Diet soda is not a safe alternative to sugary soda: artificially sweetened drinks are linked to higher mortality, especially circulatory deaths.
Original statement
ومن يتصوَّر أن الحل هو التحوُّل إلى "الدايت" يصدمه أهم رقم في الملف كله ... والقاعدة في نظام الطيبات بسيطة: لا الصودا السكرية، ولا الدايت.
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
Diet soda is not a safe alternative to sugary soda: artificially sweetened drinks are linked to higher mortality, especially circulatory deaths.
Origin
- Source status
- Archive editors
- Attribution
- Archive editors (study selection and narrative are the archive's, not necessarily Elawady's)
- Origin
- https://eltayebat.com/rule/soda/
- Attribution uncertainty
- The archive homepage states that the forbidden-food section is supported by research 'independently of Dr. Diaa's words'. No evidence was found that Elawady himself cited these studies.
- Claimed mechanism
Artificial sweeteners; (Elawady: carbonation).
- Claimed health effect
Mortality, stroke, diabetes.
- Population concerned
Adults
- Geographic restriction by Elawady
none found
Diverging source versions
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- الجن . آلام العمود الفقري . الحقيقه والسراب (Open source)
- Published
- 26 November 2025
- Timestamp
- not available (transcript has no timings)
- Attribution uncertainty
- Machine/CC transcript; wording may contain transcription errors.
Scientific assessment
Potentially true – Some evidence points in favour of the statement, but it is not sufficient for a clear judgement.
Certainty of evidence: low – Further research is likely to change the assessment considerably.
1. What was claimed?
Diet soda is not a healthy substitute; it is associated with death and disease.
2. What is demonstrably correct?
WHO 2023 (I-SOD-08): NSS do not confer long-term benefit for body fat and 'may' have undesirable effects (T2D, CVD, mortality). Mullee 2019 (A-SOD-17): HR 1.26 total and 1.52 circulatory mortality for >=2 glasses/day of ASB. Imamura 2015: ASB associated with T2D, likely biased.
3. What is wrong or exaggerated?
Associations are probably partly explained by reverse causation and confounding (WHO, Imamura, Malik 2019 note this). Within the archive's own bibliography, ASB were not associated with coronary heart disease (A-SOD-14, A-SOD-15), with gout (A-SOD-06) or with fatty liver (A-SOD-12). Malik 2019 (A-SOD-05) found ASB associations only in the highest category and only in women, which disappeared after adjustment for intermediate conditions (HR 1.00, 0.94-1.06) and in most sensitivity analyses; the authors attribute them largely to reverse causation, and replacing one daily serving of SSB with ASB was associated with 4% lower total mortality (HR 0.96, 0.94-0.98) and 5% lower CVD mortality (HR 0.95, 0.90-0.99). Imamura 2015 (A-SOD-08) concerns type 2 diabetes, not mortality; its ASB estimate is low certainty and non-significant after publication-bias calibration (RR 1.22, 0.98-1.52). Elawady himself said his objection to sodas is the carbonated water, not the sugar or sweetener (see C-SOD-14), which differs from the archive's reasoning.
4. What remains unclear?
True long-term effects of NSS.
5. Which studies support it?
A-SOD-17, I-SOD-08, A-SOD-23; A-SOD-08 (indirect: diabetes outcome, bias-sensitive).
6. Which studies contradict it?
A-SOD-14, A-SOD-15 (no CHD association), A-SOD-05 (ASB association limited to very high intake in women and explained by reverse causation; substitution of ASB for SSB associated with lower mortality).
7. What applies to Germany and Europe?
Sweeteners are authorised in the EU with ADIs; WHO's recommendation is conditional.
8. What is known about Egypt?
No Egypt-specific data.
9. What practical conclusion is appropriate?
Water is preferable to both sugary and diet sodas. For people who habitually drink sugary soda, one large cohort found switching to diet soda associated with slightly lower mortality (A-SOD-05), but this is observational and long-term benefit is not proven.
