What began as a study focused on exploring perspectives of a sugar-sweetened beverage tax among Indigenous adults later expanded to explore perceptions of diet drinks. Diet drinks are beverages sweetened without regular sugars and instead have aspartame, sucralose, or acesulfame potassium, sometimes referred to as non-nutritive sweeteners. Between June 2019 and June 2022, our research team interviewed 74 Indigenous adults living in three parts of Manitoba: Flin Flon, the North End neighbourhood in Winnipeg, and Island Lake Anishininew Nations. This study was part of a larger, multi- partner, community-based participatory study involving the National Indigenous Diabetes Association, Four Arrows Regional Health Authority, and Fearless R2W.

Results from the study demonstrated that diet drinks were viewed as an alternative to regular pop. Perceptions of how diet drinks were viewed as an alternative were however divided. Three sub- themes were prevalent in most of the discussions: health reasons, different taste preferences, and mysterious but negative health impacts of consuming diet drinks.

Diet drinks for health reasons

The main reason for diet drink consumption was health reasons. Diet drink consumption was prominent among participants with type 2 diabetes; however, younger participants frequently discussed the teasing and judgment from others about drinking diet beverages. Participants said that it was often assumed someone was drinking diet beverages for weight or diabetes management – they rarely talked about drinking diet beverages outside of the context of health. One individual mentioned that their son with type 2 diabetes drank regular pop in social situations because he did not want his peers to know about his diagnosis.

These results might suggest that diabetes stigma is more prevalent among younger adults, which is a topic of further exploration. Diabetes stigma arises due to the misconception that the individual is responsible for eating healthy foods, despite many factors that influence food intake and diabetes being influenced by factors out of one's control, such as food insecurity, intergenerational trauma, and adverse childhood experiences – all products of colonization.

Different taste preferences

Individuals who did not consume diet drinks noted their distaste for non-nutritive sweeteners. For many respondents, SSB were unmatched for pleasure and enjoyment, which was a primary reason for not consuming diet drinks. Diet drinks were not as tasty or refreshing as their sugar-sweetened counterparts, said participants. There was a shared distaste for non-nutritive sweeteners among participants -- one individual related these sweeteners to "poison" for both the taste and questionable health effects.

Mysterious but negative health impacts

A number of participants were hesitant to consume diet drinks because they were concerned about the negative health impacts of consuming non-nutritive sweeteners. Participants mentioned seeing news articles about the negative health effects of non-nutritive sweeteners, primarily aspartame, which made them question if it was any healthier than sugar. Some participants were particularly concerned about children consuming aspartame. When asked or when participants expanded on their concerns, participants were vague in their perceived health impacts, only that aspartame was worse or just as bad as sugar, cause heart problems, or were seen as chemicals.

A Google search of non-nutritive sweeteners provides a mixed bag of articles – you'll find reputable researchers, health organizations, and not-so-reputable sources demonstrating the health benefit of non-nutritive sweeteners, while others urge consumers to avoid sugar alternatives altogether. The evidence for or against non-nutritive sweeteners continues to be a topic of controversy. Unfortunately, for those looking to switch from sugar-sweetened beverages to something healthier, it can be hard to distinguish fact from fiction when looking to the internet for answers. For example, while guidelines from health organizations, such as Diabetes Canada, explicitly mention that individuals with diabetes should avoid sugary drinks and opt for water, there are no recommendations surrounding diet drinks.

Clear recommendations and addressing myths about non-nutritive sweeteners may help Indigenous communities in preventing and managing diabetes. Additionally, diabetes stigma may negatively affect dietary management of diabetes via the social labelling of foods or beverages deemed specifically for diabetes management.