Regularly drinking sugar-sweetened beverages, like soda, can increase the risk of developing diabetes. Diet sodas, which use artificial sweeteners (commonly referred to as low- or no-calorie sweeteners) often containing zero grams of sugar, are frequently suggested as an alternative to regular soda for people with diabetes. And while switching from regular to diet soda may benefit weight and diabetes, diet soda as a long-term alternative may not be as great as previously thought.  

At Vascular Care Specialists of Los Angeles, Dr. Mathew Cheung and Dr. Peter Lin discuss the effect of soda on the development of diabetes, specifically type 2 diabetes, as well as weight gain. In this post, you will also learn tips to reduce your soda consumption and lower your risk for type 2 diabetes.

With all that out of the way, the next task is to look closely at your diet soda. Every soda is different, so you may need to shop for a soda that fits your needs.

Diet vs. regular soda

The exact ingredients in a soda will vary by brand. Most sodas have added sweeteners and sodium for flavor, though. 

Regular sodas often contain sugar or high-fructose corn syrup. Diet sodas have artificial sweeteners without significant nutrients, calories, or carbohydrates. These artificial sweeteners generally don’t break down like other foods in your body, and their effects are often negligible. 

All diet sodas are different, though. They may be reduced sugar, zero sugar, or zero calories. Before drinking a diet soda, though, make sure it has one of the following approved artificial sweeteners:

• Aspartame
• Sucralose
• Acesulfame-K
• Saccharin
• Neotame
• Advantame

Of course, not all artificial sweeteners are the same, and each may interact with your body differently. Through daily blood sugar testing and A1C testing, you and your doctor can figure out which artificial sweetener is ideal for your lifestyle. 

Artificial sweeteners and blood sugar

Non-nutritive, artificial sweeteners shouldn’t usually cause your blood sugar to rise, but people who are overweight and have a lot of blood sugar may have a sugar response to artificial sweeteners, which in turn causes a rise in blood sugar. 

Talk with your doctor if you’re concerned about artificial sweeteners and your blood sugar. 

On the surface, diet soda isn’t likely to directly raise your blood sugar, but most diet sodas aren’t nutritionally “free” and may indirectly impact your blood sugar. 

1. Sodium 

Most soda has added sodium to improve the flavor. The sodium in a can of soda may not seem significant at a glance, but it adds up if you’re an avid soda drinker.

Too much sodium can lead to high blood pressure. High blood pressure can then make you susceptible to diabetes. 

Sodium can also cause dehydration, which can cause spikes in blood sugar. Frequent dehydration and spikes in blood sugar can raise your A1C levels.

2. Caffeine

Some sodas have caffeine, particularly energy drinks, and people with diabetes may find that their blood sugar is sensitive to caffeine. Caffeine may raise blood sugar levels, so ask your doctor if you should opt for caffeine-free diet soda.

3. Zero-calorie sweetness

You may be thinking: “But diet soda doesn’t have sugar!” It doesn’t have sugar, but your brain still responds to it like it’s sugary. 

This trickery may cause you to reach for another diet soda instead of water. It may also make it easier to grab a sugary snack.

Your brain treats sweetness like a reward. The more you give your brain rewards, the more it wants, and the more likely you are to consume some actual sugar. 

4. Flavor distortion

Artificial sweeteners are much sweeter than sugar and can distort your sense of taste. If you drink diet soda, other foods and flavors may become unappetizing, leading you away from healthier options.

Maintaining your blood sugar goes beyond what you drink. Your entire diet plays a role, and soda can control your diet indirectly. 

It is well established that regularly drinking sugar-sweetened beverages  — such as soda, punch, sports drinks, and sweet tea — increases the risk of type 2 diabetes. Even just one to two servings of sugar-sweetened beverages (SSBs) daily increases the risk of developing type 2 diabetes. One serving is equivalent to 8 to 12 ounces, roughly the size of a glass or can of soda, respectively. And one meta-analysis of over one million participants found that people who consumed the highest amount of SSBs had a 27% greater risk of developing type 2 diabetes than those who consumed the least. 

Sugar-sweetened beverages contribute to a higher overall caloric intake without providing much nutrition —SSBs are high in carbohydrates but low in nutrients. Moreover, SSBs don’t contribute to satiety (feeling full). Due to these reasons, SSBs are linked with weight: increasing intake of SSBs is associated with increased body weight.

Research strongly supports the association between sugar-sweetened beverages (like soda) and type 2 diabetes. So, if you regularly drink sugar-sweetened beverages (like soda), the first step to lowering your risk of type 2 diabetes may include switching to diet sodas, which can help reduce added sugar and energy intake. 

Some studies suggest that artificially sweetened beverages may be a suitable alternative to SSBs, as choosing artificially sweetened drinks instead of SSBs may lower the risk of developing type 2 diabetes. Additionally, some research shows weight loss when people choose artificially sweetened beverages instead of SSBs. One meta-analysis found drinking low- or no-calorie sweetened beverages in place of SSBs was associated with lower weight and a reduced rate of obesity. However, factors besides the switch in drinks may contribute to weight loss. 

If you never drink soda, it’s best not to start drinking regular or diet soda, as research suggests that adding it to your eating pattern can increase the risk of type 2 diabetes. Moreover, drinking diet soda a few times weekly for years may increase the risk of type 2 diabetes.

In the meta-analysis of over one million people discussed above, researchers found no benefit in switching to artificially sweetened beverages. In fact, participants who drank the most artificially sweetened beverages had a 32% greater chance of developing type 2 diabetes than those who consumed the least. This percentage was greater than what was observed when researchers compared people who drank the most regular soda with those who drank the least. Studies included in the meta-analysis followed participants for two to 20 years, showing that years-long regular diet soda drinking can influence the risk of developing type 2 diabetes. 

