Sugar-sweetened beverages (SSB’s) are the number one source of added sugar in the US Diet and are the single biggest culprit in long-term weight gain (1). In this country, people get as many as ten percent of their daily calories from the stuff, and almost two-thirds of children and adolescents soda every day (2).
Here’s an astonishing fact: when you eat solid sugary food, eventually your brain says, “enough already!” Not so with liquids. The brain simply doesn’t register “fullness” from sugar in drinks (3). As a result, “people who drink sugar-sweetened drinks do not end up eating any fewer calories from solid food than those people who do not have such drinks” (4). To make matters worse, this effect seems to be even more pronounced in children and adolescents (5).
Why is soda so dreadful? After all, it contains fructose, and so does fruit. So how bad can it be? The answer is, very bad. When you eat fruit, the body gets a pretty small “dose” of fructose (6). On the other hand, high fructose corn syrup (HFCS), which is the form of fructose in soda (as well as many processed foods), overloads the poor intestine with an amazingly large amount of free fructose (7). This fructose then goes on to increase fat production by the body and decrease the body’s sensitivity to insulin (8 ).
Yes, Soda Taxes Are a Good Idea
There’s been a lot written in scientific journals, as well as in the press, about proposed taxes on soda. A terrific article in last week Journal of the American Medical Association, written by public health experts, points out that “…reductions in SSB [sugar-sweetened beverage] consumption and the related health benefits may be greater for low-income individual because that population is more likely to consume SSB’s, and their responsiveness to SSB taxes is greater.” (9).
Of course, the soda industry is not going down without a fight. Last year, when Philadelphia’s Mayor Kenney introduced a soda tax proposal, we citizens were deluged with shameful commercials opposing the proposed “grocery tax.” Perhaps not surprisingly, the soda industry has funded studies that somehow “prove” that SSB’s do not cause weight gain and its consequences (10). Worse still, the major soda companies have lobbied against more than public health bills intended to reduce soda consumption or improve nutrition (11) and directly target marketing strategies to children (12).
How About Fruit Juice?
We’re not crazy about it.. Even pediatricians are now wary of recommending that children drink fruit juice freely (13). Juices just concentrate the sugar from fruit, while removing the fiber (9). Having said that, fruit juice is better than soda — at least it has vitamins and healthy phytochemicals. Just don’t drink a lot of it or give kids much of it at all. Let them have water with an apple instead of apple juice.
What about Diet Soda?
Sorry, Diet Coke is not the answer. For one thing, people lose more weight when they drink water than when they drink diet drinks (14, 15). This may be related to the continued craving for sweet-tasting food (16, 17). While there aren’t good studies comparing the specific metabolic effects of different sweeteners (18), they do change the intestinal microbiome in a way that may cause more glucose intolerance (19) and lead to diabetes. To make matters worse, “artificially sweetened soft drink consumption has been associated with a higher risk of stroke and dementia”(20).
Jay — I stopped drinking pop in January 2013 - this has made me feel so much better. I save so much money this way, and I know that I’m consuming less of a sugary sweetened beverage that I know my body does not need. After all this time not drinking pop, I no longer crave, want, or even like pop. I tried it the other week and it tasted so disgusting.
I don’t think I could have just gone cold turkey. I used to drink 3 12-oz Coke Zeros a day. For a week, I drank 2, then the next week I tried to cut down to 1, and after a month I was having maybe 2 a week. Eventually I was able to stop all together and I haven’t turned back to my old ways!
Janice — I still think Diet Coke is the most delicious drink in the world. Get over it, Janice.
Here’s the good news: making a single healthy change in your diet will not only add to your overall health, but will also make it easier to motivate you to make other changes (21 Hedrick). Ditch the soda!
1. Mozaffarian D et al 2011. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 2011; 364:2392-404.
2. Rosinge A et al. Sugar-sweetened beverage consumption among U.S. Adults, 2011-2014. NCHSA Data Brief No. 27-0 2017.
3. Payne AN et al. Gut microbial adaptation to dietary consumption of fructose, artificial sweeteners and sugar alcohols: implications for host-microbe interactions contributing to obesity. Obes Rev 2012; 13:799-809.
