Sugar Sweetened Beverages & Total Energy Intake: Studies Suggest That Normal-, Overweight & Obese Women CAN Compensate for 168 Additional Sugar Calories Per Day

Usually they are touted as the reason for weight gain: Sugar-containing soft drinks like the Scottish brew Irn Bru. In the study at hand, however, they helped 41 obese women lose weight - how come?

Despite the fact that it is not the first of it's kind, I decided that the paper Roy Nelson sent me the a couple of days ago may still be worth being covered in a brief article. Marie Reid and her colleagues were after all able to show that we can, theoretically and without conscious effort, compensate for the additional energy intake from sugar-sweetened beverages.

As I already mentioned, this is not the first study Reid and her colleagues from the Hull, Ulster and Herriot-Watt Universities in the UK conducted, but it is the first one where the subjects, obese women, with previous diet experience, came right from the subgroup of the population of whom we simply assume that their weight problems would (partly) result from these "empty calories".

Would the women "recognize" the 168kcal of pure sugar in their diets?

After exclusion and dropouts, Marie Reid et al. were left with a total of 41 healthy obese (BMI 30– 35 kg/m²) 20-50 year-old women who were randomly assigned to consume sucrose (n=20) or aspartame (n=21) drinks over 4 weeks in a parallel single-blind design.

Based on the previously mentioned experiments with normal- and overweight women, the researchers knew women with higher body weights had a harder time to compensate for the 168kcal the sugar-sweetened drinks delivered than their lean peers. It was thus interesting to see, whether the obese women (1) would compensate for the additional energy intake and (2) whether the compensation would be less pronounced than in the lean and overweight participants of the previous studies.

What's missing from the study at hand are the really important things, i.e. the changes in blood glucose and lipid metabolism and the differences in waist circumference and / or body fat levels. So whatever the scale of the subjects said, this and the previous studies by Reid et al. don't provide the basis for an acquittal of sugar sweetened beverages (learn more about the debate the role of Pepsi, Coke & Co in the diabesity epidemic).

Instead of simply having their subjects fill dietary records, the scientists used the weight response to judge, whether or not the women fully or partly compensated for the additional energy intake from the sugar sweetened beverages (note: the beverages contained regular sugar, no HFCS). Reid et al. did yet also analyze the changes in macronutrient composition to elucidate, whether the expected reduction in regular (food) energy intake would go at the expense of any particular macronutrient, i.e. carbs, proteins or fats.

Figure 1: Macronutrient and energy intake of the sugar (left) and aspartame (right) group (Reid. 2013)

The test drinks the scientists used came in 250 ml bottles. The women were instructed to consume four of these bottler, the content of which was sweetened with plain sucrose (fructose + glucose) or aspartame. Of the latter, the commercially available soft drinks (Irn Bru) contained

• 10.5g of sucrose, but no aspartame in the regular and (sugar)
• 0g of sucrose and a miniscule amount of aspartame in the diet variety (aspartame)

If you  do the math you can easily calculate that the regular Irn Bru provided an additional energy intake of 4x10.5g/day x 4kcal/g = 168kcal/day and a total of 4704kcal if we take the whole 4-week study period. According to the faulty rule of thumb that informs us that 1lbs of fat would equal 3,500kcal (learn why this is *bs*), the women in the "regular" Irn Bru group (sugar) should end up with "exactly" (*rofl*) 672g of additional fat on their hips.

Sugar doesn't make you fat and artificial sweeteners seem to hamper weight loss!?

I guess (or hope) that you will not really have expected to see those 672 extra grams of fat on the hips of Reid's, subjects at the end of the study. Still, most of you will probably have expected that the ladies did gain weight, right? Much to my own surprise, this was not the case: In fact, the vast majority of the ladies missed the predicted weight gain by more than 1kg (1.72 (SD 0.47) kg).

Figure 2: Illustration of the results of the study at hand (obese women) and previous studies with normal- and overweight women all of which showed sufficient energy compensation for the 4x250ml soft drinks  (Reid. 2007, 2010, 2013); note the listed "weight loss", e.g. -1.72kg, denotes the difference between the actual and the predicted body weight, see red box!

Now, being part of a study like this certainly is a confounding factor that could precipitate to conscious energy restriction. If this was the reason the ladies didn't gain weight, though, the women in the aspartame group would actually have had to lose a significant amount of weight.

It's not like the lean or overweight  women did not gain any weight at all.

