The best and worst drinks
AN APPLE A DAY - AN APPLE A DAY By Tyrone M. Reyes, M.D. () - April 10, 2007 - 12:00am
Is fruit juice healthier than water? Are diet soft drinks better than regular? Do coffee and tea prevent or cause disease? Do you need milk at all? Should you drink eight glasses of water a day? Aside from the occasional ad campaign singing praises for orange juice or green tea or wine, it’s rare to hear advice about what to drink. And most of what you do hear is a thumbs-up or thumbs-down on one beverage, not comprehensive advice that addresses water, coffee, tea, juice, milk, soft drinks, and alcohol.

Meanwhile, the thirst for new specialty drinks — such as smoothies, fitness waters, herb-infused juices, coffee combos, energy drinks — seems almost unquenchable. The problem is waistlines are also expanding along with the exotic drink choices. Calorie intake is up by as much as 15 percent in the last 20 years, and about half of the extra calories come from sweetened drinks. No wonder: A 24-ounce Starbucks vanilla bean frappuccino (without whipped cream), for example, contains about as many calories as a McDonald’s Big Mac. Energy drinks, fortified juices, exotic teas, and waters also sometimes contain other "extras" you don’t need: high levels of stimulants, vitamins, and minerals, as well as questionable herbal ingredients. For instance, a 16-ounce can of one energy drink contains almost as much caffeine as two cups of coffee, plus herbal supplements. Another drink packs 600 percent of the recommended daily value of vitamin B6 and 1,000 percent of B12 — far more than most people require.

That’s why a panel of experts, led by Dr. Barry Popkin, professor of nutrition at the University of North Carolina at Chapel Hill School of Public Health, recently formulated guidelines on the right beverages to drink. Here’s the rundown on what should go in that glass.
Healthy Beverage Guidelines
Dietary surveys show that drinks comprise about 20 percent of the calories in today’s average diet, but a healthier proportion would be about 10 percent. To help meet that goal, Dr. Popkin assembled a panel of top nutrition researchers from five major medical institutions, including Harvard and Johns Hopkins Universities, to create a beverage guideline system. The researchers ranked drink choices based on a combination of factors: calories, nutrients, health effects, and how much is practical to drink. Note that you don’t need fluids to supply calories or nutrients, so a healthy diet could rely on water alone. And none of the categories are requirements — you can be perfectly healthy without drinking coffee or tea, for example.

The experts’ recommendations on health and nutritional benefits and risks of various beverage categories were published in the American Journal of Clinical Nutrition. Much like the food pyramid, that suggests a balanced way of choosing different types of food for more healthful nutrition. The Healthy Beverage Guidelines provide a ranking system — ranking ranges from plain water at Level One to beverages that should be consumed in limited quantities at Level Six. The guidelines are designed to help consumers choose a more balanced and healthful palette of beverages, based on sugar content, fat and caffeine, and caloric count.

The pitcher (see illustration on Page E-1) is one way to follow the Beverage Guidelines Panel’s advice. A serving is one cup (8 oz.), not a 12 oz. can of soda or a 12 oz. "tall" latte. (Exception: A serving of beer is 12 oz., wine is 5 oz., and distilled spirits are 1-1/2 oz.) An ideal diet would include no beverage other than water. But the panel’s advice was adjusted to accommodate individual preferences (for sweets, alcohol, caffeine, something to pour on our breakfast cereal, etc.) and nutrient needs (for calcium, potassium, vitamin C, etc.). The most important change is to eliminate regular soft drinks and fruit drinks. Whole milk and 2% milk are missing because the panel recommended none.

• Water: Up to nine servings for women, 13 for men. (Those maximums assume you drink no other fluid that day.)

• Tea and coffee: Up to three servings of coffee or eight of tea. Without sugar and cream, coffee and black or green teas are calorie-free sources of apparently disease-fighting substances. Coffee may reduce the risk of type-2 diabetes, gallstones and, possibly, Parkinson’s disease. Tea may protect against cancer, heart disease, and perhaps osteoporosis. The panel made no recommendation on herbal teas.

The panel concluded that drinking up to four cups of coffee poses no health risk for most people. But some coffees contain unusually large amounts of caffeine, so to be safe, some scientists recommend no more than three cups a day. Because of an increased risk of miscarriage, pregnant women should limit their intake to one or two cups a day. You can safely drink larger amounts of tea because conventional types are relatively low in caffeine and most herbal varieties contain none. But experts advise moderating your intake of instant and bottled teas, since recent evidence suggests that the concentrated fluoride in some of these could harm the joints over time.

