may be beneficial at reducing major vascular outcomes.

I'm using it for social connections for prevention of dementia thus I'm ignoring the cons because I think the benefits exceed the cons. But I'm not medically trained so don't listen to me. 

Alcohol for these 12 reasons.

Yet, over the past few years, some research has found no evidence of benefit with moderate alcohol intake. And the detrimental effects of excessive alcohol use are clear. 

A large meta-analysis showed that light to moderate alcohol consumption (up to one drink per day) was associated with a reduced risk for ischemic stroke. However, heavy drinking (more than two drinks per day) significantly increased the risk for both ischemic and hemorrhagic stroke.

A separate study showed young adults who are moderate to heavy drinkers are at increased risk for stroke — and the risk increases with more years of imbibing.

In the INTERSTROKE study, high to moderate alcohol consumption was associated with increased stroke risk, whereas low alcohol consumption conferred no increased risk. 

However, Bushnell pointed out that the study data was derived from based on self-report, and that other healthy behaviors may counteract the risk for alcohol consumption.

“For alcohol, regardless of stroke risk, the most important data shows that any alcohol consumption is associated with worse cognitive function, so generally, the lower the alcohol consumption the better,” Bushnell said. 

She noted that, currently, the American Heart Association (AHA)/American Stroke Association (ASA) recommend a maximum of two drinks per day for men and one drink per day for women to reduce stroke risk.

“However, the data for the risk for cognitive impairment with any alcohol is convincing and should be kept in mind in addition to the maximum alcohol recommended by the AHA/ASA,” Bushnell advised. 

“We know excessive intake puts you at major risk for CVD, cancer, cognitive decline, and a whole host of other health ailments — no question there,” said Wallace.

The impact of moderate intake, on the other hand, is less clear. “Alcohol is a highly biased and political issue and the evidence (or lack thereof) on both sides is shoddy at best,” Wallace added. 

A key challenge is that accurate self-reporting of alcohol intake is difficult, even for scientists, and most studies rely on self-reported data from observational cohorts. These often include limited dietary assessments, which provide only a partial picture of long-term consumption patterns, Wallace noted. 

“The short answer is we don't know if moderation is beneficial, detrimental, or null with respect to health,” he said.

Bushnell reports no relevant disclosures. Wallace (www.drtaylorwallace.com) is CEO of Think Healthy Group; editor, Journal of Dietary Supplements; deputy editor, Journal of the American Nutrition Association (www.nutrition.org); nutrition section editor, Annals of Medicine; advisory board member with Forbes Health.

New study reveals: Is fruit juice as bad as soda?

Well your doctor will have to analyze the positives of these various juices vs.  this study.  But since they excluded strokes from the study, there is no idea how this would apply. That is where your doctor comes in, with their knowledge they should be able to come up with specific recommendations.  But don't worry, you will be completely on your own to figure this out. 

Cranberry juice consumption may protect against cardiovascular disease

 

Drinking low-calorie cranberry juice may help lower risk of heart disease, diabetes and stroke

 

 

Watermelon juice reverses hardening of the arteries  

Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation

Pomegranate Can Help Reduce Risk Of Heart Attacks, Strokes, Diabetes, Anemia

Regular pomegranate juice administered to hypertensive patients caused a significant drop in blood pressure [26], a reduction in carotid plaque development [27]  Aug. 2006 

Can pomegranates protect the brain from dementia?

 

 

Cardioprotective Effects of Pomegranate (Punica granatum) Juice in Patients with Ischemic Heart Disease

Chronic consumption of flavanone-rich orange juice is associated with cognitive benefits: an 8-wk, randomized, double-blind, placebo-controlled trial in healthy older adults  You doctor just needs to be able to extrapolate this to non-healthy adults, namely you.

Orange juice could help improve brain function in elderly people

Cognitive and mood improvements following acute supplementation with purple grape juice in healthy young adults It would take a lot to extrapolate this to most stroke survivors, they aren't healthy or young.

High blood pressure lowers significantly after drinking tart Montmorency cherry juice

 

I'm sure there is much more but I've only been at this 9 years. How long has your doctor been figuring out how to solve stroke?

 

 

 

New study reveals: Is fruit juice as bad as soda?

