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Topic split: Grade based payment clauses in sponsorship deals. (Read 29260 times)

stone

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Now remember the dose makes the poison, so have you checked if it's a dose applicable to humans?

https://doi.org/10.1038/nature13793:
Quote
This dose corresponds to the FDA acceptable daily intake (ADI) in humans (5 mg per kg (body weight), adjusted to mouse weights, see Methods).
What I was really struck by from the mouse study was that three chemically unrelated artificial sweetners all had the same effect. The problem seems to be the dissonance between what taste is telling the gut to expect and what it gets. And that then messes up the gut microbiota.
« Last Edit: January 31, 2024, 04:47:21 pm by stone »

petejh

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Which large scale trials? I strongly argue that you're the one missing the forest for the trees as the meta analyses are clear: artificially sweetened beverages consistently show a benefit to weight loss in human populations, contradicting what your quote says.

You will now probably produce your study and I will say that the consensus of studies shows the opposite. Let's not waste any more time. Ideally I won't have to comment on this topic again.


To waste more time.. (NNS refers to non nutritive sweeteners)

Six of these agents (aspartame, saccharine, sucralose, neotame, acesulfame-K, and stevia) have previously received a generally recognized as safe status from the United States Food and Drug Administration, and two more (Swingle fruit extract and advantame) have been added in the recent years to this ever growing list. They are claimed to promote weight loss and deemed safe for consumption by diabetics; however, there is inconclusive evidence to support most of their uses and some recent studies even hint that these earlier established benefits regarding NNS use might not be true. There is a lack of properly designed randomized controlled studies to assess their efficacy in different populations, whereas observational studies often remain confounded due to reverse causality and often yield opposite findings.

Pregnant and lactating women, children, diabetics, migraine, and epilepsy patients represent the susceptible population to the adverse effects of NNS-containing products and should use these products with utmost caution.

NNSs are ubiquitous and found in a variety of products around us. Their use has been controversial and riddled with many concerns regarding their safety. They are used by obese and lean, diabetics and nondiabetics, adults and children alike and extensive marketing and increased health awareness have led to their widespread use. They provide greater food choices to people looking to cut down calories and improve the palatability of food. However, many of their purported beneficial effects remain invalidated in large scale clinical studies, and some recent evidence also questions these previously established benefits.

Extensive marketing by the manufacturers has led to overuse, and sometimes even abuse of NNS, by the population. They are believed to suppress hunger and appetite, leading to beneficial effect on body weight and cardiometabolic profile and are consumed by both lean and obese alike. A huge number of diabetic patients too opt for these “sugar-free” sweeteners as a substitute for sugar in their diet.

The benefits of using NNS in obesity are often offset by the phenomena of compensation (ingesting calories later to compensate for energy deficit caused by NNS).

A limiting factor in the clinical evaluation of NNS has been the fact that most people use them as diet adjuncts, whereas the majority of the studies replace sugar entirely with NNS.

A 2008 study analyzing the San Antonio Heart Study population (5158 adults) indicated a positive direct dose-response correlation between NNS-containing beverage consumption and incidence of obesity in individuals with body mass index (BMI) <30

Artificial sweeteners are widely used every day in a variety of food, cosmetic, and dietary products and so, eliminating their daily use is virtually an uphill task. However, their use should be accompanied with caution in certain high-risk individuals such as pregnant and lactating women, diabetics, migraine, and epilepsy patients, and children. Children are especially important because they have higher food and beverage intake per kilogram of their body weight.[3,15] A pediatric epidemiological study has found a positive correlation between intake of NNS-containing beverage and weight gain; however, conclusive data are still lacking.[16]


(Financial Support and Sponsorship)
Nil.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899993/

Do we really think climbers, and business in general, should be pushing this stuff (and sugar it replaces) to children via the persuasive force of advertising backed by massive budgets?

« Last Edit: January 31, 2024, 04:59:27 pm by petejh »

abarro81

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More generally, the approach of linking to scientific papers from Google Scholar (which is prevalent all over the internet) is ineffective because people either won't read them, or even if they do are ill-equipped to interpret them properly.

