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High-sugar beverages such as soda are uncontroversially unhealthy, and their regular consumption is causally associated with a variety of adverse health conditions, including coronary heart disease and diabetes. The recognition of this association has led to an increase in the popularity of beverages with alternative sweeteners. The health effects of artificially sweetened products are less clearly understood and remain an active area of research, which unfortunately for rational scientific discourse means the topic also makes for effective clickbait and scare claims. One example of that phenomenon comes from the website Skinny and Healthy, which posted an article headlined Drinking One Diet Drink Daily Can Triple Risk of Dementia and Stroke. Like most citation-free science clickbait, that article primarily consisted of a copy-pasted press release, in this case for a 2017 study published in the journal Stroke which has been reframed in a way to suggest that the results were more authoritative than they actually were: Most important is that the study did not indicate that diet drinks can even be more dangerous than regular ones, or that the action of drinking a soda sweetened with artificial sweeteners causes an increased risk of stroke or dementia. That study did broadly find that drinking at least one artificially sweetened beverage daily was associated with almost three times the risk of developing stroke or dementia compared to those who drank artificially-sweetened beverages less than once a week, but the study was not designed to address causation and did not make any argument regarding it. The authors caution that the long-term observational study was not designed or able to prove cause and effect, and only shows a trend among one group of people, the press release also stated. The study authors utilized data from a well-known dataset, the Framingham Heart Study, which included questionnaires about food preferences with other health indicators taken from people at multiple times over the course of decades: An editorial written to accompany the study raised the possibility of selection biases that could have driven at least some of the associations documented, however. For example, it could be that people with existing risk factors for the cardiovascular issues that lead to stroke and dementia make a switch to artificially sweetened beverages for other health reasons and carry their increased risks with them: The 2017 study in Stroke also found, as alluded in the viral reports, that people who drank more sugar-sweetened beverages did not see an increase in the risk of stroke or dementia. This also could be the result of a form of selection bias stemming from the fact that the population most at risk from their sugary beverage consumption may have already died, affecting the statistical analysis: This 2017 study is not the only one to tackle the topic of adverse health outcomes from the consumption of artificially sweetened beverages. Other studies have looked at this and similar questions and reached differing conclusions: A 2012 study published in the American Journal of Clinical Nutrition also documented an association between low-calorie beverages and stroke but argued the results should be interpreted with caution, as no clear biological mechanism explained a link between low-calorie sweeteners and the circulatory issues that lend themselves to strokes: That study, in contrast to the 2017 paper, found in increased risk of stroke for sugar-sweetened beverage drinkers as well. While the 2017 study at issue here also found an association between stroke and artificially sweetened beverages, its authors pointed to uncertainties regarding what possible mechanism might link artificially sweetened beverages to either stroke or dementia, describing possible links as incompletely understood. Ultimately, clinical trials and not prospective cohort studies like the ones that have been used to address this question in the past will be needed to investigate causation and tease apart any possible mechanism that might exist, a point the authors of the 2017 study in Stroke made explicitly:
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