[icon name=”user” class=”” unprefixed_class=””]  By Joanne P. Shelby-Klein BSN RN

Drinking soft drinks, whether sweetened with sugar or artificial sweeteners, is a highly visible and talked about public health issue as they are believed to be major contributors to obesity and other major health problems. While it has been talked about in recent years, it is not a new problem. As far back as 1942, the American Medical Association recommended limiting added sugar intake, including those in soft drinks. Since then, several concerns have surfaced; do soft drinks cause you to over use, do they replace other healthier foods and drinks leading to poor nutrition, do they play a part in diabetes, poor heart health and cancers. So we have to ask the question, what does the research say?

WHAT IS SUGAR?

Before we look at the research, let’s look at what sugar is. Sugar is a sweet crystal that comes from various plants and is used to sweeten foods and drinks. It comes in many forms. The most well-known is sucrose or standard table sugar. Other types of sugar are lactose, fructose, glucose and dextrose. The names of most sugars end with the letters ose. Sugars such as lactose are found in milk, fructose is found in fruits and honey, and glucose circulates in the blood and is what is measured when we check blood sugar. There are also different forms of sugar:

• White sugar is pure sucrose that is usually seen as white crystals that may be tiny or large. Sugar manufactures report that the smaller the crystal, the sweeter it is. If it is mixed with syrup it is known as sugar cube.
• Brown sugar.
• Syrups are commonly used in food processing to add color and flavor to the food.

IS IT POSSIBLE TO BECOME ADDICTED TO SUGAR?

Every person has their own fluctuating sugar consumption habits that can cause us to have a few more sweets and chocolates than is really necessary. According to Dental Professionals in the United Kingdom (UK), sugar can be addictive because a slow increase in sugar consumption can lead the body to want more sugar to satisfy the sugar craving. This can be harmful to teeth, and make it harder to keep blood sugars under control and can lead to a variety of negative effects on the body. Taking in large quantities of sugar can mean that you don’t take in enough milk, calcium and other healthier foods.

HOW SERIOUS CAN IT BE TO TAKE IN TOO MUCH SUGAR?

It can be quite serious. A report published online in the Medical Observer, reported that sodas and other sugary drinks may cause nearly 184,000 deaths. Included in that number of sugary drink related deaths is 133,000 people with diabetes, 45,000 people from heart disease and 6,450 from cancer. Taking in too much sugar, especially from sugar sweetened drinks, can affect every part of the body and not just for people with diabetes.