Assessment details
- Rationale for certainty of evidence
WHO (2023) conditionally recommends against using non-sugar sweeteners for weight control because long-term benefit was not shown and observational data suggest possible harms, but notes likely confounding. Cohort associations for ASB are inconsistent (positive in EPIC, NHS; null for CHD in HPFS and NHS-CHD analyses).
- Source quality
Archive highlights positive associations and omits null findings within its own bibliography (A-SOD-14, A-SOD-15) and the authors' caveats.
- Regional transferability
High; EPIC includes Germany.
- Individual exceptions
People with diabetes: WHO's NSS recommendation explicitly excludes individuals with pre-existing diabetes.
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
Overinterpreted – A real finding exists, but the claim draws more from it than the data allow (e.g. association taken as cause, animal data applied to humans, small effect presented as large).
Research question: Is diet soda an unsafe alternative to sugary soda, i.e. are artificially sweetened beverages linked to higher (especially circulatory) mortality?
Research question in detail (PECO)
- Population
- Adults
- Intervention or exposure
- Artificially sweetened beverages
- Comparison
- Low intake; SSB; water
- Geographic scope
- universal
- Outcomes
- All-cause and circulatory mortality
- Body weight (RCTs)
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
Sugary and diet drinks linked to higher death rates
Zhang YB et al.. Adv Nutr 2021 · PMID 33786594 · DOI 10.1093/advances/nmaa110 Meta-analysisabstract checkednewly addedDose-response meta-analysis: J-shaped ASB association with CVD mortality (HR 1.15 at 2/day, 1.25 at 2.5/day).
- Actual result
- CVD mortality HR 1.15 (1.08-1.23) at 2/day.
- Methodological quality
- high
- Relevance
- direct
- Limitations
- Reverse causation.
Soft drinks and death in 10 European countries
Mullee A et al.. JAMA Intern Med 2019 · PMID 31479109 · DOI 10.1001/jamainternmed.2019.2478 Cohort studyfull text, structured risk-of-bias assessmentEPIC: ASB >=2 glasses/day associated with circulatory death HR 1.52.
- Actual result
- HR 1.52 (1.30-1.78).
- Methodological quality
- high
- Relevance
- direct
- Limitations
- Observational.
Diet drinks linked to several diseases in observational data
Diaz C et al.. Adv Nutr 2023 · PMID 37187453 · DOI 10.1016/j.advnut.2023.05.010 Systematic reviewabstract checkednewly addedUmbrella review: ASB-all-cause mortality association highly suggestive; CVD mortality weak.
- Actual result
- Credibility classes.
- Methodological quality
- moderate
- Relevance
- direct
- Limitations
- Observational.
What speaks against the claim?
Swapping sugary for diet drinks helped weight in trials
McGlynn ND et al.. JAMA Netw Open 2022 · PMID 35285920 · DOI 10.1001/jamanetworkopen.2022.2092 Meta-analysisabstract checkednewly addedNetwork meta-analysis of 17 RCTs: replacing SSB with low/no-calorie drinks reduced weight by about 1 kg without harm.
- Actual result
- -1.06 kg (-1.71 to -0.41).
- Methodological quality
- high
- Relevance
- direct for intermediate outcomes
- Limitations
- Short; industry links of authors.
Sugary and diet drinks and death in 118,000 US adults
Malik VS et al.. Circulation 2019 · PMID 30882235 · DOI 10.1161/CIRCULATIONAHA.118.037401 Cohort studyfull text, structured risk-of-bias assessmentMalik 2019: ASB not associated with higher mortality after adjustment (HR ~0.96-0.98).
- Actual result
- Pooled ASB categories ~0.96-0.98.
- Methodological quality
- high
- Relevance
- direct
- Limitations
- US health professionals.
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
Diet soda is not a proven health benefit and is associated with higher mortality in several cohorts, but RCTs show short-term benefits when it replaces sugary soda, and the cohort associations are likely partly due to reverse causation; water is preferred.
Why some studies weigh more
RCTs for intermediate outcomes vs cohorts for mortality; neither is decisive.
Is a causal relationship established? Not established Reverse causation and confounding by indication.
Remaining uncertainty
Long-term causal effects.
Justified conclusion
Partly true; 'not safe' is overstated.