Oh yes.
https://onlinelibrary.wiley.com/doi/10.1111/obr.13020 Looking at this one from Liam, it implies to me (though that may be misreading) that observational studies are more likely to show sweeteners in a negative light than randomised controlled trials. That could be because, for example, one effect of consuming the "diet" version is that you feel virtuous and therefore eat more cake (not possible on trials where placebo or sugar alternative is used; the water ones perhaps it would be but you'd have to look at their methods in more depth I imagine).
This doesn't relate to what Pete and Liam are arguing about, but does very much relate to whether sweeteners are liable to make you fatter or less healthy in the real world. If one thing's clear I'd say it's that you'd need to plug a few weeks into this to really have a good feel for the evidence and a good feel for why contradictory views exist among apparently sensible experts.

petejh

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A different way to think about sugar and sweetener beyond the details of the substance is that, as Liam says, the substances per se aren't damaging to health in moderate doses, but the damage is done by the substances sustaining in the user a desire for sweetness in their diet.

Very sweet food/drink isn't a natural thing to consume a lot of week in week out for years.

If you induce this desire for sweetness strongly enough at an early age then you're at a high risk of developing really unhelpful diet choices through your craving for sweet foods. That desire for sweetness leads to harmful diet choices over years and years. It's a gateway drugs type of effect but we have to eat to live, whereas we don't have to smoke weed or take heroin to survive.

stone

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The utterly bizarre thing though is that honey is a large part of the diet of some hunter-gather people. And yet they don't suffer from "western lifestyle" metabolic/CV diseases.  https://globalhealth.duke.edu/news/what-can-hunter-gatherers-teach-us-about-staying-healthy

Fultonius

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I just typed a reply, realised I was just going down rabbit holes and getting tetchy, deleted it...so I'm tapping out. Trying to present arguments while being at work, then while cooking risotto (no UPFs, all from scratch except the stock cube) just leads to half baked theories and getting tied in knots. Especially when it's an area I'm interested but far from expert in...

Either way, I think what's getting at me is not the presentation of the studies, accusations of funding related bias aside, they do seem to all agree that during weight loss interventions artificially sweetened drinks perform as well or better than water. OK, fair enough.

I guess for me the issue is that that's not really the question we're asking, which is more "do they lead to an overall increase in BMI/bf% on other unhealthy markers when consumed by people of a normal weight, not actively trying to lose weight."

Maybe they don't....  but Liam's linked studies don't answer this.


So much for tapping out. Right, now I'm out.
 

teestub

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petejh

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The utterly bizarre thing though is that honey is a large part of the diet of some hunter-gather people. And yet they don't suffer from "western lifestyle" metabolic/CV diseases.  https://globalhealth.duke.edu/news/what-can-hunter-gatherers-teach-us-about-staying-healthy

From article:
Quote
Similar to our Paleolithic ancestors, today’s hunter-gatherers western teenagers source their food entirely from the earth and wild animals the food cupboard an average distance of 3 metres away from the sofa, stocked with whatever convenient foodstuff that their stressed-out busy parent/s could afford to buy and be bothered to cook after a long day in the office and commute home. They’re physically active for most a tiny part of each day. For instance, the Hadza, a hunter-gatherer group, spend their days walking eight to 12 kilometers, climbing trees and digging for root vegetables western teenagers sometimes spending 120 minutes playing 5-a-side with their mates a couple of times per week or going to the skate park for a couple of hours. Their diet consists of various meats, vegetables and fruits a significant amount sugar, as well as a significant amount of honey sugar. In fact, they get 15 to 20 percent 50% of their calories from honey, a simple carbohydrate.


Yeah how bizarre...

JamieG

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Throwing fuel on the fire. But a stat in this article absolutely shocked me. Apparently tooth decay is the leading primary cause for hospital admissions in children in England.

https://amp.theguardian.com/society/2024/jan/30/pliers-abscesses-and-agonising-pain-britains-dental-crisis-as-seen-from-ae

SA Chris

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I know my nephew (not in Britain) used to be put to bed with a sippy cup full of apple juice every night and as a result had to have all his baby teeth removed under a general. It's not uncommon.

