A comprehensive study of women over 50 shows that dieting done wrong can lead to unwanted healthy outcomes. Drinking two or more Diet Cokes a day was associated with a 16% increase in the risk of early death, researchers reported.

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Although many well-intended people use low-calorie sweetened drinks to lose weight, this may put their health at risk. According to the researchers, such beverages are associated with a higher risk for stroke and heart disease.

The research team, led by Dr. Yasmin Mossavar-Rahmani from the Albert Einstein College of Medicine in the Bronx, New York, analyzed data on 81,714 post-menopausal women, whose average age was 50 to 79 at the start of the study. The participants were tracked for an average of 12 years.

Women who consumed two or more artificially sweetened diet beverages were 31% more likely to have a clot-based stroke and 29% more likely to have heart disease. Among the participants, African-American women formed the most vulnerable group.

“Many well-meaning people, especially those who are overweight or obese, drink low-calorie sweetened drinks to cut calories in their diet. Our research and other observational studies have shown that artificially sweetened beverages may not be harmless and high consumption is associated with a higher risk of stroke and heart disease,” said Mossavar-Rahmani.

The study, performed by the American Heart Association and American Stroke Association, was observational, meaning that the researchers could not directly prove that sweetened drinks cause stroke and heart problems through a causal link. We also don’t yet know which artificial sweeteners may be harmful and which may be harmless. Previously, studies established a link between diet beverages and stroke, dementia, Type 2 diabetes, obesity, and metabolic syndrome, suggesting that zero-calorie drink may be just as bad as sugary ones. A 2017 study found that diet soda might even hurt the brain.

“Unfortunately, current research simply does not provide enough evidence to distinguish between the effects of different low-calorie sweeteners on heart and brain health. This study adds to the evidence that limiting use of diet beverages is the most prudent thing to do for your health,” said Rachel K. Johnson, Ph.D., R.D., professor of nutrition emeritus

There is still much research to be done in order to investigate the effects of low-calorie sweetened beverages on our health. In the meantime, evidence so far suggests that the most prudent thing to do is to avoid them. Perhaps the best choice for a non-calorie drink is water.

The findings were reported in the journal Stroke.