Naveed Saleh, MD, MS, for MDLinx | May 23, 2019

You probably know that most sugary drinks—including sugar-sweetened beverages (SSBs) like soda, soft drinks, and fruit-flavored drinks—are bad for you. But what about 100% fruit juice, another type of sugary drink?

Drinks labeled 100% fruit juice may appear healthy and natural, but they’re nearly as unhealthy as sugar-sweetened drinks and contain just as much sugar.

Although there have been some declines in sugar consumption in recent years, people still drink a lot of sugary drinks and consume a lot of sugar in the diet. In public health campaigns, less attention has been paid to 100% fruit juices, which many consider to be healthy.
In a new study, researchers found that 100% fruit juice and sugary beverages equally increased risk of early mortality.

Just sugar and water

In a large cohort study (n=13,440; mean age: 63.6 years; 59.3% men; 70.8% overweight or obese) published in JAMA Network Open, researchers examined the link between death and the consumption of SSBs and 100% fruit juices, both alone and in combination.
Patients with known coronary heart disease (CHD), stroke, or diabetes at baseline were excluded. The researchers determined the consumption of SSBs and 100% fruit juice using food-frequency questionnaires, and patients were followed up every 6 months for an average of 6 years.
Almost all the members of the study population (97.4%) reported drinking some type of sugary beverage, with 10,873 subjects (80.9%) drinking SSBs and 12,637 subjects (94.0%) drinking fruit juices. Average sugary beverage consumption was 8.4% of total energy intake per day.
During follow-up, 168 subjects died from CHD-related causes, and 1,000 died from any cause. The risk-adjusted hazard ratio—a measure of instantaneous risk—was 1.44% (95% CI: 0.97-1.33) for death from CHD and 1.14% (95% CI: 0.97-1.33) for all-cause mortality in subjects who had the highest amount of sugar intake.
The authors concluded that increased consumption of sugary beverages, including 100% fruit juices, upped all-cause mortality in older adults.
“Fruit juices are still widely perceived as a healthier option than SSBs. However, they often contain as much sugar and as many calories as SSBs. Although the sugar in 100% fruit juices is naturally occurring rather than added, once metabolized, the biological response is essentially the same,” wrote Marta Guasch-Ferré, PhD, and Frank B. Hu, MD, PhD, Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, in an invited commentary.

• See Also: Healthy habits: Can there be too much of a good thing?

While 100% fruit juices do contain vitamins and phytonutrients, which make them slightly healthier than most SSBs, the main ingredients in both are sugar and water. These sugars are either a mix of the monosaccharides glucose and fructose or the disaccharide sucrose, which is metabolized into equal parts fructose and glucose.
Notably, the authors doubted that obesity itself was the mechanism that led to higher risks of CHD mortality and overall mortality.
“Given that the higher risk with sugary beverage consumption occurs even when controlling for [body mass index] and the lack of significant interaction between sugary beverage consumption and weight status, our findings suggest that other factors are at play,” they wrote. “Sugary beverages increase insulin resistance and CHD mortality risk independent of adiposity. Insulin resistance is known to increase triglyceride levels and atherosclerosis, which are important cardiovascular disease risk factors.”
The authors suggested that, given the dietary repercussions of all types of sugary drinks, public health efforts should be expanded to target not only sugar and SSBs, but also fruit juices.

Too much sugar

The only other study on the association between mortality risk and sugar consumption was conducted by researchers at the CDC and published in JAMA Internal Medicine. The researchers mined data from the National Health and Nutrition Examination Survey and found a higher risk of cardiac mortality among US adults who ate more sugar.
The adjusted mean percentage of daily calories due to added sugar went up from 15.7% in 1988-1994 to 16.8% in 1999-2004, and then dropped back down to 14.9% in 2005-2010. In total, 71.4% of US adults consumed 10% or more calories from added sugar. Furthermore, 10% of US adults consumed 25% or greater calories from added sugar in 2005-2010.
Age-, sex-, and race/ethnicity–adjusted hazard ratios of cardiovascular disease mortality spanning quintiles of the percentage of daily calories ingested from added sugar were 1.00 (reference), 1.09 (95% CI: 1.05-1.13), 1.23 (1.12-1.34), 1.49 (1.24-1.78), and 2.43 (1.63-3.62; P < .001), respectively. After controlling for sociodemographic, behavioral, and clinical factors, hazard ratios were 1.00 (reference), 1.07 (1.02-1.12), 1.18 (1.06-1.31), 1.38 (1.11-1.70), and 2.03 (1.26-3.27; P=0.004), respectively.
“Most US adults consume more added sugar than is recommended for a healthy diet,” concluded the authors. “We observed a significant relationship between added sugar consumption and increased risk for [cardiovascular disease] mortality.”