This is not "sugar induced weight loss"! If you look at the graphs from the previous studies (left) in which Reid et al. did not use the "compared to expected weight gain" trick, it's obvious that only the lean women got away without weight gain.  In the overweight and obese women, there was a small, but due to the large outliers statistically non-significant increase in body weight.

I mean, you would certainly expect the women in the placebo group to take the same measure to make sure the potentially sugary (remember this is a randomized, blinded study) brew they were drinking would not end up on their hips.

A brief glance at the total energy intake in Figure 1 appears to confirm that: The women in the aspartame group did also reduce their energy intake. Due to significant differences among the study participants this did however not lead to a net change in body weight. From a statistical perspective, this means that the body weight of "Mrs. Average" did not change - neither in response to the sugar- nor in the aspartame sweetened drinks. 

Wtf? Sugar does not make you fat!? There are a couple of good reasons we got to be cautious with generalizing assessments like "sugary drinks are not the problem!":

1. 

   In contrast to the study Sartor et al. found that their participants gained 1kg of fat in only four weeks "on" Lucozade energy drinks | more

   Neither this study nor the previous studies measured the health-relevant changes in body composition of which the 2012 study by Sartor et al. clearly shows that they will occur if you simply add a bunch of sugary energy drinks to your diet (learn more).
2. With its 100% plain sugar content, the beverage the scientists used is not representative of the "average" soda. It is thus unwarranted to conclude that the lean, overweight and, in the study at hand, obese subjects would also be able to compensate for beverages with HFCS, dextrose or whatever other funky caloric sweeteners the industry uses.

Even if (2) was not true and similar compensatory effects wouldn't be observed with sweeteners, the data from the study at hand clearly weakens the "empty calories" argument. It does so, however, without being the first class acquittal Sugar Nutrition UK was probably hoping for when they decided to provide the financial means for this study.

References

• Reid M, Hammersley R, Hill AJ, Skidmore P. Long-term dietary compensation for added sugar: effects of supplementary sucrose drinks over a 4-week period. Br J Nutr. 2007 Jan;97(1):193-203.
• Reid M, Hammersley R, Duffy M. Effects of sucrose drinks on macronutrient intake, body weight, and mood state in overweight women over 4 weeks. Appetite. 2010 Aug;55(1):130-6.
• Reid M, Hammersley R, Duffy M, Ballantyne C. Effects on obese women of the sugar sucrose added to the diet over 28 d: a quasi-randomised, single-blind, controlled trial. Br J Nutr. 2013 Oct 29:1-8. [Epub ahead of print]

Melato Cola™ or What? Fructose for Improved Glucose Metabolism and Melatonin to Counter Fructose Overload

There was a time, when Coke still contained "coke"... so why not add some melatonin for health benefits? I am obviously just kidding here, but a combination of fructose + melatonin may actually make sense.

The title of today's SuppVersity article is confusing, I know. Firstly, it contains the almost heretical notion that fructose could actually improve instead of impair your glucose metabolism and secondly it does not appear to make sense that you would have to use melatonin to counter the pro-diabetic effects of fructose, if the latter is in fact so good for you.

Before you are getting totally confused, let me clarify how the improvements in glucose metabolism and the melatonin-powered diabesity protection go together: Both have been observed in a recent study from the Pontificia Universidad Católica Argentina in Buenos Aires, Argentina (Cardinali. 2013), in the course of which the improved glucose metabolism was nothing but a side-finding of a study Cardinali et al. conducted to  examine the effect of melatonin when it is administered to rodents simultaneously with fructose in the drinking water.

This is the Coke + sufficient sleep study ;-)

Obviously this is not as the subheading would suggest the "coke + sufficient sleep study", but in light of the fact melatonin is after all the "sleep" hormone and in view of the results of a recent study by Senador et al. who observed that fructose had a negative effect on glucose management only, when it was available during the light phase (which is the inactive phase for a rodent; cf. Senador. 2012), it comes close; and that despite the fact that fructose timing was yet not an issue in the study at hand. Instead of modifying the timing, Cardinali et al. used different amounts of fructose with half of the rodents in the experimental arm of the study having a 5% and the other half having a 10% fructose solution as their main water supply.

Figure 1: Glycemia (mg/dL) 0-140min after 2g/kg body weight  glucose tolerance test (Cardinali. 2013)

If we trust the nutritiondata.com information about the average fructose content of a "carbonated beverage, cola, with higher caffeine" ...

