Q&A: risks of sugar substitutes; pros/cons of daily aspirin; vitamin K2 for bone health; & comparing statins + side effects
Keep your questions coming! ❄️
ICYMI 👉
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In this week’s reader-submitted Q&A, we’re tackling these questions:
Are sugar substitutes safe to consume?
Should I take a daily aspirin?
Is vitamin K2 important for bone health?
What are the side effects of statins—and which one is best to take?
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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: SUGAR SUBSTITUTES
Dr. McBride, I am always on a diet. I am someone who drank Tab soda back in the 80s. Yes I am that old. I am worried about what you will say but I have to ask: are sugar substitutes safe to use? Please say yes.
Love, your forever dieting reader in TX
Ha! Thanks for your question! The short answer is: yes, most sugar substitutes are considered safe to consume for the vast majority of people. However, whether they’re a good choice for you depends on your unique health circumstances, preferences, and the role these sweeteners play in your diet.
Most sugar substitutes, including aspartame, sucralose, stevia, and monk fruit, are rigorously tested and approved by food safety agencies like the FDA. For the average person, they’re safe to consume in moderation. That said, there’s some debate about long-term effects, especially with synthetic sweeteners like aspartame and saccharin. While studies in the 1970s raised concerns about cancer risks, more recent, well-designed research has largely debunked those fears at typical consumption levels.
The natural sweeteners like stevia and monk fruit are often perceived as healthier options because they’re plant-derived, but “natural” doesn’t always mean better or safer. Allergic reactions and digestive issues, though rare, can occur with these too.
One of the most significant concerns about sugar substitutes isn’t about their safety—it’s about their potential effects on our metabolism and relationship with food. Some research suggests that artificial sweeteners can alter gut bacteria, which may influence metabolism and blood sugar regulation. Additionally, consuming sweet-tasting foods, even if they’re calorie-free, can perpetuate cravings for sugar, making it harder to reduce your overall sweet intake.
There’s also the simple fact that these substitutes are often found in highly processed foods. Even if the sweetener itself is safe, relying heavily on these foods could mean you’re missing out on whole, nutrient-dense options that provide more long-term health benefits.
When deciding whether to include sugar substitutes in your diet, ask yourself: Are they helping you meet your health goals? Are they improving your overall diet quality? If the answers are yes, enjoy them in moderation. If not, consider other ways to cut back on sugar that prioritize whole, unprocessed foods.
The upshot: If sugar substitutes help you cut down on added sugar and manage conditions like diabetes or weight gain, they can be a helpful tool. But ultimately, what matters most is the big picture of your diet and lifestyle, not the presence or absence of sugar substitutes alone. I hope that helps!
QUESTION #2: DAILY ASPIRIN
The advice on aspirin seems to change with the winds. I have a family history of heart attack and strokes - yet when I went for my annual visit with primary care doctor says I no longer need to take a baby aspirin every day. I don’t have stomach ulcers or bleeding issues, which I know is a risk. What advice are you giving your patients?
- Karen N.P.
Dear Karen,
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