Keep it in perspective

But does this mean you should avoid fruit juice altogether? Not if it’s your only source of nutrition, says Isabel Maples, MEd, RDN, registered dietitian and spokesperson, Academy of Nutrition and Dietetics, Chicago, IL.
“When eating healthier, don’t be afraid to pour a glass of juice!” she said. “Most children, teens, and adults don’t get the nutrition that they need because they’re not eating enough fruit. Drinking fruit juice can help fill that nutrient gap. Plus, juice tastes good, so people are likely to substitute juice for sugary drinks.”
Maples said it’s true that our bodies digest fruit juice just like sugar-sweetened beverages, but she insists that sugar is not evil. “Not too long ago, fat was food enemy #1. It’s not sugar that is bad—it’s too much added sugar, and it’s how sugar squeezes good nutrition out of the diet because we eat fewer nutrition-packed foods like fruit. For better nutrition, keep the five food groups in balance.”
She added, “When fear, not facts, drive our food decisions, extremes can happen…and suddenly, food is no longer fun. That’s when good nutrition suffers.”

Dementia Linked To Beverage Drunk By 50% Of People Every Day

Only rarely do I ever drink a soda, it is coffee or wine all the time for the best benefits, sometimes  cranberry pomegranate juice. Beer is quite acceptable since at bars you never know how long ago that bottle of wine was opened. 
http://www.spring.org.uk/2017/04/beverage-dementia.php

Half of Americans use a drink linked to dementia on any given day.

Both sugary and artificially sweetened ‘diet’ drinks are linked to dementia by two new studies.

People who drink sugary beverages tend to have poorer memories, smaller brains and a smaller hippocampus (an area vital for learning and memory).

Diet sodas, though, don’t seem much safer.

A follow-up study found that people who drink diet sodas are three times more likely to develop dementia and stroke, compared to those who drink none.

Both studies show associations, so it doesn’t prove cause and effect.

Professor Sudha Seshadri, who led the research, said:

“These studies are not the be-all and end-all, but it’s strong data and a very strong suggestion.

It looks like there is not very much of an upside to having sugary drinks, and substituting the sugar with artificial sweeteners doesn’t seem to help.

Maybe good old-fashioned water is something we need to get used to.”

Excess sugar intake has long been linked to obesity, diabetes  and heart disease.

Its effect on the brain is more of an unknown (although what are the chances it’s going to be good for us?!)

More surprising is the link between diet sodas and dementia.

The researchers suggest it could be down to the artificial sweeteners used.

Sugar is toxic to the brain

This is certainly not the first study to link sugar intake with dementia.

A recent study linked excess sugar intake with Alzheimer’s disease.

It suggested that too much glucose (sugar) in the diet damages a vital enzyme which helps fight the early stages of Alzheimer’s disease.

High blood sugar levels have also been linked to memory problems.

The researchers in this study think that sugar could have a ‘toxic’ effect on the brain.

The studies were published in the journals Stroke and Alzheimer’s & Dementia (Pase et al., 2017; Pase et al., 2017).

Sugar-Sweetened and Artificially Sweetened Beverages in Relation to Stroke and Dementia

Be careful out there.  Don't drink soda at all. 

Sugar-Sweetened and Artificially Sweetened Beverages in Relation to Stroke and Dementia

Are Soft Drinks Hard on the Brain?

Heike Wersching, Hannah Gardener, Ralph L. Sacco

Download PDF

https://doi.org/10.1161/STROKEAHA.117.017198

Stroke. 2017;48:1129-1131

Originally published April 24, 2017

• Article
• Info & Metrics

• Editorials
• American Heart Association
• beverages
• diet
• hypertension
• stroke

See related article, p 1139.

