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How Soft Drinks are Harming Americans' Health

 Michael F. Jacobson, Ph.D.

The following excerpt is from an article posted at the Center for Science in the Public Interest, a Ralph Nader spinoff.

(Complete article can be read at   http://www.cspinet.org/sodapop/liquid_candy.htm)

Health Impact of Soft Drinks

    The soft-drink industry has consistently portrayed its products as being positively healthful, saying they are 90% water and contain sugars found in nature. A poster that the National Soft Drink Association has provided to teachers states:

As refreshing sources of needed liquids and energy, soft drinks represent a positive addition to a well-balanced diet....These same three sugars also occur naturally, for example, in fruits....In your body it makes no difference whether the sugar is from a soft drink or a peach.

M. Douglas Ivester, Coca-Cola's chairman and CEO, defending marketing in Africa, said, "Actually, our product is quite healthy. Fluid replenishment is a key to health....Coca-Cola does a great service because it encourages people to take in more and more liquids."

    In fact, soft drinks pose health risks both because of what they contain (for example, sugar and various additives) and what they replace in the diet (beverages and foods that provide vitamins, minerals, and other nutrients).

Obesity

    Obesity increases the risk of diabetes and cardiovascular disease and causes severe social and psychological problems in millions of Americans. Between 1971-74 and 1988-94, obesity rates in teenage boys soared from 5% to 12% and in teenage girls from 7% to 11%. Among adults, between 1976-80 and 1988-94, the rate of obesity jumped by one-third, from 25% to 35%.

    Numerous factors -- from lack of exercise to eating too many calories to genetics -- contribute to obesity. Soda pop adds unnecessary, non-nutritious calories to the diet, though it has not been possible to prove that it (or any other individual food) is responsible for the excess calories that lead to obesity. However, one recent study found that soft drinks provide more calories to overweight youths than to other youths. The difference was most striking among teenage boys: Soda pop provides 10.3% of the calories consumed by overweight boys, but only 7.6% of calories consumed by other boys. There was no consistent pattern of differences with regard to intake of calories, fat, or several other factors.

    Obesity rates have risen in tandem with soft-drink consumption, and heavy consumers of soda pop have higher calorie intakes. While those observations do not prove that sugary soft drinks cause obesity (heavy consumers may exercise more and need more calories), heavy consumption is likely to contribute to weight gain in many consumers.

    Regardless of whether soda pop (or sugar) contributes to weight gain, nutritionists and weight-loss experts routinely advise overweight individuals to consume fewer calories -- starting with empty-calorie foods such as soft drinks. The National Institutes of Health recommends that people who are trying to lose or control their weight should drink water instead of soft drinks with sugar.

Bones and Osteoporosis

    People who drink soft drinks instead of milk or other dairy products likely will have lower calcium intakes. Low calcium intake contributes to osteoporosis, a disease leading to fragile and broken bones. Currently, 10 million Americans have osteoporosis. Another 18 million have low bone mass and are at increased risk of osteoporosis. Women are more frequently affected than men. Considering the low calcium intake of today's teenage girls, osteoporosis rates may well rise.

    The risk of osteoporosis depends in part on how much bone mass is built early in life. Girls build 92% of their bone mass by age 18, but if they don't consume enough calcium in their teenage years they cannot "catch up" later. That is why experts recommend higher calcium intakes for youths 9 to 18 than for adults 19 to 50. Currently, teenage girls are consuming only 60% of the recommended amount, with soft-drink drinkers consuming almost one-fifth less than nonconsumers.

    While osteoporosis takes decades to develop, preliminary research suggests that drinking soda pop instead of milk can contribute to broken bones in children. One study found that children 3 to 15 years old who had suffered broken bones had lower bone density, which can result from low calcium intake.

Tooth Decay

    Refined sugar is one of several important factors that promote tooth decay (dental caries). Regular soft drinks promote decay because they bathe the teeth of frequent consumers in sugar-water for long periods of time during the day. An analysis of data from 1971-74 found a strong correlation between the frequency of between-meal consumption of soda pop and dental caries. (Those researchers considered other sugary foods in the diet and other variables.) Soft drinks appear to cause decay in certain surfaces of certain teeth more than in others.

    Tooth-decay rates have declined considerably in recent decades, thanks to such preventive factors as fluoride-containing toothpaste, fluoridated water, tooth sealants, and others. Nevertheless, caries remains a problem for some people. A large survey in California found that children (ages 6 to 8, 15) of less-educated parents have 20% higher rates of decayed and filled teeth. A national study found that African-American and Mexican-American children (6 to 18 years old) are about twice as likely to have untreated caries as their white counterparts. For people in high-risk groups, prevention is particularly important.

    To prevent tooth decay, even the Canadian Soft Drink Association recommends limiting between-meal snacking of sugary and starchy foods, avoiding prolonged sugar levels in the mouth, and eating sugary foods and beverages with meals. Unfortunately, many heavy drinkers of soft drinks violate each of those precepts.

Heart Disease

    Heart disease is the nation's number-one killer. Some of the most important causes are diets high in saturated and trans fat and cholesterol; cigarette smoking; and a sedentary lifestyle. In addition, in many adults a diet high in sugar may also promote heart disease.

    High-sugar diets may contribute to heart disease in people who are "insulin resistant." Those people, an estimated one-fourth of adults, frequently have high levels of triglycerides and low levels of HDL ("good") cholesterol in their blood. When they eat a diet high in carbohydrates, their triglyceride and insulin levels rise. Sugar has a greater effect than other carbohydrates. The high triglyceride levels are associated with a higher risk of heart disease. It would make sense for insulin-resistant people, in particular, to consume low levels of regular soft drinks and other sugary foods. Research is needed on insulin resistance in adolescents.