Why do studies seem to disagree?
Cohort harm signals vs RCT benefits: different outcomes (mortality vs weight), durations and populations (diet drinks chosen by people with risk factors).
Does this depend on the country?
- General biological effects
- Universal.
- Legal rules
- Sweeteners authorised in EU with ADIs; WHO 2023 conditional recommendation.
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- Difference CI symmetry – -1.06 kg symmetric; z -3.2 recalculated
- ASB dose-response CIs – Log-symmetric at 1.5, 2, 2.5 servings/day recalculated
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- Mortality with ASB
- Starting level
- low (observational studies)
- Reasons for downgrading
- risk of bias (reverse causation)
- inconsistency
- Result
- low
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Clinical guidelines and official statements checked
- WHO: Use of non-sugar sweeteners: WHO guideline (2023), publication page (I-SOD-08) (2023) · Original publication
Guidance on NSS use to reduce unhealthy weight gain and NCD risk; not based on toxicological safety assessment and not intended to replace JECFA acceptable daily intakes; accompanying news release: recommends against NSS for weight control (conditional). - ADA: 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2026 (Diabetes Care 2026;49 Suppl 1:S89-S131; I-INTC-03) (2026) · Original publication
Rec. 5.14: minimise sugar-sweetened beverages, sweets, refined grains, processed and ultra-processed foods. Rec. 5.21: encourage water over other beverages (A). Rec. 5.22: nonnutritive sweeteners can replace sugar-sweetened products if consumed in moderation and for the short term (B). Rec. 5.25: replace sugar-sweetened beverages (including any juices) with water or low/no-calorie beverages and minimise foods with added sugar (B).
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| Europe PMC | 26 October 2026 | (TITLE:"non-sugar sweeteners" OR TITLE:"artificially sweetened beverages" OR TITLE:"artificial sweeteners") AND (mortality OR cardiovascular OR stroke OR dementia) AND (meta-analysis) AND PUB_YEAR:[2019 TO 2026] | both directions | 63 | |
| PubMed | 26 October 2026 | McGlynn ND[au] AND sweetened beverages AND JAMA Netw Open[ta] | contradicting evidence | 1 | |
| PubMed | 26 October 2026 | (sugar-sweetened beverages[ti]) AND (cardiovascular[ti] OR coronary[ti] OR mortality[ti]) AND meta-analysis[pt] | both directions | 4 |
Open questions
Long-term RCTs.
How deeply was this checked?
11 linked studies: 4 checked in full text (3 of them with a structured risk-of-bias assessment), 7 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: Potentially true (low)
- 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: Potentially true (low)
New evidence on both sides (umbrella and dose-response meta-analyses; RCT network meta-analysis; 2026 consensus) leaves the balance unchanged.
New sources: I-SOD-101 I-SOD-102 I-SOD-103 I-SOD-120
In plain language
Some large studies found more deaths among heavy diet-soda drinkers, but others found no link with heart disease. People who are already overweight or ill often choose diet drinks, which can create a misleading link. In one large US study, people who replaced a sugary drink with a diet drink had a slightly lower death risk. The WHO advises not to rely on sweeteners for weight control because no long-term benefit has been shown. Plain water is the best alternative.
Studies on this claim
Studies supporting the claim (4)
-
Soft drinks and death in 10 European countries
Mullee A et al.. JAMA Intern Med 2019 · PMID 31479109 · DOI 10.1001/jamainternmed.2019.2478Cohort studycited by the Tayebat archivefull text, structured risk-of-bias assessment★ key studyTwo or more soft drinks a day were linked with higher death rates; for diet drinks the link was even stronger, which may partly reflect who chooses diet drinks.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Are total, SSB and ASB soft drinks associated with total and cause-specific mortality?
- How was the study done?
Population-based prospective cohort (EPIC), 10 European countries.
- How many people, animals or samples were studied?
451,743; 41,693 deaths; Adults without cancer, heart disease, stroke or diabetes
- What was actually found?