4. Appelhans BM et al. Beverages contribute extra calories to meals and daily energy intake in overweight and obese women. Physiol & Behav 2013; 122:129-33.
5. Jastreboff A et al. Altered brain response to drinking glucose and fructose in obese adolescents. Diabetes 2016; 65(7):1929-39.
6. Ludwig DS. Examining the health effects of fructose. JAMA 2013:310(1):33-4.
7. Bray GA et al. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 2004; 79:537-43.
8. Stanhope KL et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreased insulin sensitivity in overweight/obese humans. J Clin Invest 2009; 119:1332-4.
9. Powell LM, Maciejewsi ML. Taxes and sugar-sweetened beverages. JAMA 2018; 319(3):229-30.
10. Schillinger D et al. Do sugar-sweetened beverages cause obesity and diabetes? Industry and the manufacture of scientific controversy. Ann Intern Med 2016;165(12):895-7.
11. Aaron DG, Siegel MB. Sponsorship of National Health Organizations by Two Major Soda Companies. Am J Prev Med 2017; 52(1):20-30.
12. Boyland EJ et al. Advertising as a cue to consume: a systematic review and meta-analysis of ethe effects of acute exposure to unhealthy food and nonalcoholic beverage advertising on intake in children and adults. Am J Clin Nutr 2016; 102(3):519-33.
13. Policy Statement from the American Academy of Pediatrics, May, 2017.
14. Madjd A et al. Beneficial effects of replacing diet beverages with water on type 2 diabetic obese women following a hypo-energetic diet: A randomized, 24-week clinical trial. Diab Obes Metab 2017; 19(1):125–32.
15. Huang M et al. Artificially sweetened beverages, sugar-sweetened beverages, plain water, and incident diabetes mellitus in postmenopausal women: the prospectvie Women’s Health Initiative observational study. Am J Clin Nutr 2017; 106:614-22.
16. Zhu Y et al. Maternal consumption of artificially sweetened beverages during pregnancy, and offspring growth through 7 years of age: a prospective cohort study. Intl J Epidemiol 2017; 1-10.
17. Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity. Circulation 2016; 133:187-225.
18. Sylvetsky AC et al. Understanding the metabolic and health effects of low-calorie sweeteners: methodological considerations and implications for future research. Rev Endocr Metab Disord 2016; 17:187–94.
19. Suez J et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature 2014; 514(7521):181-6.
20. Pase MP et al. Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia. Stroke. 2017;STROKEAHA.116.016027. Originally published April 20, 2017.
21. Hedrick V et al. Dietary quality changes in response to a sugar-sweetened beverage-reduction intervention: results from the Talking Health randomized controlled clinical trial. Am J Clin Nutr 2017;105(4):824-33.
Cheeseman CI, Tsang R.
Stanhope KL et al
Wolf AM, Woodworth KA. Am J Medicine (2009)
Elliott SS et al 2002;
Teff KL et al 2009).
Schillinger D et al.
Hedrick V et al. Dietary quality changes in response to a sugar-sweetened beverage-reduction intervention: results from the Talking Health randomized controlled clinical trial. Am J Clin Nutr 2017;105(4):824-33
Ludwig D. Examining the health effects of fructose.JAMA 2013; 310(1):33.
Suez J et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature 2014; 514(7521):181-6.
Policy Statement from the American Academy of Pediatrics, May, 2017
Madjd A et al. Beneficial effects of replacing diet beverages with water on type 2 diabetic obese women following a hypo-energetic diet: A randomized, 24-week clinical trial. Diab Obes Metab 2017; 19(1):125–32.
Zhu Y et al. Maternal consumption of artificially sweetened beverages during pregnancy, and offspring growth through 7 years of age: a prospective cohort study. Intl J Epidemiol 2017; 1-10.
Pan A, Hu FB. Effects of carbohydrates on satiety: differences between liquid and solid food. Curr Opin Clin Nutr and Metab Care 2011 14:385-90.