Although the consumption of sodas has been decreasing in most Western countries during the past 2 decades, sugar-sweetened beverages (SSBs) are the leading sources of added sugars in the US diet and are increasing on a global level.^1–3 As measured by the recommendation of the 2015 World Health Organization Guideline on the intake of free sugars, a single can of sugar-sweetened soda contains about the upper limit of the recommended 25 to 50 g per day.⁴ Moreover, the American Heart Association/American Stroke Association has defined 1 component of an ideal cardiovascular diet as consisting of ≤450 kcal/wk of SSBs. The harmful effects of regular SSB consumption, including weight gain, the metabolic syndrome, and type 2 diabetes mellitus, have been demonstrated in numerous large observational studies.^5–9 Furthermore, a higher intake of SSBs has been repeatedly associated with increased risks of hypertension, coronary heart disease, and stroke, as well as with adverse changes in lipid levels and inflammatory markers.^10,11 A recent estimation based on nationally representative data calculated that >50 000 cardiometabolic deaths in US adults in 2012 can be attributed to high SSB consumption, making SSBs the leading factor associated with cardiometabolic mortality in young and middle-aged adults.¹²

Artificially sweetened beverages (ASBs) are marketed as healthier alternatives to SSBs. Their consumption is rising in the United States, particularly among children.¹³ The American Heart Association and American Diabetes Association have given a cautious nod to the use of artificial sweeteners in place of sugar to combat obesity, metabolic syndrome, and diabetes mellitus,^14,15 but there is still uncertainty about the benefits and even healthfulness of ASBs.¹⁶ Several large observational studies, including the Atherosclerosis Risk in Communities Study,¹⁷ the Framingham Heart Study,¹⁸ and the Multi-Ethnic Study of Atherosclerosis,¹⁹ reported a positive association between diet soda consumption and increased risks of the metabolic syndrome and type 2 diabetes mellitus. Results from the Northern Manhattan Study further indicated that diet soda consumption was associated with an increased risk of stroke, myocardial infarction, and vascular death,²⁰ and a study based on combined data from the Nurses’ Health Study the Health Professionals Follow-Up Study reported higher incidence of hemorrhagic strokes in subjects with high regular low-calorie soda intake.²¹ Alternatively, other longitudinal studies have not confirmed the association between the intake of ASB and cardiovascular disease risk.^11,22

In this issue, Pase et al²³ contribute new data to this debate. Using prospective data from the Framingham Offspring Cohort, they analyzed the relationship between recent and long-term consumption of SSBs and ASBs and the risks of incident stroke and dementia. On the basis of participants who completed a validated food frequency questionnaire between 1998 and 2001 and additionally during at least 1 of the 2 previous examination cycles (1991–1995 and 1995–1998), the authors found that during a follow-up of 10 years, higher recent and cumulative intake of artificially sweetened soft drinks was associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer’s dementia. The effects persisted when analyses were adjusted for total caloric intake, diet quality, physical activity, and smoking status. However, the associations between recent and higher cumulative intake of artificially sweetened soft drinks and dementia were no longer significant after additional adjustment for vascular risk factors and diabetes mellitus.

In the study by Pase et al,²³ the intake of SSBs was not associated with stroke or dementia. This finding could be attributed to selection bias, such that particularly vulnerable participants, that is, long-term SSB consumers with a very high cardiovascular risk died earlier. This could also explain the lower-risk profile of high SSB consumers compared with high ASB consumers the data of which were collected in 1998 to 2001. As already discussed, the results from previous studies of associations between SSB and stroke and the direct causal pathways linking SSB and vascular outcomes provide ample evidence to support World Health Organization and American Heart Association/American Stroke Association initiatives to reduce the consumption of SSBs.

The interpretation of the association between ASB consumption and vascular outcomes is more controversial. Is there a direct or indirect causal pathway or is there an association because of bias from reverse causation? As discussed in the works of Gardener et al²⁰ and Pase et al,²³ confounding by reverse causation cannot be ruled out in these observational studies. People at increased risk of vascular events because of preexisting vascular risk factors may switch from regular to diet soft drinks in an attempt to control weight and insulin resistance. It is entirely possible that the intake of ASB starts after the cardiovascular risk is increased and, therefore, is a marker of a high-risk profile rather than being a causal risk factor for stroke or dementia. The data presented by Pase et al²³ can be interpreted in favor of this hypothesis: compared with people with high intake of SSBs, participants regularly consuming ASB showed a higher prevalence of hypertension, diabetes mellitus, and cardiovascular disease.