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It's amazing that the view i'm presenting is the one that seems to be coming across as 'fringe', when it's actually the consensus based upon well supported mainstream science (despite Pete's quote from an individual study in the Indian journal or Pharmacology that incorrectly says "there's a lack of properly designed randomized controlled studies"). It's the carnivore/fasting/gut microbiome enhancing diets (insert flavour of the week) that are fringe! Of course, these ideas sell more diet books and Netflix documentaries to a crowd that's eager for the next magic bullet.

Individual mechanisms can demonstrate negative effects in relation to a certain type of food/substance/drug/activity whilst the overall impact of that food/substance/drug/activity is neutral or positive (of course, the opposite can be true as well). Here's a good example: raw broccoli fed to pigs damages the DNA in their colon cells, which is associated with cancer (https://pubmed.ncbi.nlm.nih.gov/26059489/). But what do the randomised human controlled trials show when people eat more cruciferous vegetables? I'll not waste my time posting the links because sensible people will already be able to guess the result - yep, reduced cancer risk.

I'm not going to reply to everyone individually. I've already posted and attempted to summarise the research I wanted to post on this matter. I see a few individual studies being posted in response, but nothing substantial enough to contradict the meta analyses.

https://onlinelibrary.wiley.com/doi/10.1111/obr.13020 Looking at this one from Liam, it implies to me (though that may be misreading) that observational studies are more likely to show sweeteners in a negative light than randomised controlled trials. That could be because, for example, one effect of consuming the "diet" version is that you feel virtuous and therefore eat more cake (not possible on trials where placebo or sugar alternative is used; the water ones perhaps it would be but you'd have to look at their methods in more depth I imagine).
This doesn't relate to what Pete and Liam are arguing about, but does very much relate to whether sweeteners are liable to make you fatter or less healthy in the real world. If one thing's clear I'd say it's that you'd need to plug a few weeks into this to really have a good feel for the evidence and a good feel for why contradictory views exist among apparently sensible experts.

It's the the opposite in the study you've quoted:

"Here, our meta-analysis suggests that the use of NNS results in clinically appreciable lower weight/BMI values in certain research or clinical scenarios. When acknowledging this variety of contexts in the analysis, the effect is more evident when NNS are used as a substitute for sucrose, especially in adults, in subjects presenting overweight/obesity, and in those following an unrestricted diet."

When study participants are allowed to eat whatever they like, the groups drinking artificially sweetened beverages tend to naturally restrict their calorie intake. Swapping regular sugar sweetened beverages for artificially sweetened beverages is probably one of the best and easiest single things an overweight person could do to assist with weight loss (obviously they should do other things too).

You are right that observational studies are more likely to show sweeteners in a negative light if they don't account for confounding variables. This is because those who drink more artificial sweetened beverages tend to already be more overweight and have more health problems. A similar effect occurs for meat. In these studies, vegetarian diets lead to longer, healthier lives, which is an effect that reduces/disappears when you account for confounding variables (e.g. smoking, alcohol).

What a thread! Great reading.

Liam, while I would struggle to refute the individual studies you linked, I'm trying to understand the point your trying to defend. That putting artificial sweeteners in food is a good thing? That there's nothing to worry about in the general direction of our national diet and the trajectory of the nations health?