• OBESITY. There is a relationship between drinking sugar sweetened beverages, weight gain and obesity based on data from the Nurses’ Health Study, Health Professionals study and Women’s Genome Health Study. It also showed that people who have a genetic risk for becoming overweight, may be more susceptible to weight gain from drinking sugar sweetened drinks. Studies have also shown that cutting down on the amount and number of sugary drinks consumed and replacing them with water or other non-caloric drinks can decrease weight gain.
• FATTY LIVER: The liver is the second largest organ in the body. It is about the size of a football and weighs about 3 pounds. It is located on the right side of the body and is protected by the rib cage. A Fatty liver occurs when there is a build- up of more than 10% fat cells in the liver. A fatty liver can happen because of diabetes, high cholesterol and/or high triglycerides. A study published in June 2015 in the Journal of Hepatology shows that drinking sugar sweetened beverages shows an increased risk for fatty liver disease in people who are overweight while drinking diet soda did not increase the risk of fatty liver. The results showed that adults who drank more than 1 sugar sweetened soda were more at risk for fatty liver disease than adults who drank no sugar sweetened drinks. The results were adjusted for age, sex, alcohol and diet soft drink consumption as well as Body Mass Index. Developing a fatty liver can put a person at risk for non-alcohol related hepatitis as well as liver cancer and liver failure. More studies are recommended in the relationship between sugar sweetened drinks and fatty liver.
• DIABETES AND METABOLIC SYNDROME: The relationship between diabetes and sugar sweetened drinks has been overlooked. However in 2010, Diabetes Care and the Harvard School of Public Health reported that drinking just one or two sugar sweetened beverages in a day has a 26% risk of developing Diabetes Type 2 and a 20% risk of Metabolic Syndrome. This report examined 11 studies that looked at diabetes and metabolic syndrome and how many sugar sweetened drinks people drank in a day. It also showed that the risk for the presence of diabetes and metabolic syndrome when drinking more than one can of a sugar sweetened beverage per day was as high as cigarette smoking. It reported that some of the effects seemed to be related to the increased calories and extra pounds. High fructose corn syrup has been shown to increase the risk of obesity, increased blood triglycerides and HDL cholesterol, and may have a different and unknown effect on diabetes and metabolic syndrome. This is important because high fructose corn syrup is contained in most sugar sweetened drinks.
• OBESITY: The New England Journal of Medicine reported that people who consume more sugar sweetened drinks may be more at risk for obesity and the genetic effects on obesity and points to a need to evaluate ways to decrease the amount of sugary drinks consumed to assist in decreasing the risk of obesity and other chronic diseases. This has led to the recommendation that sugary drinks should be replaced with water or other non-caloric drinks to help decrease the weight gain and obesity risk especially in children and teens. However, studies also show that cutting back on the amount of sugar sweetened drinks is not enough to prevent weight gain and obesity, increasing physical activity and exercise also plays an important role in losing and maintaining the correct body weight.
• HEART AND CARDIAC EFFECTS: Harvard School of Public Health reported the following on a study conducted with male healthcare workers; males who drank more than 6.5 sugar sweetened drinks per week had a 20% greater chance of having a heart attack than those who never drank sugary drinks. These results support recommendations to cut back on the amount of sugary drinks consumed as a way of preventing heart disease. Each serving of sugar sweetened drink consumed per day has been found to increase the risk of heart disease by 19% in men and 15% in women.
• BRAIN and MEMORY: A diet rich with high fructose corn syrup and sugar sweetened drinks may make it more difficult for your brain to learn new things and create problems with memory. UCLA conducted a study on rats that looked at what happens when the brain is exposed to a steady diet of sugar drinks containing high fructose corn syrup. The findings showed that a steady diet of high fructose containing foods and drink can change the brains ability to learn and memorize. Fructose and high fructose corn syrup are found in processed foods, soft drinks, condiments, apple sauce and baby foods. These are the foods that can affect learning and remembering. This study also found that Omega 3 Fatty Acids added into the diet helped control the damage.

ARE ARTIFICIAL SWEETENERS ANY BETTER TO USE?

Before this question can be answered, it is important to know what an artificial sweetener is. An artificial sweetener, also known as an intense sweetener, is an alternative to or a substitute for natural table sugar. They taste many times sweeter than natural sugar and can be used by people with diabetes as well as people who desire weight control or weight loss. There is still an ongoing debate about whether artificial sweeteners pose a health threat if taken in more than acceptable quantities. Currently there are 6 artificial sweeteners approved for use in the United States.

• Aspartame, also known as, Equal and NutraSweet is 180 times sweeter than natural sugar
• Acesulfame-K, known as Sunett and Sweet One is 200 times sweeter than natural sugar
• Saccharin, packaged as Sweet N Low and Necta Sweet is 300 times sweeter than natural sugar.
• Sucralose or Splenda is 600 times sweeter than natural sugar.
• Neotame is 7000 to 13000 times sweeter than natural sugar.

Stevia is a sugar substitute, or non-caloric sweetener, that has not been evaluated by the FDA at this time. Stevia comes from the leaves of a shrub, related to the daisy family that grows in Central and South America. It has been used as a natural sweetener for centuries. There is no clinical data available on the substance and its use.

Sugar Alcohols, such as Erythritol and Xylitol, have been used for years to sweeten things like chewing gum, candy, fruit spreads, and cough syrup. There have been few reports of harmful effects from these products.

While these sugar substitutes or artificial sweeteners are being used today in various foods and especially diet or low calorie drinks, there is conflicting and inconclusive evidence as to their benefits and effectiveness. If you are an adult trying to eliminate sugary sodas from your daily diet, short term use of diet sodas may help you to eliminate sodas completely. For children, it is best to avoid artificial sweeteners all together, as the long term effects of these sweeteners are not known in children.