>=2 glasses/day vs <1/month: total soft drinks HR 1.17 (1.11-1.22); SSB 1.08 (1.01-1.16); ASB 1.26 (1.16-1.35); ASB and circulatory deaths 1.52 (1.30-1.78); SSB >=1/day and digestive deaths 1.59 (1.24-2.05).
- How large was the observed effect?
HR 1.17 total; 1.08 SSB; 1.26 ASB
- What do the results mean in everyday life?
Soft drinks are linked with earlier death in Europe.
- What are the study's limitations?
Observational; drink intake asked only once at baseline; residual confounding; diet-drink results may reflect people at risk switching to diet drinks; sugar-sweetened drinks were not linked to heart or circulatory deaths in this cohort.
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
High (includes Germany).
- What can explicitly not be concluded from this study?
It cannot prove that soft drinks cause death, nor that sugary soft drinks raise cardiovascular death in Europeans (that association was not significant here).
-
WHO on non-sugar sweeteners
World Health Organization. WHO news release 2023Guideline / position statementindependent cross-checkfull text checked★ key studyWHO advises not to use sweeteners for weight control, because no long-term benefit was shown; possible harms may be confounded.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Should NSS be used for weight control/NCD risk reduction?
- How was the study done?
International guideline (news release read in full).
- How many people, animals or samples were studied?
Not applicable; All people except those with pre-existing diabetes
- What was actually found?
Recommends against NSS to control weight or reduce NCD risk; NSS confer no long-term benefit for body fat; potential undesirable effects (T2D, CVD, mortality) from long-term use; recommendation conditional because observed links might be confounded by baseline characteristics and complicated patterns of NSS use.
- How large was the observed effect?
Not applicable
- What do the results mean in everyday life?
Water or unsweetened drinks are preferable.
- What are the study's limitations?
Conditional; observational evidence for harms
- What does it say about Elawady's specific claim?
Supports C-SOD-10 (no proven benefit); limits C-SOD-06 (confounding).
- Do the results apply to Germany and Europe?
Applies globally.
- What can explicitly not be concluded from this study?
That sweeteners cause disease.
-
Diet drinks linked to several diseases in observational data
Diaz C et al.. Adv Nutr 2023 · PMID 37187453 · DOI 10.1016/j.advnut.2023.05.010Systematic reviewindependent cross-checkabstract checked★ key studyAcross many studies, regular diet-drink consumers had more obesity, diabetes, hypertension, heart disease and deaths; stroke and heart-death links were weak.
ASB-all-cause mortality association highly suggestive; CVD mortality weak.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Grade the credibility of links between diet drinks and health.
- How was the study done?
Umbrella review of meta-analyses.
- How many people, animals or samples were studied?
55 underlying studies.
- What was actually found?
Several associations highly suggestive; stroke and cardiovascular mortality weak.
- How large was the observed effect?
Credibility classes, not single effect sizes.
- What do the results mean in everyday life?
Diet drinks are not proven healthy; causation unclear.
- What are the study's limitations?
Observational; reverse causation likely.
- What does it say about Elawady's specific claim?
Partly supports 'diet soda is not a safe alternative'; does not support strong stroke effects.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot show that sweeteners cause these diseases.
-
Sugary and diet drinks linked to higher death rates
Zhang YB et al.. Adv Nutr 2021 · PMID 33786594 · DOI 10.1093/advances/nmaa110Meta-analysisindependent cross-checkabstract checked★ key studyPooled cohorts: each daily sugary drink was linked to 8% higher overall and cardiovascular mortality; diet drinks were linked at 1.5 or more per day.
ASB J-shaped association with CVD mortality at >=1.5 servings/day.
Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Pool cohort studies on sweetened drinks and death.
- How was the study done?
Dose-response meta-analysis.
- How many people, animals or samples were studied?
About 0.9-1 million participants.
- What was actually found?
Sugary drinks linked to more deaths; diet drinks at higher doses too.
- How large was the observed effect?
SSB HR 1.08 per serving.
- What do the results mean in everyday life?
Fewer sugary drinks is consistent with longer life; diet drinks are not clearly protective.
- What are the study's limitations?
Observational; reverse causation for diet drinks.
- What does it say about Elawady's specific claim?
