What is its just diet coke?
Additional Information
A new observational study of almost 13,000 Brazilian adults looked at the association between zero and low calorie sweeteners and cognitive function.
Published in Neurology.
A prospective cohort study: mean age 51.9 ± 9.0 years, 54.8% women, 43.2% Black/mixed race.
Followed for a median of 8 years.
Data from the ELSA-Brasil cohort.
Dietary intake of low- and no-calorie sweeteners (LNCSs) was assessed via food frequency questionnaire.
They included: aspartame, saccharin, acesulfame k, erythritol, xylitol, sorbitol, and tagatose
Sucralose could not be assessed because it was approved in Brazil during the study's dietary assessment period.
Participants were grouped by average daily sweetener intake into High (avg 191mg/day), medium and low (20mg/day) consumption groups.
Cognitive function was measured serially across memory, verbal fluency, and executive function domains.
Adjusted for age, sex, HTN, CV disease.
What did they find?
The highest consumption group of combined LNCSs was associated with faster decline in verbal fluency and global cognition, particularly among participants younger than 60 years.
The highest intake group experienced a 62% faster rate of cognitive decline than the lowest intake group… equivalent to roughly 1.6 years of additional brain aging.
The middle consumption group showed a 35% faster cognitive decline vs. the lowest intake group.
No significant association was found in those aged over 60 years.
When individual sweeteners were analyzed, aspartame, saccharin, acesulfame K, erythritol, sorbitol, and xylitol were each independently associated with faster decline in global cognition, with memory and verbal fluency most affected.
Tagatose was the only sweetener not associated with cognitive decline.
Tagatose is often found in dairy products, because it is formed when milk is heated. It is similar in texture and appearance to sucrose and is 92% as sweet but with only 38% of the calories.
The association was more pronounced in participants with diabetes though those without diabetes also showed associations with faster decline in verbal fluency and global cognition.
Consider that individuals with diabetes are more likely to consume LNCSs because of medical advice to reduce sugar consumption.
No association was found between any LNCS and performance of executive function.
Important Limitations and Context
This is an observational study and cannot establish causation.
Using self-reported dietary information is notoriously inaccurate.
Take Home: Multiple artificial sweeteners (Not just sweetened beverages) are associated with cognitive decline ESPECIALLY in midlife and in those with diabetes.
References
Gonçalves NG, et al. Association Between Consumption of Low- and No-Calorie Artificial Sweeteners and Cognitive Decline: An 8-Year Prospective Study. Neurology. 2025 Oct 7