Whether the observed associations between ASBs and vascular outcomes reflect reverse causation bias is difficult to elucidate. In the epidemiological literature, adjustment for vascular risk factors has typically attenuated many of the effects of ASBs. This can be interpreted as either a reduction in bias because of confounding or blocking of potential indirect causal pathways through which ASB consumption may impact cerebrovascular health. ASB consumption may occur because of weight gain but could also exacerbate these conditions. Disentangling these effects and their temporality is challenging in epidemiological studies. Sensitivity analyses such as excluding high-risk subjects also attenuated effects in this study, but similar analyses have not resulted in the attenuation of effects in all studies. Sensitivity analyses in which the first several years of follow-up are excluded is also an option to help minimize bias caused by reverse causality, and such analyses have not eliminated the observed relationship between ASB consumption and diabetes mellitus.²⁴

From a biological perspective, there are no obvious pathways. Studies on the effects of ASB consumption on weight gain have yielded inconsistent results. There is some experimental work suggesting that artificial sweeteners may increase cravings for high glycemic and high-calorie foods, induce glucose intolerance, or impair caloric compensation, thereby increasing calorie intake and body weight.^25,26 Another proposed mechanism refers to advanced glycation end products, which are produced during the process of caramelization used in some ASBs and SSBs which might be proinflammatory and promote insulin resistance.¹⁸ Other hypothesized mechanisms linking ASB consumption with adverse vascular effects and insulin resistance include hormonal and microbiota effects,²⁵ and the phosphoric acid in diet soda has also been hypothesized to play a role in vascular outcomes.⁸ None of these hypotheses have been adequately proven calling for more experimental studies. In light of inconsistent evidence in the epidemiological literature, coherence with laboratory findings will provide important information to determine causality.

Nevertheless, both, the causal and bias hypotheses, are possible interpretations of these observational data, and further studies are needed. One possibility could be a cohort starting in childhood and following up through adolescence and adulthood thereby closely monitoring changes in nutrition and the development of (subclinical) vascular disease. Long-term prospective studies will help inform the temporality of vascular outcomes in relation to ASB consumption and the sensitive periods during the life course during which ASB consumption may have the greatest impact on brain and heart health. Another, less valid, but faster, option would be a retrospective collection of data on lifetime exposures on nutrition and associated health behaviors to facilitate the characterization and stratification of different exposure groups.²⁰ In future epidemiological studies, we recommend greater collection of data that may help answer these questions, including previous weight fluctuations, dieting behavior, changes in SSB/ASB consumption over time, and reasons for choosing ASB consumption.

The work by Pase et al²³ highly encourages further discussion and more research into this question, for even small causal effects would have tremendous effects on public health due to the popularity of both ASB and SSB consumption. The current body of literature is inconclusive about the causal nature of the associations between ASB consumption and risk of stroke, dementia, diabetes mellitus, and the metabolic syndrome. The growing number of epidemiological studies showing strong associations between frequent consumption of ASBs and vascular outcomes, however, suggests that it may not be reasonable to substitute or promote ASBs as healthier alternatives to SSBs. Both sugar-sweetened and artificially sweetened soft drinks may be hard on the brain.

Diet Soda vs. Regular Soda: Is One Worse For You Than The Other?

Good luck. I try not to drink either very much.
http://www.medicaldaily.com/diet-soda-vs-regular-soda-one-worse-you-other-308063

Woman Drinks Only Soda for 16 Years, Suffers Heart Problems

You can read it all at the link, I'll highlight concerns we should know about.

Woman Drinks Only Soda for 16 Years, Suffers Heart Problems

High amounts of caffeine can also increase urine production and decrease potassium reabsorption, the researchers said. Potassium plays a role in helping a person's heartbeat, and low levels of potassium may cause heart rhythm problems.
So the amount of coffee you are drinking may need to adjust your potassium intake. I eat 3 bananas a day, that may not be enough for the 8-12 cups of coffee I drink. Question for your doctor.

As If You Needed Another Reason to Avoid Soda: Study Shows One Can Per Day Increases Your Risk of Stroke

See how long before your doctor tells you about this, I'm guessing 20 years.
http://www.wetpaint.com/moms/articles/as-if-you-needed-another-reason-to-avoid-soda-study-shows-one-can-per-day-increases-your-risk-of-stroke
Turns out it’s not just diet soda that’s bad for you. Women’s Health reports that a new study out of Japan shows a whopping 83% increase in the chance of stroke in women who had about one sugary soda per day. Just one!

