Hard facts about soft drinks
AN APPLE A DAY - Tyrone M. Reyes M.D. (The Philippine Star) - August 6, 2013 - 12:00am

Soft drinks have become so commonplace that many Filipinos don’t go a day without drinking one or more of these carbonated drinks. The problem? Downing too much of this beverage could have health consequences.

In fact, studies have found an association between a person’s soda habit and the rising rate of obesity and type 2 diabetes.  Concerns have also been raised about the toll these beverages might have on the heart, bones, kidneys, and other body organs.

As a result, some governments abroad have banned or limited the sale of soft drinks in schools.  Last May, for example, Peru approved a law designed to reduce child obesity by encouraging healthier eating habits in schools.  It regulated advertising for fatty foods and fizzy soft drinks in schools, the first step in a plan to ban some junk food altogether. Some schools in the Philippines have also already taken out soda drinks from their cafeterias.

If you drink diet soda, you may think you have little to worry about.  Yet, research suggests that even these low-calorie soft drinks can contribute to weight gain and other problems.  Here’s more of what you should know.

Spoonfuls of sugar

Many of the concerns about soft drinks center on the amount of sugar — and calories — they contain.  After all, just one regular, 12-ounce soda typically has nine teaspoons of sugar and 140 calories.  Yet, some soft drinks are now bottled or served in even larger sizes.

Of course, not all sugars may be bad for you.  Those that occur naturally in fruits and dairy products, such as milk, are considered part of a nutritious diet.  However, the sugar found in soft drinks is added to the beverage — either in the form of natural sugar or chemically manufactured syrups, such as high-fructose corn syrup — and offers little more than empty calories.

The American Heart Association recommends that people should limit their sugar intake.  For men, it should be no more than 150 calories (or nine teaspoons), and for women, no more than 100 calories (or about six teaspoons) of added sugar a day.  Regular soft drinks make it all too easy to exceed this amount.  In fact, along with other sugar-sweetened beverages, these drinks have become one of the main sources of added sugar in the Filipino diet.

Diet soft drinks have few, if any, calories and contain artificial sweeteners, rather than added sugars. Still, just like regular sodas, diet versions have little or no nutritional value and contain additives, such as caffeine or phosphoric acid, which could potentially cause health problems.

Possible health consequences

It’s no secret that obesity and type 2 diabetes have been on the rise. Soft drinks, of course, can’t take all the blame.  But experts generally agree that the consumption of these beverages, which has steadily increased, has contributed to the Filipinos’ growing problem with excess weight and weight-related health problems.

Part of the reason is that consuming extra calories from liquids may cause more weight gain than do extra calories from foods.  That’s because liquid calories may not fill you up.  As a result, you may eat or drink even more to feel satisfied.  Indeed, research has shown that adults and children who regularly drink beverages high in added sugars tend to have higher calorie intakes overall and experience greater weight gain.  And, as weight gain increases, so does the risk of developing type 2 diabetes.

Although diet sodas are low in calories, nutrition surveys have shown that those who drink them regularly don’t always eat healthier or lose weight.  That may be because diet sodas can leave less room for fruits, vegetables, low-fat milk, and other food and drinks that can help with weight loss and maintenance.  Some data even suggest that the artificial sweeteners in diet drinks may increase sugar cravings and encourage poor food choices. Unfortunately, weight gain and diabetes aren’t the only problems associated with regular soft drinks consumption.  Others include:

• Metabolic syndrome.  A study in the journal Circulation found that middle-aged adults who drink one or more regular or diet soft drinks daily had an increased risk of developing metabolic syndrome — a cluster of conditions that includes high blood pressure, excess weight around the waist, elevated cholesterol levels, and insulin resistance.  Together, these conditions significantly increase the risk of heart disease, stroke, and diabetes.

• Osteoporosis. An increase in soda consumption can cause other beverages, such as milk, to be sidelined.  This, in turn, may lower calcium intake and raise the risk of osteoporosis, a condition in which bones are weak and more prone to fracture.  It’s also possible that the phosphoric acid and caffeine found in cola soft drinks may promote the loss of calcium in bones, causing them to become more fragile. However, more study is needed on this aspect.