Supports the direction of both claims.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot prove causation.
No study in this group is marked as key.
Studies contradicting or limiting the claim (4)
-
Sweetened drinks and heart disease in men
de Koning L et al.. Circulation 2012 · PMID 22412070 · DOI 10.1161/CIRCULATIONAHA.111.067017Cohort studycited by the Tayebat archiveabstract checkedMen with highest sugary-drink intake had 20% more heart disease; diet drinks showed no link.
ASB not associated with CHD or biomarkers.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Are SSB and ASB associated with CHD and biomarkers?
- How was the study done?
Prospective cohort (HPFS) 22 years.
- How many people, animals or samples were studied?
42,883; 3,683 CHD cases; Male health professionals
- What was actually found?
Top vs bottom SSB quartile RR 1.20 (1.09-1.33); ASB RR 1.02 (0.93-1.12); SSB associated with higher TG, CRP, IL-6, TNF receptors and lower HDL, Lp(a), leptin.
- How large was the observed effect?
RR 1.20 (SSB); 1.02 (ASB)
- What do the results mean in everyday life?
Sugary, not diet, drinks linked to heart disease.
- What are the study's limitations?
Observational design; residual confounding possible; Self-reported dietary intake
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
Causation.
-
Sugary drinks and heart disease in women
Fung TT et al.. Am J Clin Nutr 2009 · PMID 19211821 · DOI 10.3945/ajcn.2008.27140Cohort studycited by the Tayebat archiveabstract checkedTwo or more sugary drinks a day: 35% higher heart disease risk; diet drinks not linked.
Artificially sweetened beverages not associated with CHD.
Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Is SSB consumption associated with CHD in women?
- How was the study done?
Prospective cohort (NHS) 1980-2004.
- How many people, animals or samples were studied?
88,520; 3,105 CHD cases; Women aged 34-59 without CHD, stroke, diabetes
- What was actually found?
RRs 1.0, 0.96, 1.04, 1.23 (1.06-1.43) for 1/d and 1.35 (1.07-1.69) for >=2/d (P trend <0.001); attenuated but significant after BMI, energy and diabetes adjustment; ASB not associated.
- How large was the observed effect?
RR 1.35 (1.07-1.69)
- What do the results mean in everyday life?
Sugary drinks linked to heart disease.
- What are the study's limitations?
Observational design; residual confounding possible; Self-reported dietary intake
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
Causation.
-
Sugary and diet drinks and death in 118,000 US adults
Malik VS et al.. Circulation 2019 · PMID 30882235 · DOI 10.1161/CIRCULATIONAHA.118.037401Cohort studycited by the Tayebat archivefull text, structured risk-of-bias assessment★ key studyTwo or more sugary drinks a day: 21% higher death risk; diet drinks linked only at the highest intake and only in women.
ASB association limited to highest category and to women (NHS); authors call for confirmation.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Are SSB and ASB associated with total and cause-specific mortality?
- How was the study done?
Two prospective cohorts (HPFS 1986-2014; NHS 1980-2014); repeated FFQs; Cox models.
- How many people, animals or samples were studied?
118,363 (37,716 men; 80,647 women); 36,436 deaths; Health professionals and nurses free of chronic disease at baseline
- What was actually found?
SSB >=2/d vs <1/mo: total mortality HR 1.21 (1.13-1.28); CVD mortality 1.31 (1.15-1.50); cancer mortality 1.16 (1.04-1.29). ASB: only highest category, total 1.04 (1.02-1.12), CVD 1.13 (1.02-1.25); association in NHS but not HPFS (P interaction 0.01); not with cancer mortality.
- How large was the observed effect?
HR 1.21 total, 1.31 CVD (SSB)
- What do the results mean in everyday life?
Regular sugary drinks are linked with earlier death.
- What are the study's limitations?
Health professionals (limited generalisability); Observational design; residual confounding possible; Self-reported dietary intake
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
That diet drinks are as harmful as sugary ones; causality
-
Swapping sugary for diet drinks helped weight in trials
McGlynn ND et al.. JAMA Netw Open 2022 · PMID 35285920 · DOI 10.1001/jamanetworkopen.2022.2092Meta-analysisindependent cross-checkabstract checked★ key studyIn 17 randomised trials, replacing sugary drinks with low- or no-calorie drinks lowered weight by about 1 kg, similar in direction to water.