WHAT DOES THE RESEARCH SAY?

Several reliable long term studies have shown that artificially sweetened drinks, taken on a regular basis will reduce the intake of non- nutritious calories and help with weight loss or maintenance. There are other studies that appear to contradict these findings and show that artificial sweeteners have no effect at all on weight loss or may cause people to gain weight.

Let’s review one study that had 3682 participants and looked at the relationship between consuming artificially sweetened drinks and weight gain over a 7-8 year time frame. The results showed that those who drank artificially sweetened drinks had a 47% increase in body mass index or BMI (meaning they gained weight) as opposed to people who did not have artificially sweetened drinks. All the study participants had adjustments made for standard weight gaining factors such as change in diet and exercise habits as well as diabetes.

Another study, called the Northern Manhattan Study, looked at how often the 2564 participants drank diet and regular sodas. They found that people who drank diet sodas on a daily basis had a 43% greater risk of a vascular incident such as a stroke, than those who drank no diet sodas.

A report released in June 2015 shows a review of several studies that found using drinks with artificial sweeteners is associated with a risk of diabetes, metabolic syndrome and weight gain. The report also found three mechanisms that may contribute to the risk:

• Artificial sweeteners may cause the brain to respond to the signal sweetness sends out to eat more, leading to more calorie consumption and weight gain as a result.
• Artificial sweeteners may interfere with micro bacteria in the abdomen and cause glucose or sugar intolerance.
• Artificial sweeteners may affect not only glucose absorption but also insulin release to help keep the blood sugar under control.

The evidence is inconclusive when it comes to the use of artificial sweeteners and complicates the issue of what is better for you, sugary drinks or artificially sweetened drinks. The evidence points to health problems that can occur with consumption of either type of drink. For long term good health, sugar sweetened or artificial sweetened drinks are best enjoyed in moderation such as once or twice a month.

REFERENCES

1. Medical Observer. (2015, June) Sugary Drinks May Cause 184,000 Deaths a Year: A Global Study. Retrieved from URL http://medicalobserverph.com/adulthealth-sugary-drinks-may-cause-184000-global-deaths-a-year-study/

2. British Dental Health Foundation. (2015, March) Are you addicted to sugar? BDJ Team.Retrieved from URL: http://www.nature.com/articles/bdjteam201536

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4. Ma, J. et al. (2015). Sugar-sweetened beverage, diet soda, and fatty liver disease in the Framingham Heart Study cohorts. Journal of Hepatology. Retrieved from URL: http://www.journal-of-hepatology.eu/article/S0168-8278(15)00240-8/abstract

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7. Neale T. (2015) Sugary Drinks Tied to More Heart Attacks. Medpage Today. Retrieved from URL: http://www.medpagetoday.com/Cardiology/MyocardialInfarction/31614

8. Vartanian, LR. Et al. (2007, April). Effects of Soft Drink Consumption on Nutrition and Health: A Systematic Review and Meta Analysis. American Journal of Public Health. 2007 April;97(4): 667-675.

9. Schmidt, Elaine. (2012, May). This is your brain on sugar: UCLA study shows high-fructose diet sabotages learning, memory. Retrieved from URL: http://newsroom.ucla.edu/releases/this-is-your-brain-on-sugar-ucla-233992

10. Springer Science+Business Media. “Are diet soft drinks bad for you?.” ScienceDaily. ScienceDaily, 31 January 2012. <www.sciencedaily.com/releases/2012/01/120131092746.htm>.

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14. Harvard School of Public Health. Artificial Sweeteners. Retrieved from URL: http://www.hsph.harvard.edu/nutritionsource/healthy-drinks/artificial-sweeteners/

15. American Liver Association. NAFLD, Non Alcoholic Fatty Liver Disease. Retrieved from URL: http://www.liverfoundation.org/abouttheliver/info/nafld/

16. http://www.drugs.com/npc/stevia.html