Additional studies further suggest that long-term consumption of artificially sweetened beverages in place of SSBs may not be a healthy alternative. One cohort study that followed individuals for seven years found that drinking one or more diet sodas per day was associated with a 67% increased risk of type 2 diabetes compared to consuming no diet sodas. And an analysis of three cohort studies found that drinking more than one diet soda per week was associated with an increased risk of developing type 2 diabetes. 

A diet soda every once and a while is fine and may help with reducing your intake of sugar-sweetened beverages. But long-term regular consumption of diet soda may be problematic, as research suggests it is associated with the risk of developing type 2 diabetes. 

Research is mixed and evolving on whether diet soda contributes to weight gain. Some researchers believe that artificial sweeteners may increase appetite, leading to eating more food, contributing to weight gain. Another theory is that people who drink diet soda regularly may be reaching for other sources of sugar to compensate for the loss of satisfaction with diet soda. 

One study of older adults found that frequent diet soda consumption was associated with increases in weight circumference, a marker of weight gain. Study participants who drank diet soda daily had a change (increase) in waist circumference nearly 4 times that of those who did not. There was no clear association between regular soda consumption and waist circumference. As people age, the risk of cardiometabolic diseases (like type 2 diabetes) rises. Similarly, waist circumference tends to increase with age. And increases in waist circumference are associated with more visceral (abdominal) fat, which is also a risk factor for type 2 diabetes. But other factors (like age) may be influencing the relationship between diet soda and weight gain.

A significant amount of the research linking diet soda to type 2 diabetes comes from observational studies, which cannot explain whether diet soda causes type 2 diabetes. A link may exist between diet soda intake and type 2 diabetes independent of body mass index (BMI) and waist circumference, two factors associated with an increased risk of type 2 diabetes. But, other factors — such as dietary habits like food preferences, changes to satiety (feelings of fullness), and the individual’s risk of diabetes — likely mediate the relationship between artificially sweetened sodas and type 2 diabetes. 

Water is generally considered the preferred beverage for people with type 2 diabetes. Drinking water instead of SSBs is associated with lower body weight, a result similar to substituting SSBs with low- and no-calorie sweetened beverages. But water is superior to low- and no-calorie sweetened beverages for outcomes related to type 2 diabetes. One meta-analysis found that drinking water instead of SSBs was associated with a lower incidence (occurrence) of type 2 diabetes than swapping SSBs for low- or no-calorie sweetened beverages. And another meta-analysis of randomized controlled trials observed that water was more effective at reducing HbA1c levels than low- or no-calorie sweetened beverages. 

We recommend water as an alternative to regular and diet soda. But sometimes you may crave something with flavor or fizz. Instead of reaching for a soda (diet or regular), try one of these alternatives.

1. Water

Staying hydrated with plain water is always a healthy choice. It has no calories and no sugar and helps maintain overall hydration levels.

2. Herbal or fruit-infused water

Adding slices of fresh fruit (such as lemon, lime, berries, or cucumber) or herbs (like mint or basil) to water can enhance flavor without adding significant calories or sugar.

3. Unsweetened tea

Unsweetened herbal or brewed teas, such as green or black tea, can provide a flavorful option without adding extra calories or sugar. Be cautious with sweetened or flavored teas, which may contain added sugars.

4. Sparkling water

Carbonated or sparkling water can provide a fizzy and refreshing alternative to soda without added sugars or artificial sweeteners. Look for unsweetened or naturally flavored options.

Switching from regular to diet soda is a step in the right direction for reducing your risk of type 2 diabetes. But, as discussed above, long-term diet soda consumption is not without its potential effects on health. And limited research exists on the long-term impact of artificially-sweetened beverages on weight control and the risk of diabetes and cardiovascular disease. Ultimately, the goal should be to limit sugar-sweetened and artificially sweetened beverages. 

Reducing soda and diet soda intake can be a positive step towards adopting a healthier lifestyle. But knowing where and how to start can be overwhelming. Here are some tips to help you reduce your consumption:

• Set a goal: Determine how many diet sodas you currently consume in a day or week and set a realistic goal for reducing that amount. Gradually decrease your intake instead of quitting cold turkey, as this can make the transition easier.
• Identify triggers: Pay attention to the situations or emotions that prompt you to reach for a diet soda. It could be stress, boredom, or certain social settings. Identifying these triggers can help you find alternative strategies to cope or address those situations without relying on diet soda.
• Find alternatives: Explore other beverage options —like the ones mentioned above — that you enjoy and that align with your health goals. Experiment with herbal teas, flavored water, sparkling water, or unsweetened beverages to find alternatives that satisfy your cravings.
• Stay hydrated: Often, people turn to diet sodas for hydration or to quench their thirst. Ensure you drink enough water throughout the day to stay hydrated. Carry a reusable water bottle with you as a reminder to drink water regularly.
• Seek support: Let your friends, family, or coworkers know about your goal to reduce diet soda intake. Having their support and encouragement can make it easier to stay on track. You may even find others interested in joining you on your journey to reduce soda consumption.

Remember, reducing diet soda intake is gradual, and being patient with yourself is essential. Celebrate small victories along the way and focus on the positive changes you make for your overall health. If you find it challenging to make significant changes on your own, consider seeking the support of endocrinologists, registered dietitians, an exercise physiologist, and a community of other individuals trying to develop healthier behaviors to benefit their type 2 diabetes.