• the rodents in the 10% fructose group were consuming the total carbohydrate equivalent of coke, but with a 100% instead of ~50% fructose content, while
• the rodents in the 5% fructose group were consuming less total carbohydrates, but roughly the same amount of fructose someone would ingest if he drank nothing but coke.

A direct comparison of either of the groups to the "coke only"-drinking human being is thus not warranted.

It is nevertheless intriguing that the 5% fructose group showed a significantly higher glucose tolerance - not just compared to the 10% fructose group, but also compared to the control group that was fed with water, only (see figure 1).

"Meta-Analysis: Lower Glucose, Insulin and HbA1c Levels From 'Catalytic' Dose of 36g Fructose" | read more

"But isn't fructose the reason you develop diabetes?" Before we get on to the effects of melatonin, I want to emphasize that this is by no means an outlier, in fact, I have written about the catalytic effects of 36g of fructose in a previous post "6x Bananas a Day!? Meta-Analysis: Lower Glucose, Insulin and HbA1c Levels From 'Catalytic' Dose of 36g Fructose" (learn more).

Previous studies have also shown that a 2:1 mixture of glucose + fructose is at least up to the regular glucose only drinks in terms of post-workout glycogen repletion (learn more) - partly because the fructose will keep the liver occupied, while the muscles suck up the glucose.

As previously mentioned the main research interest of the Argentinian scientists was not the effect of fructose on the glucose sensitivity of their rodents, but rather if the administration of 25 μg/mL of melatonin in the tapwater the rodents received would lead to significant changes in the study outcomes.

Figure 2: Effects of melatonin in drinking water with or without 5% [left] and 10% [right] fructose on body weight, systolic blood pressure and glucose response to glucose tolerance test (Cardinali. 2013)

As you can see in figure 1 it did: Melatonin did ameliorate the weight gain, and the increase in blood pressure that was observed even with only 5% fructose in the drinking water. It did not improve the glycemic response of the rats in the 5% fructose group even more, though, but it bulnted the negative effects of the 10% fructose solution had on the glycemic response in the glucose tolerance (figure 2, right).

SuppVersity Suggested Read: "Circadian Rhythmicity - Sunlight, Bluelight, Backlight & Co Mess Learn How THey W/ Your Internal Clock. Plus: Tips & Tricks to Prevent Negative Side-Effects" | read more

Is a melatonin solution the solution? If we also consider the negative effects of 10% fructose feeding on LDL (the rodents on 10% + Mel had even lower LDL than the control), the normalization of triglycerides and the potential therapeutic reduction in uric acid (-30% even vs. control), of which Cardinali et al. point out that it could have therapeutic effects in people with gout and other uric acid related metabolic disorders, it would appear smart that do dissolve the human equivalent dose of 21-35mg melatonin in your drinking water in the morning and keep guzzling it all day long.

Well, as I said, it "would appear to be" smart, but is it really smart? I wouldn't be too sure about that. Despite the fact that that you probably won't die, the chronically increased systemic melatonin levels could have long-term negative consequences on your circadian rhythm that could undo all potential benefits.

Restricting your fructose intake to fructose from fruit, only, getting enough sleep and using melatonin timely, i.e. 20min before bed would thus appear to be a more prudent approach to improve / maintain optimal blood glucose levels and insulin sensitivity. And if you are more into hard facts than "erring on the side of caution", you may consider the acute decrease in glucose tolerance, Cagnacci et al. observed in postmenopausal women, when they participated in a blood glucose test after the administration of 1 mg melatonin more convincing (Cagnacci. 2001).

References:

• Cagnacci A, Arangino S, Renzi A, Paoletti AM, Melis GB, Cagnacci P, Volpe A. Influence of melatonin administration on glucose tolerance and insulin sensitivity of postmenopausal women. Clin Endocrinol (Oxf). 2001 Mar;54(3):339-46. 
• Cardinali DP, Bernasconi PA, Reynoso R, Toso CF, Scacchi P. Melatonin may curtail the metabolic syndrome: studies on initial and fully established fructose-induced metabolic syndrome in rats. Int J Mol Sci. 2013 Jan 25;14(2):2502-14.
• Senador D, Shewale S, Irigoyen MC, Elased KM, Morris M. Effects of restricted fructose access on body weight and blood pressure circadian rhythms. Exp Diabetes Res. 2012;2012:459087.