The study lasted for 18 years, and shows that even women who curbed their soda intake during the study’s first three to nine years still had an increased risk of stroke. So the soda you drink today, even if you stop years from now, can come back to haunt you in a big way.

More at link.

Sugary drinks linked to higher stroke risk: study

Another one of these alarmist titles, putting all the prevention responsibility on you. Doctor question.
http://o.canada.com/2012/10/31/sugary-drinks-linked-to-higher-stroke-risk-study/

Regular soda intake spikes stroke risk

These are observational studies so you can compare these dangers to diet soda dangers yourself.
http://www.onlinenews.com.pk/details.php?id=191777
ISLAMABAD: Regularly quaffing sugar-sweetened, low-calorie sodas is likely to spike risk of a stroke, but intake of caffeinated or decaffeinated coffee seems to lower it, a study reveals.
The study is the first to examine soda`s effect on stroke (when brain is deprived of blood supply) risk. Previous research has linked sugar-sweetened beverage consumption with weight gain, diabetes, high blood pressure, high cholesterol, gout and coronary artery disease.
"Soda remains the largest source of added sugar in the diet," said Adam Bernstein, study author and research director at Cleveland Clinic`s Wellness Institute, the American Journal of Clinical Nutrition reported.
"What we`re beginning to understand is that regular intake of these beverages sets off a chain reaction in the body that can potentially lead to many diseases - including stroke," added Bernstein, according to a university statement.
The research analyzed soda consumption among 43,371 men, who participated in the Health Professionals Follow-Up Study between 1986 and 2008, and 84,085 women who participated in the Nurses` Health Study between 1980 and 2008. During that time, 2,938 strokes were documented in women while 1,416 strokes were documented in men.
In sugar-sweetened sodas, the sugar load may lead to rapid increases in blood glucose and insulin which, over time, may lead to glucose intolerance, insulin resistance, and inflammation, all of which are risk factors of ischemic stroke (blood supply to the brain is blocked). This risk for stroke appears higher in women than in men.
Conversely, coffee contains chlorogenic acids, lignans and magnesium, all of which act as antioxidants and may reduce stroke risk. When compared with one serving of sugar-sweetened soda, one serving of decaffeinated coffee was associated with a 10 percent lower risk of stroke.

Diet drinks here:
http://oc1dean.blogspot.com/2012/02/heart-danger-in-diet-drinks.html

Sugary soda ups risky fat deposits

So I guess I shouldn't be drinking the old-style Mountain Dew. But then there is the risk associated with diet sodas to consider.
http://www.kdvr.com/lifestyle/sns-rt-us-sugary-sodatre80b1ws-20120112,0,4156385.story
Drinking a liter of regular cola every day increases the amount of fat in the liver and in the muscles and surrounding the organs in the belly, according to a new Danish study.

That kind of fat buildup has been linked in other studies to an increased risk of diabetes and heart disease.Sign Up to Receive Daily Deal Alerts - Up to 80% Off Dining, Entertainment & More
"This study suggests that the adverse effects of sugary beverages go beyond just weight gain or fat gain. It's the gaining of the wrong fat in the wrong places," said Dr. Frank Hu, a professor at the Harvard School of Public Health, who was not involved in this study.

The researchers, led by Dr. Bjrn Richelsen at Aarhus University Hospital in Denmark asked people to drink either a liter of water, milk, diet cola or regular cola each day for six months.

The 47 people who participated in the study were all overweight or obese.

Richelsen said his team chose to study this group because they anticipated overweight or obese people would be more sensitive to dietary changes than people of normal weight.

At the end of the study the regular cola drinkers ended up with 25 percent more fat surrounding their organs, and just about doubled the amount of fat in the liver and muscle.

Such increases "are in most studies associated with an enhanced risk for developing the metabolic syndrome, type 2 diabetes...cardiovascular diseases, and non-alcoholic liver diseases," Richelsen told Reuters Health by email.

Metabolic syndrome is a group of health factors that is linked to an increased risk of diabetes, heart disease and stroke.

The type of fat Richelsen's group studied -- called ectopic fat -- is thought to be more dangerous to people's metabolic health than "subcutaneous" fat, the kind that collects under the skin.

