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Business & Profession Retina, Other

Generally Regarded as Safe

I’m a child of the 1980s and, when I think about it, people were thinner back then. So it’s quite odd that it was also the decade in which ‘diet’ carbonated drinks came to market and Spandex-clad aerobics instructors started to yell at us to move our bodies on breakfast TV. Did we need to be even thinner and healthier? In any case, why are we not all gods and goddesses in human form today?!

Something else happened in 1981. After extensive study, the FDA approved aspartame and acesulfame potassium as ‘generally regarded as safe’ food additives. In short, food and drink manufacturers can use the ingredients, and the public should be fine to consume them.

Here’s the thing. On average, we developed-nation dwellers consume fewer calories than 30–40 years ago. But we’re bigger and more likely to be diabetic than in the past. And now, we read that aspartame consumption is associated with increased HbA1c, hunger – and that the rates of proliferative diabetic retinopathy (PDR) soar as diet soda consumption increases (1) – see Ditch the Diet… Drinks.

There are a number of potential explanations. Perhaps those who are overweight or diabetic/prediabetic choose to avoid ‘full-fat’ Coke and go for the Diet or Zero alternatives. Another explanation is that artificial sweeteners alter gut bacterial flora, which then affects energy metabolism (experiments have shown that you can turn a fat mouse thin – and vice versa – by changing their gut bacteria). Or perhaps after 20–30 years of near-daily consumption, ingredients ‘generally regarded as safe’ might not be particularly safe after all – in this case, to the retina.

But I see hope. When you’re a child of the 1980s, you’ve also seen a number of dietary fads come and go: fat is bad, fat is good; carbs are good, carbs are bad; monounsaturated fats are the Devil’s work, polyunsaturated fats are so much healthier. We are still figuring out that it’s far more complicated than that. And when there’s solar-system’s-worth of data out there, there’s insight to be had. When the ferocious pace of artificial medical intelligence helps us mine the golden nuggets of what’s actually good (and bad) for you, I suspect many ‘old wives’ tales’ of fish being good for your brain, and so on, will objectively be proven right. Hopefully, we will then be able identify compounds that are generally regarded as ‘safe,’ sparing us from more of what it looks like we have here: a full pipeline of PDR cases waiting to happen.

Mark Hillen

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  1. EK Fenwick et al., “Diet soft drink is associated with increased odds of proliferative diabetic retinopathy”, Clin Exp Ophthalmol. [Epub ahead of print] (2018). PMID: 29360260.
About the Author
Mark Hillen

I spent seven years as a medical writer, writing primary and review manuscripts, congress presentations and marketing materials for numerous – and mostly German – pharmaceutical companies. Prior to my adventures in medical communications, I was a Wellcome Trust PhD student at the University of Edinburgh.

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