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Tim Harlan, M.D.

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Soft Drinks, Sugary Beverages and Your Risk of Disease

Posted: 12/15/10 08:27 AM ET

The research is more and more clear that sugar-sweetened beverages (SSBs) cause health problems. When researchers look at this issue they don't include just soft drinks, such as sodas or colas, but they also look at sweetened fruit drinks like punch (not those that are 100 percent juice) as well as energy and vitamin water drinks.

In a recent analysis researchers looked at the health issues caused by SSBs. Their meta-analysis combined the results and data of several studies to yield results for evaluation as if they were all one study. The strength of this method lies in the fact of its aggregate size: The larger and longer a study is, the more reliable are its results. The drawback is that this is a grouping of studies, all performed by different people with different standards and methods.

This particular analysis, reported in Diabetes Care, grouped together 11 prospective studies that included over 310,000 people. The researchers looking at SSBs standardized the serving size of the sugar-sweetened beverage consumption measured in each of the 11 studies. They then standardized the various levels of intake into groups: from none or less than one serving per month up to more than one serving per day. The amount of soft drinks drunk by individuals who developed Type 2 diabetes or metabolic syndrome was then compared to the amount drunk by those who did not develop these conditions. (Metabolic syndrome is defined by those with a grouping of conditions: high blood pressure, central obesity, high blood sugars and cholesterol abnormalities.)

The scientists found that even when they took into account variables such as Body Mass Index or individual caloric intake, those who drank at least one 12-ounce serving of a sugar-sweetened beverage per day were 20 percent more likely to develop metabolic syndrome and 26 percent more likely to develop Type 2 diabetes than those who drank less than one serving per month.

In their report, the researchers note that these results can't be attributed only to soda-drinking people being overweight because of the extra calories they are consuming. Indeed, the sugars (mostly high fructose corn syrup) used in these drinks are thought to contribute to the risk of metabolic syndrome and Type 2 diabetes because they promote fat deposits around the internal organs (contributing to poor cholesterol scores) and contribute to a higher sugar load, which leads to insulin resistance -- one of the symptoms of metabolic syndrome.

Another recent study focusing on the effects of consuming fructose alone (not High Fructose Corn Syrup) versus glucose, was published in The Journal of Clinical Investigation. A multi-university team of researchers recruited 32 men and women between the ages of 40 and 72 to participate in a feeding study. The participants all had a Body Mass Index between 25 and 35 (clinically overweight to clinically obese), and had no history of surgery for weight loss, diabetes, high blood pressure or high triglycerides. Those who already drank one or more sugar-sweetened beverage per day were also excluded from the study.

To set a baseline to compare against, the participants spent two weeks eating nothing but the foods provided to them by the researchers. Each person's diet was specifically designed to maintain their current weight and to provide 15 percent of calories from protein, 30 percent from fat and 55 percent from carbohydrates. During this baseline period the subjects gave blood for cholesterol and other tests, received a glucose tolerance test, and had their abdomens scanned to ascertain how much body fat was deposited around their internal organs versus beneath the skin.

Then for the following eight weeks the participants were randomly assigned to one of two groups: a fructose group and a glucose group. While both groups were given three daily servings of a sweetened beverage to drink with their three daily meals, one group's drink was sweetened with fructose while the other was sweetened with glucose. For those eight weeks the subjects were instructed to follow their usual diets and to avoid drinking other sugar-sweetened beverages or any fruit juices. At the end of the eight weeks the participants again had their cholesterol checked along with a glucose tolerance test and an abdominal scan.

The researchers found that both groups gained weight over the course of the eight weeks: between three and five pounds. However, those who were assigned to the fructose group were at much greater risk of diabetes because the amount of fat around their internal organs increased markedly while they decreased their sensitivity to insulin. Those in the glucose group, on the other hand, deposited most of their fat beneath the skin. Further, both groups' HDL levels (the good cholesterol) stayed the same while the LDL cholesterol (the bad cholesterol) increased significantly for those drinking the fructose-sweetened beverages.

This is a small study, but significant in that it specifically compares glucose with fructose. The results are extremely concerning, but few commercial beverages are sweetened only with fructose; most are sweetened with sucrose, which is half glucose and half fructose. High Fructose Corn Syrup is between 45-58 percent glucose and 42-55 percent fructose. Will HFCS affect your visceral fat, cholesterol levels and insulin sensitivity the same way fructose does? We can't yet be sure, but there is at least one well designed animal study that says yes.

What we can be sure of is that sugar-sweetened beverages add a lot of calories to your diet that aren't very satisfying. Drink water, tea or coffee instead. We know for sure that they're good for you.

 
 
 

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The research is more and more clear that sugar-sweetened beverages (SSBs) cause health problems. When researchers look at this issue they don't include just soft drinks, such as sodas or colas, but th...
The research is more and more clear that sugar-sweetened beverages (SSBs) cause health problems. When researchers look at this issue they don't include just soft drinks, such as sodas or colas, but th...
 