RCTs show small benefit when diet drinks replace sugary drinks.
Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Compare diet drinks, sugary drinks and water as substitutes.
- How was the study done?
Network meta-analysis of randomised trials.
- How many people, animals or samples were studied?
1733 adults with overweight or obesity.
- What was actually found?
Diet drinks instead of sugary drinks: about 1 kg less weight and less liver fat.
- How large was the observed effect?
-1.06 kg (-1.71 to -0.41).
- What do the results mean in everyday life?
For heavy soda drinkers, diet drinks can be a step down; water remains first choice.
- What are the study's limitations?
Short trials; several authors with industry links.
- What does it say about Elawady's specific claim?
Weakens the claim that diet soda is clearly harmful.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot show long-term safety.
No study in this group is marked as key.
Studies with mixed or unclear results (3)
-
Sugary drinks, diet drinks, juice and diabetes
Imamura F et al.. BMJ 2015 · PMID 26199070 · DOI 10.1136/bmj.h3576Meta-analysiscited by the Tayebat archivefull text, structured risk-of-bias assessmentEach daily sugary drink was linked with 13-18% more diabetes; diet drinks and juice also showed (possibly biased) links.
ASB association likely biased (publication bias, residual confounding).
Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Are SSB, ASB and fruit juice associated with T2D independently of adiposity?
- How was the study done?
Systematic review and random-effects meta-analysis of prospective cohorts; PAF estimation (US, UK).
- How many people, animals or samples were studied?
17 cohorts; 38,253 cases; 10,126,754 person-years; Adults without diabetes
- What was actually found?
Per serving/day: SSB +18% (9-28%; I2 89%) and +13% (6-21%) after adiposity adjustment; ASB +25% and +8% (publication bias and residual confounding indicated); fruit juice +5% (-1 to 11%) and +7% (1-14%). PAF: 8.7% USA, 3.6% UK.
- How large was the observed effect?
+18% per serving (+13% adiposity-adjusted)
- What do the results mean in everyday life?
Neither diet drinks nor juice are proven healthier alternatives to sugary drinks.
- What are the study's limitations?
High heterogeneity; observational studies; protocol not registered; ASB and juice results likely biased
- What does it say about Elawady's specific claim?
Supports C-SOD-01; mixed for C-SOD-10; limits C-SUG-06 (juice association).
- Do the results apply to Germany and Europe?
High (UK PAF estimated).
- What can explicitly not be concluded from this study?
Causation; that diet drinks or juice cause diabetes; diet-drink effects on mortality
-
Sweetened drinks dose-response
Qin P et al.. Eur J Epidemiol 2020 · PMID 32529512 · DOI 10.1007/s10654-020-00655-yMeta-analysiscited by the Tayebat archiveabstract checkedEach extra 250 mL/day of sugary drinks was linked with 12-19% higher risks of obesity and diabetes; diet drinks showed similar links.
Does the study support the specific claim? Yes · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Dose-response of SSB/ASB with obesity, T2D, hypertension, mortality.
- How was the study done?
Dose-response meta-analysis of prospective cohorts.
- How many people, animals or samples were studied?
39 articles; Adults
- What was actually found?
Per 250 mL/day SSB vs ASB: obesity RR 1.12 vs 1.21; T2D 1.19 vs 1.15; hypertension 1.10 vs 1.08; all-cause mortality 1.04 vs 1.06 (with I2 up to 92.6%).
- How large was the observed effect?
T2D RR 1.19 per 250 mL/d (SSB)
- What do the results mean in everyday life?
More sweetened drinks, more risk in observational data.
- What are the study's limitations?
High heterogeneity; Cohorts only; Reverse causation for ASB
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
Causation, especially for diet drinks.