"It is well-established that ectopic fat is 'unhealthy' and induces dysfunction of the organs involved," Richelsen said.

Hu said the results from Richelsen's experiment complement those that have surveyed people about their soda drinking habits.

"This study provides another piece of evidence to support the recommendations for the reduction of sugar-sweetened beverage consumption," Hu told Reuters Health.

DO SODA TAXES WORK?

The American Heart Association recommends drinking no more than about three cans of soda a week, while young men far exceed that, with about two cans a day on average (see Reuters Health report of August 31, 2011).

Some cities and states in the United States have batted around the idea of a tax on sugar-sweetened drinks to curb people's consumption.

Denmark has instituted a tax on sugary items, but Richelsen said it's not clear how it has impacted consumers.

One study at a hospital cafeteria found that raising the price of soda by 35 cents reduced sales by 26 percent (see Reuters Health report of June 18, 2010).

The current study, published in the American Journal of Clinical Nutrition, did not find that the cola drinkers gained more weight than the other groups.

Richelsen said it's possible that the people reduced the amount of calories they ate or drank to compensate for the extra calories in the pop.

The researchers point out in their study that the sugar in soda from Denmark is different from most sodas in the United States.

In Europe, the sweetener is sucrose, as opposed to the high fructose corn syrup used in the U.S.

"It is quite convincing from the scientific literature that it is the fructose part of the sugar molecule...that is the primary culprit in inducing fat synthesis in the liver," Richelsen said.

Given that there is extra fructose in high fructose corn syrup, Richelsen said, soda from the U.S. could lead to more pronounced problems with fat gain.

5 Foods That Can Trigger a Stroke

I think this is just some hyperbole to get you to read it. But it worked, didn't it?
http://beinglatino.wordpress.com/2011/09/21/5-foods-that-can-trigger-a-stroke/
Few things feel more terrifying and random than a stroke, which can strike without warning. And fear of stroke — when a blood vessel in or leading to the brain bursts or is blocked by a blood clot, starving brain cells of oxygen and nutrients — is well founded. After all, stroke is the number-three killer in the U.S., affecting more than 700,000 people each year. Here are five foods that cause the damage that leads to stroke.

1. Crackers, chips, and store-bought pastries and baked goods

Muffins, doughnuts, chips, crackers, and many other baked goods are high in trans fats, which are hydrogenated oils popular with commercial bakeries because they stay solid at room temperature, so the products don’t require refrigeration. Also listed on labels as “partially hydrogenated” or hydrogenated oils, trans fats are found in all kinds of snack foods, frozen foods, and baked goods, including salad dressings, microwave popcorn, stuffing mixes, frozen tater tots and French fries, cake mixes, and whipped toppings. They’re also what makes margarine stay in a solid cube. The worst offenders are fried fast foods such as onion rings, French fries, and fried chicken.

Why it’s bad – For years scientists have known trans fats are dangerous artery-blockers, upping the concentrations of lipids and bad cholesterol in the blood and lowering good cholesterol. Now we can add stroke to the list of dangers. This year researchers at the University of North Carolina found that women who ate 7 grams of trans fat each day — about the amount in two doughnuts or half a serving of French fries — had 30 percent more strokes (the ischemic type, caused by blocked blood flow to the brain) than women who ate just 1 gram a day. Another recent study, also in women, found that trans fats promoted inflammation and higher levels of C-reactive protein, which have been linked to an increased risk of diabetes, heart disease, and stroke.

What to do – Aim to limit trans fats to no more than 1 or 2 grams a day — and preferably none. Avoid fast-food French fries and other fried menu items and study packaged food labels closely. Even better, bake your own cookies, cakes, and other snacks. When you can’t, search out “health-food” alternative snacks, such as Terra brand potato chips and traditional whole grain crackers such as those made by Finn, Wasa, AkMak, Ryvita, and Lavasch.

2. Smoked and processed meats

Whether your weakness is pastrami, sausage, hot dogs, bacon, or a smoked turkey sandwich, the word from the experts is: Watch out.

Why it’s bad – Smoked and processed meats are nasty contributors to stroke risk in two ways: The preserving processes leave them packed with sodium, but even worse are the preservatives used to keep processed meats from going bad. Sodium nitrate and nitrite have been shown by researchers to directly damage blood vessels, causing arteries to harden and narrow. And of course damaged, overly narrow blood vessels are exactly what you don’t want if you fear stroke.

