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Hey everyone, it's Mikki here. You're listening to Mini Mikkipedia on a Monday. And today I want to chat about that headline. And I don't know that you saw it, but someone sent it to me maybe about 10 days ago, stormed it actually, my physio friend in Gizzy. And she's like, what do you reckon? And the headline was that drinking diet sodas or diet cokes or whatever.

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increases your risk of type 2 diabetes. It was out of Australia and I immediately called BS on that. I'm like, look, something is amiss here because if we think about it sensibly, it doesn't really make sense because sweeteners do not trigger the same insulin and glucose response that sugary beverages do, which can over time increase a person's risk for type 2 diabetes. So I'm like, I'm going to look into this. And I know you might wonder, why would you bother, Mickey, because

01:00
who would even notice what does it even matter? But it does matter because if people get wind of this idea that drinking diet sodas is as bad for you as drinking sugary beverage, then they may likely be steered towards the sugar sweetened beverages as opposed to the diet beverage. And honestly, that would be way worse than any diet beverage would be from a metabolic health perspective. So I'm like, what is happening in this study that makes them claim that?

01:30
How can I tease a partner and actually get some sort of answers here? So just to bring you up to speed, if you're not familiar, there was an Australian study that was published in the Diabetes and Metabolism Journal. This was just last week that linked both sugar-sweetened beverages and artificially sweetened beverages to a higher risk of developing type 2 diabetes. And it seemed pretty impressive, right? Over 36,000 people were followed for nearly 14 years. However,

02:00
The devil is always in the details when it comes to this type of research. So first, this type of study used to make the claim that drinking soft drinks increase the risk of type 2 diabetes. The type of study where they looked at habits and health parameters of people across a long time period is designed to test for associations that researchers are then able to test in a randomized controlled trial.

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because it is hard to run a randomized controlled trial in this instance. Because when we're looking at risk of something like type 2 diabetes, because type 2 diabetes takes years, if not decades to develop. So an RCT is considered gold standard to truly determine if, for example, diet drinks had a causal role in type 2 diabetes. And because that outcome of risk take years, if not decades to develop, you just can't test it in an RCT. So this type of

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epidemiological research can only show associations and it cannot be ruled out that what we are really seeing here, this is my first point, could be reverse causality. That people who are trying to lose weight or manage their blood sugar who might be at risk of type 2 diabetes may be more likely to drink diet soda as part of the strategy. And so it's not that the diet soda was the cause of the diabetes. And a good metaphor to sort of use here is if, for example, your house is on fire,

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and you call the fire brigade and they come to put the fire out and they're at the scene of the crime, someone might go, well, every time there's a fire, there's a fire truck there. So is it the fire truck that's causing the fire? Clearly it isn't, right? And so that's reverse causality in sort of action. So we cannot rule out the fact that people who are at risk of type two diabetes will just be choosing to drink diet soda as a way to sort of mitigate that risk.

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But you never know which is which, right? In the context of this particular research, we can look at similar studies and there are ones available, other population-based research, which do in fact show a similar finding. However, those studies do suffer from the same limitations which I will work you through in the next couple of minutes. So you cannot rely on a study like this to give you these clear outcomes for what it's worth your other large scale trials, which show a completely different

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relationship. do bear that in mind. You also want to think about the mechanism. If diet soft drink increases someone's risk of type 2 diabetes, well certainly it's clearly not sugar doing the work, right? Because sugar is the thing that does that and there's no sugar in diet soft drinks. The researchers put forward a couple of mechanisms. They point to an altered gut microbiome, which has been found in other trials as a potential cause for this

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blood sugar regulation issue and this changes change in that blood sugar sort of kinetics. However, this isn't a set in stone finding because as is always there's yet other trials to show that there's no meaningful difference in gut microbiome when consuming high quantities of both sucralose and aspartame. And these are the two most commonly used sweeteners, especially in diet drinks. And look, in truth, studies looking at gut microbiome are somewhat limited. Is that

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gut microbiome is changing all of the time. And even if it wasn't so labile, few could definitively say what the clinical significance of a change in the microbiome actually is. And look, the gut is a super important part of our overall health, but it's very difficult to pinpoint what particular changes in the gut actually mean for overall health outcomes. The researchers of the present study also posited that the change in insulin response when consuming diet sodas

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influence type 2 diabetes risk. They actually referenced a study, but the study they referenced didn't actually show a change in glucose or a change in appetite. In fact, the authors of the study they referenced suggested diet soda could actually be helpful for glucose regulation, not harmful. This is not an uncommon finding actually that a reference list used to support a claim is actually not supporting the claim that is trying to be justified.