-
Diet drinks: short-term substitute, not a long-term goal
Choi JH et al.. Diabetes Metab J 2026 · PMID 41531289 · DOI 10.4093/dmj.2025.0848Guideline / position statementindependent cross-checkabstract checkedKorean experts found that swapping sugary drinks for diet drinks lowered weight slightly in trials, but long-term observational links to disease mean water is the better goal.
Short-term substitution beneficial; long-term use not recommended.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Give evidence-based advice on sugary and diet drinks.
- How was the study done?
Meta-analysis of trials plus review of cohort reviews.
- How many people, animals or samples were studied?
14 trials and 20 reviews.
- What was actually found?
Swapping lowered weight by 0.73 kg; long-term cohort links for both drink types.
- How large was the observed effect?
-0.73 kg body weight.
- What do the results mean in everyday life?
Diet drinks can help people cut sugary drinks, but water is best.
- What are the study's limitations?
Consensus; abstract reviewed.
- What does it say about Elawady's specific claim?
Partly supports 'diet soda is not a safe alternative'.
- Do the results apply to Germany and Europe?
Applicable in principle.
- What can explicitly not be concluded from this study?
Cannot settle whether sweeteners cause disease.
No study in this group is marked as key.
Regional context
Germany / EU
Sweeteners are authorised in the EU with ADIs; WHO's recommendation is conditional.
Egypt
No Egypt-specific data.
What applies in my country?
General scientific assessment
Potentially true Diet soda is not a proven health benefit; evidence of real harm is uncertain.
The following areas of food safety are relevant to this statement:
- Additives and processing
- Controls, imports, recalls, labelling
Honey, sugar, sweets
Choose a country to see the checked information for it.
Limits: legal rules describe what is allowed, not what every single food contains. Measurement data come from samples and are meaningful only together with their method details.
Country of residence or purchase Compare with another country
References
- Association Between Soft Drink Consumption and Mortality in 10 European Countries.. Mullee A et al.. JAMA Intern Med 2019 · PMID 31479109 · DOI 10.1001/jamainternmed.2019.2478
- WHO advises not to use non-sugar sweeteners for weight control in newly released guideline (Use of non-sugar sweeteners: WHO guideline, 2023) — news release. World Health Organization. WHO news release 2023
- Artificially Sweetened Beverages and Health Outcomes: An Umbrella Review.. Diaz C et al.. Adv Nutr 2023 · PMID 37187453 · DOI 10.1016/j.advnut.2023.05.010
- Association of Consumption of Sugar-Sweetened Beverages or Artificially Sweetened Beverages with Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies.. Zhang YB et al.. Adv Nutr 2021 · PMID 33786594 · DOI 10.1093/advances/nmaa110
- Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men.. de Koning L et al.. Circulation 2012 · PMID 22412070 · DOI 10.1161/CIRCULATIONAHA.111.067017
- Sweetened beverage consumption and risk of coronary heart disease in women.. Fung TT et al.. Am J Clin Nutr 2009 · PMID 19211821 · DOI 10.3945/ajcn.2008.27140
- Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults.. Malik VS et al.. Circulation 2019 · PMID 30882235 · DOI 10.1161/CIRCULATIONAHA.118.037401
- Association of Low- and No-Calorie Sweetened Beverages as a Replacement for Sugar-Sweetened Beverages With Body Weight and Cardiometabolic Risk: A Systematic Review and Meta-analysis.. McGlynn ND et al.. JAMA Netw Open 2022 · PMID 35285920 · DOI 10.1001/jamanetworkopen.2022.2092
- Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction.. Imamura F et al.. BMJ 2015 · PMID 26199070 · DOI 10.1136/bmj.h3576
- Sugar and artificially sweetened beverages and risk of obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality: a dose-response meta-analysis of prospective cohort studies.. Qin P et al.. Eur J Epidemiol 2020 · PMID 32529512 · DOI 10.1007/s10654-020-00655-y
- Health Effects of Sugar-Sweetened and Artificially Sweetened Beverages: Umbrella Review and Evidence-Based Consensus Statement of the Korean Diabetes Association and the Korean Nutrition Society.. Choi JH et al.. Diabetes Metab J 2026 · PMID 41531289 · DOI 10.4093/dmj.2025.0848