Surely I don't actually need to answer your final question? Obesity is a national crisis. However, you're right, I should set out exactly what my main point is. Anyone debating with me, please consider it within the context of the paragraph below:

Artificial sweeteners have been researched for decades and the systematic reviews and meta analyses tend to show neutral or positive health effects, principally through aiding weight loss. As is typical for anything we can consume, there are mechanistic studies implicating artificial sweeteners with negative health effects, but this does not seem to be borne out in human populations. For someone who is a normal, healthy weight, drinking artificially sweetened beverages is not going to make them fat/diabetic/have cancer/etc. Go ahead and drink the diet coke if you want the diet coke. For someone who is overweight, artificially sweetened beverages might actually be part of a weight loss strategy, particularly if it is replacing sugar sweetened beverages. Are there individuals who might not do well with artificial sweeteners? Probably. If you are one of those people (whether it's placebo or otherwise) then avoid them.




abarro81

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In what's perhaps a good example of misunderstanding, you've entirely misunderstood my point. The effect I mentioned would be inherently excluded from any blinded RCT (at least with placebo or sugar, as I said I don't know what they do with water) because the blinding of the participants would exclude it as a possibility. You could remove this as a "confounding variable" in other studies but that might obscure what's actually going on.

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jwi

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Re "blind test"

I know more than half of adult humans can tell with high accuracy when they are given alchohol placebo instead of alchohol, at least in doses meaningful for studies. That is why I'm very sceptical about all "double-blind" tests of alchohol.

I am pretty confident that I would be able to tell if I'm given a heafty dose of sugar or not from the after taste. Sure, in meaningless low doses, masked by other tastes that I am unfamiliar with I might not be able to tell sugar apart from other sweeteners, but those have to be edge cases.

Fultonius

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JWI, I can't be assed again trawling the papers referenced, but I don't think any were "blinded", just randomised and controlled against water, so yes, the participants knew they were on the sugar free drink or water. Not sure how you could ever get around that?

Liam, I still think you're "extending" the conclusions from the studies. Again, starting with a premise that the studies were fairly undertaken and reported:

Quote
Artificial sweeteners have been researched for decades and the systematic reviews and meta analyses tend to show neutral or positive health effects, principally through aiding weight loss. Agreed the studies show this, no issue here - we're talking about overweight people who need to lose weight, and are on a weight loss program and know they're on sugarfree drinks - how do they control for the placebo effect, or other effects of it not being blind?

As is typical for anything we can consume, there are mechanistic studies implicating artificial sweeteners with negative health effects, but this does not seem to be borne out in human populations. For someone who is a normal, healthy weight, drinking artificially sweetened beverages is not going to make them fat/diabetic/have cancer/etc. The studies referenced do not even try to answer this question - they are not taking people from day 1 who are healthy and drink mainly water, putting them on diet coke for 15 years and seeing what the resultant outcome is - they're short trials looking at the intervention impact of swapping sugary drinks for sweetened or water, so I don't think they do show this....

Go ahead and drink the diet coke if you want the diet coke. Whooaaaa not so fast. This is where I think we disagree, and where the observational studies and the gut microbiome stuff may outweigh, may outweigh and "weight loss" benefits. If you don't currently drink many sugary drinks (I don't, maybe one glass of fruit juice every couple of weeks, the odd coke on the weigh back from a winter climb, the odd irn bru with a hangover), I don't think that suggesting smashing in to sweetened drinks is such sage advice . Who knows, maybe in 50 years you'll be proven right and we'll be proven wrong. So be it. Until then I'll be on the water thanks!

For someone who is overweight, artificially sweetened beverages might actually be part of a weight loss strategy, particularly if it is replacing sugar sweetened beverages Again, fine, if they help some people get off fullfat redbvll and this makes them a bit healthier, then fine .

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Fultonius, I think your comments are fair and reasonable there. We just disagree slightly on the dangers of consuming sweeteners at a normal BMI; we've already had 50 years for them to be proven dangerous in which they haven't been.

Right, so what are we getting on to next? Personally i'm more concerned with the pesticides in my vegetables (including organic) and heavy metals in my fish...  :worms:

GazM

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Sorry if it seemed like a bit of a pile on Liam, and thanks for replying to my comment. I guess in the context of the thread and general discussion about healthy diets, public health, poverty affecting diets etc it seemed a bit odd that you were so vehemently defending quite an academic point about artificial sweeteners. In my eyes they are very much part of the poor quality easy access 'junk' food landscape that is responsible for many of these issues.

As for pesticides in vegetables, I think you'll be on the same side as Prof. Spector this time.

 

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