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Yes, this paper has been published. Yes, it is referencing other studies. It doesn't have this linear sort of like obvious line of truth, if you like, particularly when this completely actually goes against what the authors were trying to justify. And given the benefit of consuming diet soda for weight loss, which we see time and again in large population-based studies, and weight loss reduces the risk of metabolic disease such as type 2 diabetes, the suggestion that diet sodas contributes to the risk

06:46
Really doesn't make sense, does it? So what could we be seeing in a study like this then? So what the study did was participants were asked once in the early 90s how often they drank sugary or diet soft drinks. They were then followed for around 14 years. No further diet data was collected. Just think about that. Diabetes was self-reported via mailed questionnaires. They were not clinically verified with labs or glucose tests and

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The outcome was that they found that people who drank more than one artificially sweetened beverage a day had a 38 % increased risk of developing type 2 diabetes. Sounds pretty scary, I know. This was even after adjusting for body mass and waist size. All of that said, this is observational data and not a randomized controlled trial. And the people who drank the most diet drinks weren't metabolically average. In fact, they were more likely to have a higher BMI, more likely to carry central fat,

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more likely to smoke, less physically active, had poorer overall diet quality, and this was a kicker, notably they still drank more sugar sweetened beverages than all of the other groups as well. So even though the researchers in research like this are just for variables, statistical models cannot scrub out all of that overlap. They aren't isolated behaviors or characteristics.

08:09
They're all part of a broader metabolic pattern. And I mentioned reverse causality above as well, is that people at higher risk of diabetes may drink more diet sodas in an attempt to manage their weight or blood sugar. Interestingly, the link between sugary drinks and diabetes did not disappear once they adjusted for body weight and waist size, which does reinforce the idea that excess adiposity, not the sugar alone, may be a more direct driver of diabetes risk. But for artificially sweetened beverages, the association did persist, though it was weaker.

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which headlines spun into proof that diet drinks cause diabetes. look, as Dr. John Ioannidis, he's a professor at Stanford and one of the most respected critics of medical research, points out in his landmark paper, Why Most Published Research Findings Are False, a small risk increase like the 38 % reported in this study are especially prone to bias, confounding and measurement error.

09:07
Even when adjusting for known variables, unmeasured or imprecisely measured factors can still distort these results. In studies based on self-report data and one of food questionnaires, it's almost impossible to rule out these kind of distortions, making it risky to treat correlation as causation. Just think about that. One diet food frequency questionnaire in 14 years, and this is what we're basing these findings on. How often have you ever changed your diet? I mean, I'm picking most of you have made

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some significant change over the last 14 years. So in plain English, associations like this one are often driven by bias, behavior, and background noise, not biology. So if you're metabolically healthy, you're active, eating a nutrient-dense diet, a splash of Stevia, diet tonic, the sucralose that is in my Musashi energy drink, bloody love them, is not going to give you diabetes. This study doesn't prove causation and shouldn't drive public

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policy or fear based headlines. And this is a real, a really important point because the newspaper article that were talking to the authors or the news piece that was talking to the authors was headed along the line that diet soft drinks should be given a sugar tax the way that sugary sweetened beverages are. I could not even believe that the authors were saying this, that they were literally believing their data. Like I thought they were smarter than that. Like just shows how weirded people get to some ideas that they have. As always,

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What really matters is your overall lifestyle. Of course, your protein intake, your movement, your muscle mass, your sleep, your stress and food quality. Not the fact that you enjoy a diet soft drink. So that's my Nemecapedia. I would love to hear if you'd heard of the study, what your thoughts are. Hit me up in the DMs. I'm at threads, X and Instagram @mikkiwilliden, Facebook @mikkiwillidenNutrition or head to my website, mikkiwilliden.com. And you could book a call with me if you like.

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Alright team, you have the best week. See you later.