Water or Diet Soda - What's the Better Diet Beverage? Study Confirms Fake Sweetness Promotes Weight & Waist Loss, Decreases Hunger, Blood Pressure, Cholesterol & Trigs

There is one thing that's not debatable, compared to regular coke, diet coke is a diet beverage.

I am probably repeating myself, when I tell you that there are still many people out there who don't understand that it makes a fundamental difference if you are looking at potential pro-obesogenic effect of non-nutritive sweeteners (NNS) in an energy restricted vs. ad-libitum diet scenario. In view of the discussions revolving around the last article on a similar matter, I still thought it was prudent to mention that something that could potentially increase the cravings for sweets is not going to make you fat, if you don't give in to the urges.

Apropos urges, if you look at the abstract of the study I am about to discuss in today's SuppVersity article, you will realize that this effect does not existent.

You can learn more about sweeteners at the SuppVersity

Unsatiating Truth About Sweeteners?

Will Artificial Sweeteners Spike Insulin?

Sweeteners & the Gut Microbiome Each is Diff.

Sweeter Than Your Tongue Allows!

Stevia, Much More Than Sweet?

Artif. Sweetened Foods Help Weight Loss!

In fact, a brief glimpse at the data scientists from the University of Colorado it's obvious that the exact opposite happens. After 12 weeks on  those of the 158 subjects who had been randomized to consume at least 24 fluid ounces of a non-nutritive sweetened beverage of their choice per day had not jus lost 46% more body weight than their peers who had been confined to water for 12 weeks, they also experienced a slight decline in hunger.

Figure 1: Changes in body weight, waist circumference & hunger in the course of the 12-week study (Peters. 2014)

In the water only group, on the other hand, the perceived desire to eat e the water drinkers increased in the course of the study period - certainly a potential reason they lost ~2kg less body weight than their peers did over the course of the 12-week study.

There are a few drawbacks to the study you should know of: Firstly, 12 weeks is not a very long study period and someone who is obese would have to benefit for at least 50 weeks to lose more than the pathetic 6kg of weight the subjects in the study and hand lost. Secondly, the results cannot be used in non-diet contexts - if there is no calorie restriction, the effects may be very different. Thirdly, the subjects were all already non-nutritive sweetener consumers. For someone who is used to regular coke the effects may thus not be as pronounced. And fourth- and lastly, the authors are stuck for an answer to the most important question: Why does it work? In know this is a typical physicist thing, but as long as we can't explain it, it does not really exist for us ;-)

As the data in Figure 2 goes to show you, this weight loss benefit was not bought dearly! On the contrary, the non-nutritive sweetener group who had received gift coupons from the Coca-Cola Company, PepsiCo and Dr Pepper Snapple Group that were redeemable for bottled water or NNS beverages at retail stores, didn't just record greater weight loss and less hunger, they had also higher reductions in blood pressure, waist circumference, total and LDL cholesterol and triglycerides.

Figure 2: Changes in systolic BP, total, LDL and HDL cholesterol and triglycerides (Peters. 2014)

Personally I would exclude that this is in any way directly related to the use of dietary sweeteners. reducing effects of the non-nutritive sweeteners may thus eventually tipped the balance in favor of the aspartame, acesulfam-k and stevia group.

What's much more likely is that these additional benefits are - just like the increased weight loss - attributable to an increased adherence to the energy deficient diet and a lower number of (sweet) cheat meals. In combination with the ~30min of extra physical activity the "diet coke junkies" performed, the appetite suppressive effects may thus well explain the statistically significant advantage the scientists from the University of Colorado and the Temple University recorded in their latest study.

Yes, some sweeteners can increase the amount of insulin your pancreas produces, but there are only few scenarios in which these effects could make you fat - and dieting is not one of them | learn more

Bottom line: If we assume that none of the sponsors American Beverage Association messed with the objectively measured results of the study at hand, we are dealing with another experimental confirmation of what the majority of fitness, bodybuilding and fitness competitors have been saying for years: "Diet coke & co help me stick to my diet and everything that helps me stick to my diet will help me to step on stage in picture perfect form." I am not sure why this sounds incredible do some people, but the way you see fitness forum visitors keep accusing artificially sweetened beverages for their own failure is another hilarious instance of the scapegoatism millions of failed dieters use to find ever-new excuses for their own mistakes and shortcomings.