Kidney Stones

    Kidney (urinary) stones are one of the most painful disorders to afflict humans and one of the most common disorders of the urinary tract. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a unit of the National Institutes of Health, more than 1 million cases of kidney stones were diagnosed in 1985. NIDDK estimates that 10 percent of all Americans will have a kidney stone during their lifetime. Several times more men, frequently between the ages of 20 and 40, are affected than women. Young men are also the heaviest consumers of soft drinks.

    After a study suggested a link between soft drinks and kidney stones, researchers conducted an intervention trial. That trial involved 1,009 men who had suffered kidney stones and drank at least 5 1/3 ounces of soda pop per day. Half the men were asked to refrain from drinking pop, while the others were not asked. Over the next three years drinkers of Coca-Cola and other cola beverages acidified only with phosphoric acid who reduced their consumption (to less than half their customary levels) were almost one-third less likely to experience recurrence of stones. Among those who usually drank soft drinks acidified with citric acid (with or without phosphoric acid), drinking less had no effect. While more research needs to be done on the cola-stone connection, the NIDDK includes cola beverages on a list of foods that doctors may advise patients to avoid.

Additives: Psychoactive Drug, Allergens, and More

    Several additives in soft drinks raise health concerns. Caffeine, a mildly addictive stimulant drug, is present in most cola and "pepper" drinks, as well as some orange sodas and other products. Caffeine's addictiveness may be one reason why six of the seven most popular soft drinks contain caffeine. Caffeine-free colas are available, but account for only about 5% of colas made by Coca-Cola and Pepsi-Cola. On the other hand, Coca-Cola and other companies have begun marketing soft drinks, such as Surge, Josta, and Jolt, with 30% to 60% more caffeine than Coke and Pepsi.

    In 1994-96, the average 13- to 18-year-old boy who drank soft drinks consumed about 1²/3 cans per day. Those drinking Mountain Dew would have ingested 92 mg of caffeine from that source (55 mg caffeine/12 ounces). That is equivalent to about one six-ounce cup of brewed coffee. Boys in the 90th-percentile of soft-drink consumption consume as much caffeine as is in two cups of coffee; for girls the figure is 1½ cups of coffee.

    One problem with caffeine is that it increases the excretion of calcium in urine. Drinking 12 ounces of caffeine-containing soft drink causes the loss of about 20 milligrams of calcium, or two percent of the U.S. RDA (or Daily Value). That loss, compounded by the relatively low calcium intake in girls who are heavy consumers of soda pop, may increase the risk of osteoporosis.

    Caffeine can cause nervousness, irritability, sleeplessness, and rapid heart beat. Caffeine causes children who normally do not consume much caffeine to be restless and fidgety, develop headaches, and have difficulty going to sleep. Also, caffeine's addictiveness may keep people hooked on soft drinks (or other caffeine-containing beverages). One reflection of the drug's addictiveness is that when children age six to 12 stop consuming caffeine, they suffer withdrawal symptoms that impair their attention span and performance.

    Several additives used in soft drinks cause occasional allergic reactions. Yellow 5 dye causes asthma, hives, and a runny nose. A natural red coloring, cochineal (and its close relative carmine), causes life-threatening reactions. Dyes can cause hyperactivity in sensitive children.

    In diet sodas, artificial sweeteners may raise concerns. Saccharin, which has been replaced by aspartame in all but a few brands, has been linked in human studies to urinary-bladder cancer and in animal studies to cancers of the bladder and other organs. Congress has required products made with saccharin to bear a warning label. The safety of acesulfame-K, which was approved in 1998 for use in soft drinks, has been questioned by several cancer experts. Also, aspartame should be better tested.

Do Sweetened Sodas Lead to Diabetes?
Published 11/02/2004
Andrew Weil, M.D.

Q. I’ve been trying to avoid artificial sweeteners so I’ve been buying regular soft drinks. Now I hear that they can lead to diabetes. If I limit myself to one per day, would that be alright?

A.  If I were you, I would choose something else to drink. Results of a study published in the Aug. 25, 2004, issue of the Journal of the American Medical Association showed that drinking a single sugar-containing soda per day was linked to weight gain and increases a woman’s risk of developing diabetes by 83 percent over that of women who have less than one sweetened drink per month.

Researchers at Harvard drew the conclusions about diabetes from a study that followed more than 91,000 women between 1991 and 1999, tracking their weight, their diet, and their incidence of diabetes. They found that women who consumed sugary soft drinks didn’t compensate for the extra calories the beverages contain by cutting back on the amount of food they ate. In fact, they tended to eat more than women who avoided sweetened drinks. Those women who drank at least one sugar-containing soda gained an average of 10.3 pounds over a four-year period. Women who did not drink them gained a bit less than three pounds on average over this time period.

Apart from the extra calories, the reason why sugary drinks present such a high risk of weight gain and diabetes is not known. However, another study reported this summer suggests that the high fructose corn syrup often used for sweetening may play a role by tinkering with the way appetite is regulated. Published in the June 4, 2004, issue of the Journal of Clinical Endocrinology and Metabolism, this study showed that after a group of normal-weight women ate a meal and then drank a beverage flavored with the amount of fructose found in two cans of soda, levels of two hormones, insulin and leptin, declined. These hormones help signal that we've had enough to eat. The fructose also seemed to boost levels of the appetite-stimulating hormone ghrelin. No such effects occurred when the women drank glucose-sweetened beverages. The researchers theorized that the hormonal changes seen during the study could promote overeating and consequently, obesity.

I’ve warned before about consuming high fructose corn syrup, which is used to sweeten most soft drinks (and is also a convenient marker of low-quality foods). And, of course, sodas of any kind don’t belong in a healthy, well-balanced diet. Opt instead for filtered water, iced tea and sparkling water mixed with natural fruit juice.