• Skim or low-fat milk and unsweetened fortified soy drinks: Up to two servings. These provide calcium, protein, and other nutrients and help supply the recommended three daily servings of dairy or calcium-fortified soy.

• Diet drinks: Up to four servings. These add no calories, and consuming up to four servings a day appears to be safe. However, artificially sweetened drinks may contribute to a taste for sugary foods.

• Fruit juices, whole milk, and sports drinks: Up to one serving. These exact a high-calorie price for their nutrients. Unlike whole fruit, juice doesn’t contain fiber or satisfy hunger. Commercial vegetable juices generally supply fewer calories but lots of sodium. A cup of whole milk has nearly twice the calories of skim milk plus eight grams of fat, half of it saturated. The electrolytes and calories in sports drinks aren’t useful unless you exercise strenuously for more than an hour.

• Soft drinks and juice drinks: Up to one serving. These contain lots of calories and virtually no nutrients.
Liquid Calories Go Down Easy
Drinks don’t fill you up the way solid food does. Suppose you have a small café mocha with breakfast (240 calories), a medium soft drink with lunch (210 calories), an eight-ounce energy drink mid afternoon (115 calories), and a beer after work (150 calories). Those add about 700 extra calories to your day and, by the end of the week, an extra pound of weight.

The main culprit, sugar, lurks in places that might surprise you, such as flavored waters and ready-to-drink teas. Juice drinks and smoothies are among the worst offenders. A 24-ounce Jamba Juice Banana Berry smoothie, for example, has as much sugar as four-and-a-half chocolate bars. You should also check the fat content of lattes, frappes, chai teas, smoothies, and other creamy drinks. A 32-ounce Dunkin’ Donuts Vanilla Bean Coolatta packs more than an entire day’s ration of saturated fat. You can slash the fat and calories in creamy drinks by skipping the whipped cream and substituting nonfat soy milk for whole milk.

Alcohol is double trouble for the calorie-conscious, since it can boost your appetite. If you imbibe, opt for wine or light beer over mixed drinks, and limit your intake. Finally, be aware of portion sizes. Restaurants often use huge cups or glasses. And check the number of servings in bottles and cans.
Energy Drinks Can Be Risky
Many so-called energy drinks contain mostly sugar and caffeine. Other ingredients have little or no benefit or are untested. Here are some common additives:

• Amino acids. Drinks can contain up to 10 times the usual dietary intake of taurine, an amino acid vital to the brain, heart, and muscles. But taurine is so plentiful in dietary protein that you typically maintain a large surplus. Drink makers bill it as a detoxifier, but human studies have not supported the claim. There is no evidence that the small amounts of other added amino acids, such as arginine, glutamine, and leucine, speed recovery from exercise as claimed.

• Herbals. Bee pollen, ginkgo biloba, milk thistle, and other herbals are added for reasons ranging from improving memory to boosting immunity. Often there’s little or no evidence to back up the claims or support the safety of these ingredients. And the amount in a single energy drink is probably too small in most cases to have any effect, good or bad, although allergic reactions are still possible.

• Stimulants. Ounce for ounce, most energy drinks have about as much caffeine as coffee. Some also contain ginseng, which can intensify caffeine’s effects. Caffeine has the same kick, whether it’s refined or extracted from herbal sources. Over time, too much caffeine can speed bone loss and possibly raise blood pressure. And consuming large amounts of caffeine may increase the risk of heart disease and premature death. Moreover, energy drinks can be a dangerous mix with alcohol, because the stimulants create a false sense of sobriety and coordination. The drinks are also a poor choice before exercising since the caffeine can speed up the heart and reduce its blood supply, while the sugar slows fluid absorption.

• Sugars. Fructose, galactose, glucose, glucoronolactone, and sucrose are all sugars, which may produce a short-lived buzz.

• Vitamins. You need B vitamins to help extract energy from food, but most people get plenty from their diet; the high levels in energy drinks won’t do the job any better. You don’t need the extra vitamin C in many drinks. And fortification can be harmful if the total amount from supplements and fortified foods exceeds safe limits.

Is all this talk about beverages making you thirsty? I suggest you reach for a glass of that good old pure liquid — water!

AMERICAN JOURNAL OF CLINICAL NUTRITION CAFFEINE CALORIES COFFEE DRINK DRINKS HEALTHY BEVERAGE GUIDELINES
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