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Artifician Sweetned Beverages: Stroke and Dementia

Friday, April 28, 2017

Sugar and artificially-sweetened beverage intake have been linked to cardiometabolic risk factors, which increase the risk of cerebrovascular disease and dementia.

A prospective cohort study published in Stroke on April 24, 2017, analyzed data collected from 2,888 subjects for incident stroke. The subjects were part of the community-based Framingham Heart Study Offspring cohort, aged between 45 and 91 years, with a mean age of 62 years. Forty five percent of the subjects were men.

They also analyzed data collected from 1,484 of the 2,888 Framingham Heart Study participants over the age of 60 years for incident dementia, with a mean age of 69. Forty six percent were men.

Beverage intake was quantified using a food-frequency questionnaire at cohort examinations between 1991 and 1995, 1995 and 1998, 1998 and 2001. They quantified consumption and cumulative consumption by averaging across examinations. Many of the subjects consumed one or more sugar or artificially-sweetened soft drinks per day. 

Surveillance for incident events commenced at last examination (2001) and continued for 10 years.

During this 10 year period, 97 cases of incident stroke (82 ischemic) and 81 cases of incident dementia (63 consistent with Alzheimer’s disease) were identified.

After adjustments for age, sex, education (for analysis of dementia), caloric intake, diet quality, physical activity and smoking, higher recent and higher cumulative intake of artificially sweetened soft drinks were associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer’s disease dementia.

Ischemic stroke (strokes by blocked artery to the brain), dementia and Alzheimer’s disease incidence were not associated with sugar-sweetened beverages.


Conflicting data

The Nurses’ Health Study and Health Professionals Follow-Up Study reported that greater consumption of both sugar and artificially sweetened soft drinks was each independently associated with a higher risk of incident stroke over 29 years of follow-up for women and 22 years of follow-up for men.  

The Northern Manhattan Study, a population-based multiethnic cohort reported that daily consumption of artificially sweetened soft drink was associated with a higher risk of combined cardiovascular events, but not stroke when examined as an independent outcome.


Previous studies linking artificially sweetened beverage consumption of negative health consequences have been questioned based on concerns regarding residual confounding and reverse causality (do sicker individuals consume diet beverages as a means of negating a further deterioration in health?).

One of the study limitations we try to identify include the absence of minorities and gender bias in study subject selection. In this study case, the generalizabition of findings was investigator reported, suggesting the subject selection was limited to populations of non-European decent. 


This new study seems to be the first to report an association between daily intake of artificially sweetened soft drinks, and an increased risk of both all-cause dementia and dementia linked to Alzheimer’s disease.

The conclusion suggests that further research is needed to replicate the findings and to investigate the mechanisms underlying the reported association.

Ellen Troyer with Spencer Thornton, MD, David Amess and the Biosyntrx staff


Stroke remains a major public health concern in this country, with more than 600,000 cases diagnosed annually. Our bottom line suggestion: Limit soft drinks to no more than one a week if you must, including those sweetened with real sugar and artificial sweeteners.

As for our sweet-tea-drinking friends and family, they also need to address their habit sooner rather than later because their quality of life may depend on breaking that much-loved, mostly regional addiction. 


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