Where does diet soda fall with vices?

Dear Dr. Roach: I’ve never smoked, drank alcohol or used illegal drugs. My doctor says I’m in great health. My only vice is drinking diet soda. I’d like to know what you think about it. — P.V.

Compared with sugarsweetened soft drinks, diet sodas are probably less harmful in several ways. The effects vary by person.

Diet sodas are acidic and drinking too many can weaken the enamel on your teeth.

The effect of diet sodas on weight is complicated. Paradoxically, many people will gain weight when switching to diet soda.

Some of the sweeteners in diet sodas can cause intestinal problems in susceptible people. If you have no symptoms from drinking diet sodas, have no weight issues, get your teeth checked regularly and have good oral hygiene, then the risk is modest.

Dear Dr. Roach: I have read numerous articles regarding the use of marijuana but have not seen a reference to cannabinoid hyperemesis syndrome. I would appreciate your thoughts. — D.L.

Cannabis use is indeed increasing, and one unusual side effect is the hyperemesis (literally, “too much vomiting”) syndrome. This most often occurs in daily users of cannabis. The vomiting tends to occur in cycles. This is followed by a recovery phase lasting weeks or months. The diagnosis can be confused with cyclical vomiting syndrome, and the correct diagnosis is often missed.

Physicians sometimes fail to think of the diagnosis or have never learned of it. Cannabis users are sometimes highly resistant to the idea that the cannabis is causing these symptoms. Further, cannabinoids are sometimes used to relieve nausea, so the mechanism of cannabinoid hyperemesis syndrome is not understood.

During the acute phase, treatment is supportive care. However, the long-term treatment is cannabis cessation.