I’m supposing, from the above exchange, that I suffer from impatience. The OP asks for an authoritative study, and some excellent practical explanations have been offered, mainly “no one wants to fund such a study because there’s no ROI in it,” but it still seems frustrating to have artificial sweeteners that fail at what I presume their purpose to be: to offer a low-calorie substitute for weight-loss purposes. Near as I can tell, medical science is saying that I can drink a liter of sugary Coca-Cola or sugar-free Coca-cola but they’re both going to have the same results on my weight loss and my diabetes, so I should avoid them both equally.
My doctor recommended a sugar substitute derived from monkfruit, though I did notice that it looks like sugar but tastes like pretty much nothing. Maybe it’s designed that way, to give people the placebo effect? I can put two teaspoons of monkfruit sugar in my coffee and it tastes the same as if I’d put in nothing at all.
Contrarily, I love sucralose. It’s the first substitute that I can stand to drink at all. It works especially well in lite rather than diet drinks, where the sugar content is lowered but not eliminated. Those can be made as good as full sugar drinks.
I’ve looked into the research. From what I’ve read, my takeaway is that people with poor eating habits will continue to have poor eating habits even if they drink some low-calorie beverages. OTOH, people who use diet drinks as part of an overall food control program don’t have unusual problems because of substitutes. (That’s an opinion, not a scientific truth.)
As has been explained, separating out this one particular small component of food is impossible in large-scale real-world studies. Too many other much more important factors will drown it in the data.
If you don’t look to substitutes as a panacea, they can play a part in calorie control and reducing carbohydrates. You have to do your part as well, managing all the other aspects of food if you want to see a difference.
I don’t really get why this isn’t offered as medical advice, instead of “Substitutes are as bad as sugar. Never take them. If you need a sweet, just have a little sugar,” which is what I’ve been told by several doctors, and which doesn’t make any sense to me at all. Of course, guzzling gallons of it and eating foolishly will not have a salubrious effect. But logic tells me that a glass of diet soda as a substitute for dessert, for example, should have a small positive effect but I’ve been told “No, it has a large negative effect–do not drink it. It will cause weight gain, and it will make your blood sugar levels rise.”
I suspect doctors say what they do because as a general rule people are idiots.
I’m in cardiac rehab after triple-bypass surgery. We get nutrition advice to change our diets. The fact sheets they pass out apparently assume that all we did seven days a week was have grand slams at Dennys and never read a nutrition label in our lives. None of it is modified for people who might possibly have a more advanced or nuanced feel for the subject.
It’s just easier for them to pitch the spiel at the least knowledgeable people and let the others pick and choose what’s new and what behaviors they have to modify. I keep getting told by doctors to go onto the Mediterranean Diet. Why? Because studies of people who live in the Mediterranean basin show that that’s a healthy lifestyle for the heart. What about those of us who don’t live there and can’t switch over completely for various reasons? What modifications will work and which won’t? No clue. That’s too hard to study, and too complex to personalize without hiring a private dietician and chef.
All diets work for some people. All medications work for some people. All healthy advice works for some people. That’s why it’s always a good idea for doctors to try them out. Who wants to hear that none of them may work for you personally? Or that 90% of the effort has to come from you changing everything about your life?
You’re one of seven billion people with seven billion different genetic heritages and seven billion different life histories. You’re the stake in a game of horseshoes. Close counts.
Does the science say that? The studies I linked to above say more weight loss was observed in those who drank water; artificial sweetener is a little worse, and sugary drinks are a lot worse for weight loss, for at least certain groups of people.
" Another clinical trial led by researchers at the University of North Carolina at Chapel Hill found that overweight and obese adults who were instructed to give up sugary beverages for water or low-calorie sweetened beverages for six months lost an average of 2 percent to 2.5 percent of their body weight. But the group that switched to water showed significant improvements in their blood sugar levels, a risk factor for diabetes, while the group that used low-calorie sweeteners did not."
Among [the group with high amounts of midsection fat], those who drank diet beverages gained about a pound during the study, while those who switched to water lost roughly half a pound. But the people with high levels of belly fat who continued drinking sugary beverages gained an average of 10 pounds.”