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When you work up a thirst, what’s your favorite drink? Many people with diabetes reach for diet soda—and why not? With plenty of flavor but no calories or carbs, it may seem like an ideal choice. But new research suggests you might want to think twice about your diet soda habit.

According to a study published in Stroke, an American Heart Association journal, people who drank at least one diet soda per day for years had nearly three times the average risk of having a stroke or developing dementia—including Alzheimer’s disease.

That’s an alarming figure, but keep one thing in mind: while this observational study can reveal a link between diet soda and health hazards, it can’t prove cause and effect.

Gathering data

About 4,000 adults took part in the study. To establish their long-term drinking habits, they logged their beverage consumption three times during seven years. They also had a magnetic resonance imaging (MRI) scan and cognitive tests to check their brain size, thinking, and memory. Then older participants were monitored for stroke and dementia over 10 years, comparing those who drank diet soda to those who didn’t.

“It was somewhat surprising that diet soda consumption led to these outcomes,” said Matthew Pase, a fellow in the Boston University School of Medicine neurology department, who is a corresponding author on the study. In a press release, he noted that previous research has found a correlation between diet soda and stroke risk, but the association with dementia was a new finding.

Was diabetes a factor?

Diabetes raises the risk of heart disease and dementia, but it’s hard to say whether it played a role in the latest study’s findings. Researchers took a variety of factors into account including age and diet, but they couldn’t completely control for diabetes because some participants may have developed it during the study. Still, the researchers say that diabetes and other preexisting conditions can’t completely explain the nearly tripled risks of stroke and dementia they found in diet soda drinkers.

Is one artificial sweetener more likely to raise those risks than another? The study didn’t look into that. It also didn’t investigate whether participants were consuming other foods and drinks with artificial sweeteners in them that may have influenced the results. More research is needed to answer such questions. For now, this article from Business Insider can help you learn more about the different safety profiles of six common artificial sweeteners.

Healthy ways to wet your whistle

If you’d like to reduce or eliminate diet soda from your diabetes diet, there are plenty of refreshing and healthy alternatives. Plain water is hard to beat, and you can flavor it with a slice of fruit or a splash of cranberry or pomegranate juice. If you’re craving bubbles, sparkling water can be a great alternative. Unsweetened almond milk is low in calories and carbs. Smoothies are a tasty way to get more fruits and veggies. Even coffee and tea can be fine choices—just watch what you add to them.

What are your favorite diabetes-friendly beverages? Share your best ideas by commenting below.