Many studies have linked processed meats to coronary artery disease (CAD); one meta-analysis in the journal Circulation calculated a 42-percent increase in coronary heart disease for those who eat one serving of processed meat a day. Stroke is not the only concern for salami fans; cancer journals have reported numerous studies in the past few years showing that consumption of cured and smoked meats is linked with increased risk of diabetes and higher incidences of numerous types of cancer, including leukemia.

What to do – If a smoked turkey or ham sandwich is your lunch of choice, try to vary your diet, switching to tuna, peanut butter, or other choices several days a week. Or cook turkey and chicken yourself and slice it thin for sandwiches.

3. Diet soda

Although replacing sugary drinks with diet soda seems like a smart solution for keeping weight down — a heart-healthy goal — it turns out diet soda is likely a major bad guy when it comes to stroke.

Why it’s bad – People who drink a diet soda a day may up their stroke risk by 48 percent. A Columbia University study presented at the American Stroke Association’s 2011 International Stroke Conference followed 2,500 people ages 40 and older and found that daily diet soda drinkers had 60 percent more strokes, heart attacks, and coronary artery disease than those who didn’t drink diet soda. Researchers don’t know exactly how diet soda ups stroke risk — and are following up with further studies — but nutritionists are cautioning anyone concerned about stroke to cut out diet soda pop.

What to do – Substitute more water for soda in your daily diet. It’s the healthiest thirst-quencher by far, researchers say. If you don’t like water, try lemonade, iced tea, or juice.

4. Red meat

This winter, when the respected journal Stroke published a study showing that women who consumed a large portion of red meat each day had a 42-percent higher incidence of stroke, it got nutrition experts talking. The information that red meat, with its high saturated fat content, isn’t healthy for those looking to prevent heart disease and stroke wasn’t exactly news. But the percentage increase (almost 50 percent!) was both startling and solid; the researchers arrived at their finding after following 35,000 Swedish women for ten years.

Why it’s bad – Researchers have long known that the saturated fat in red meat raises the risk of stroke and heart disease by gradually clogging arteries with a buildup of protein plaques. Now it turns out that hemoglobin, the ingredient that gives red meat its high iron content, may pose a specific danger when it comes to stroke. Researchers are investigating whether blood becomes thicker and more viscous as a result of the consumption of so-called heme iron, specifically upping the chance of strokes.

What to do – Aim to substitute more poultry — particularly white meat — and fish, which are low in heme iron, for red meat. Also, choose the heart-healthiest sources of protein whenever you can, especially beans, legumes, nuts, tofu, and nonfat dairy.

5. Canned soup and prepared foods

Whether it’s canned soup, canned spaghetti, or healthy-sounding frozen dinners, prepared foods and mixes rely on sodium to increase flavor and make processed foods taste fresher. Canned soup is cited by nutritionists as the worst offender; one can of canned chicken noodle soup contains more than 1,100 mg of sodium, while many other varieties, from clam chowder to simple tomato, have between 450 and 800 mg per serving. Compare that to the American Heart and Stroke Association’s recommendation of less than1,500 mg of sodium daily and you’ll see the problem. In fact, a nutritionist-led campaign, the National Salt Reduction Initiative, calls on food companies to reduce the salt content in canned soup and other products by 20 percent in the next two years.

Why it’s bad – Salt, or sodium as it’s called on food labels, directly affects stroke risk. In one recent study, people who consumed more than 4,000 mg of sodium daily had more than double the risk of stroke compared to those who ate 2,000 mg or less. Yet the Centers for Disease Control estimate that most Americans eat close to 3,500 mg of sodium per day. Studies show that sodium raises blood pressure, the primary causative factor for stroke. And be warned: Sodium wears many tricky disguises, which allow it to hide in all sorts of foods that we don’t necessarily think of as salty.

Some common, safe-sounding ingredients that really mean salt:

• Baking soda
• Baking powder
• MSG (monosodium glutamate)
• Disodium phosphate
• Sodium alginate

What to do – Make your own homemade soups and entrees, then freeze individual serving-sized portions. Buy low-sodium varieties, but read labels carefully, since not all products marked “low sodium” live up to that promise.

• 5 Surprising Signs of an Unhealthy Heart