•  Kidney problems.  There’s some evidence that colas are linked to the formation of kidney stones.  This could have something to do with the high levels of phosphoric acid in carbonated colas.  Drinking two or more regular or diet colas a day also may increase the risk of chronic kidney disease, according to a study in the journal Epidemiology.

• Dental concerns.  Both the acid content and sticky sugars in soft drinks can contribute to dental issues, such as tooth decay. If you frequently sip sodas, acid has more time to attack your teeth or wear them down.

• Caffeine reactions.  Although the caffeine found in many soft drinks can help people feel more awake and energized, it can also cause nervousness and irritability.  In some people, caffeine can also interfere with sleep, raise blood pressure and cause a fast or irregular heartbeat — especially when consumef in large quantities.

Cancer and other concerns

In the past few years, there had been reports of other medical concerns regarding the intake of too much soft drinks.  For example, soft drinks had been tied to a higher risk of pancreatic cancer, according to research published in the February 2010 issue of Cancer Epidemiology, Biomakers & Prevention.  The study did not examine whether there was a link between diet soft drinks and pancreatic cancer, so it is unknown if a similar link exists.

In Boston, researchers have found that cola consumption (regular and diet) was associated with a significantly increased risk of developing of high blood pressure among almost 30,000 middle-aged women in the Nurses’ Health Study.  In another study, published in the June 2010 issue of Circulation, researchers found that reducing the consumption of sugar drinks (sodas and other sugary drinks) by an average of one serving per day could lower both your systolic and diastolic blood pressure readings a small but significant amount.  The reductions, in turn, could lower your stroke risk by eight percent and your risk of coronary heart disease by five percent.

Soft drinks, fruit drinks, and other sweetened beverages may also threaten your heart.  In a study published in the April 1, 2009 American Journal of Clinical Nutrition, researchers tracked more than 88,000 women in the Nurses’ Health Study from 1980 to 2004.  Those who drank at least two sweetened beverages a day had a 35-percent higher risk of heart attack than those who drank less than one a month.  Women who drank one sweetened drink a day had a 23-percent higher risk.

There’s also relatively new information that sugar-sweetened and diet soft drinks alike may increase the risk of a stroke, as reported in the May 2012 issue of the American Journal of Clinical Nutrition.  The findings come from an analysis of two long-term studies, the Nurses’ Health Study, which begun in 1976 with 121,700 women, and the Health Professionals Follow-Up Study, which started in 1986 with 51,529 men.  What they found was a red flag: Sugar-sweetened and diet soft drinks alike were associated with a higher risk of stroke, particularly in women. The more sugar-sweetened soft drinks the women drank, the higher their risk of stroke.

The Nurses’ Health Study also found an association between the incidence of gout and the intake of sweetened soft drinks and orange juice consumptions.  Likewise, a diet high in sugary sodas may also affect the liver.  In an Israeli research published in the Journal of Hepatology in 2009, researchers reported that people with non-alcoholic fatty liver disease consumed five times as many carbohydrates from soft drinks, as those without the disease.

Caution

When you read about study findings, remember that an association between two things — in this case, consuming soft drinks and the risk of certain medical conditions — is not the same as a cause-and-effect relationship.  It is very important to make healthy food and beverage choices, but it is also important to resist jumping to unproven conclusions, such as “food X causes disease Y.”

For instance, one basic question, of course, is whether the effects observed that are attributed to soft drinks are a direct effect of the beverage or associated with the characteristics of people who consume them.  Alice Lichtenstein, DSc, director of Tufts University’s HNRCA Cardiovascular Nutrition Laboratory, says, “One is always concerned that these data are confounded by characteristics of people who chose to drink sugar-sweetened soda and other diet and lifestyle choices they make.  Poor choices in the beverage category are likely accompanied by poor choices in other food categories and physical activities (or the lack thereof).”

“Nevertheless,” she adds, “there appears to be no benefit of drinking sugar-sweetened drinks and when one is thirsty, it is certainly easy to guzzle a large number of unneeded calories in a very short time.  You can save a lot of money by simply drinking water — and save enough to invest in a good pair of walking shoes!”

ALICE LICHTENSTEIN AMERICAN JOURNAL OF CLINICAL NUTRITION DIET DRINKS HEALTH STUDY RISK SOFT STUDY SUGAR
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