 
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01:51 PM on 12/16/2010
The two studies you mention both had serious problems with methodology. The final study you refer to as "well-designed" was anything but. It only took a few hours for nutrition experts to question the findings of the Princeton study. NYU Nutrition Professor Marion Nestle wrote: “I don’t think the study produces convincing evidence of a difference between the effects of HFCS and sucrose on the body weight of rats. I’m afraid I have to agree with the Corn Refiners on this one. So does HFCS make rats fat? Sure if you feed them too many calories altogether. Sucrose will do that too.”
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08:20 AM on 12/17/2010
The study compared fructose and glucose, not sucrose.
11:53 AM on 12/16/2010
so...Am I supposed to avoid all drinks containing sugar? I live around the corner from a juice stand. For a buck I watch them squeeze oranges and juice carrots and I drink that for breakfast. Sometimes its apples and bananas or strawberries or pomegranate. Is that too much sugar? What about cocktails? I used to avoid traditional sodas and mixers and went with mineral water for a while then heard that any carbonated drink can sap your calcium levels. Whats a girl to do?
12:28 PM on 12/16/2010
Moderation in all things.
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Fred Butters
01:19 PM on 12/16/2010
I'd skip the juice and just eat the whole fruit. The real point is to cut down total sugar intake, so if you have some juice here and there you'll probably be fine... if you have juice daily and eat processed food (which almost always has added sugar), high carb foods (which just break down to glucose) and dessert, you'll most likely be at higher risk of things like diabetes, heart disease, hypertension etc.

Also note that HFCS and sugar are both bad. Just because some studies show that HFCS is slightly worse, does not mean sugar is somehow "good."
09:52 PM on 12/15/2010
Thanks for the article Dr. Harlan. There is so much money riding on topics like this. Your article is not only informative but sadly, political.
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jgarma
05:44 PM on 12/15/2010
Very insightful. The research is underscoring what we empirically observe when graphing overweight and obese adults as a percent of population against commercialization of fructose as the ubiquitous sweetener. Fat goes up as fructose use goes up.

Glucose did compare favorably against fructose in the study cited by Dr.Harlan in terms of the amount of fat and where it's placed on/in the body. But another important distinction between glucose and fructose is how they are metabolized.

Our bodies metabolizes fructose in a much different way than glucose. The entire burden of metabolizing fructose falls on the liver.

Glucose is the sugar type that we all need. Our brains and each cell in our bodies are powered by glucose. Our bodies are designed to use it. As a result, nearly all of it that’s ingested is used — “burned up” — soon after ingested.

The details about glucose vs frutose can be read about here:
http://www.garmaonhealth.com/2010/02/beware-fructose/
05:41 PM on 12/15/2010
Yet again, more evidence to support the attachment of warning labels on the front of all HFC infested drinks.
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Amadahy
loves peanut M&Ms and Whippoorwills
04:31 PM on 12/15/2010
It would be great if more restaurants, convenience stores, and retail establishments carried drinks which have fewer calories. It's been heartening to see Subway and other places offer green teas, unsweetened brewed teas, and bottles of water. But there's still a long way to go.

Many places I can either get full calorie soda, no calorie soda (yuck), or "healthy" options such as full calorie Nestea, Hi-C, or Lemonade. That's not good enough, and manufacturers are equally to blame for not providing healthy alternatives for businesses to provide to their customers.
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02:26 AM on 12/16/2010
Why don't you just drink tap water? I do, once you drink only that you don't really want anything else.
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Heather Victoria Swanson
My moral standing is lying down.
01:51 PM on 12/17/2010
I know this isn't something that happens everywhere, but I'm Canadian (and lived in a small town called Walkerton when I was little; my father had been transferred there from our hometown of Toronto, and we didn't understand why an otherwise healthy man suddenly had three lengthy hospital stays in 2 years...), and there are statistics saying that the Walkerton Tragedy has scared a lot of Canadians away from drinking tap water. (Hopefully the moderators will let this link through, but if not, I recommend looking up Walkerton, Ontario on Wikipedia: http://en.wikipedia.org/wiki/Walkerton_Tragedy ) It's a sad state of affairs when we've become afraid of drinking just about EVERYTHING - no sodas because of sugar, no fruit juices if you have issues with metabolizing fructose, no coffee/tea with caffeine, no milk for fear of growth hormones, no bottled water because of environmental impact (and the issues with certain plastics apparently being toxic), and for some of us no tap water! Crazy.
03:52 PM on 12/15/2010
As a registered dietitian, I do not believe that sugar-sweetened beverages are the primary cause of any health problems. The risk factors for type 2 diabetes include age, obesity, family history, physical inactivity, race/ethnicity, higher than normal blood glucose levels, and prior gestational diabetes in women. Metabolic syndrome itself is a group of risk factors that together contribute to the incidence of heart disease, stroke, and diabetes.

Moreover, as the article states, one of the cited studies was a meta-analysis, meaning the authors took the results of several studies and combined them into one. However, this type of study does not prove a cause-and-effect relationship, and therefore in this case can not directly link consumption of sugary beverages to metabolic syndrome or type 2 diabetes.

I tell my clients, which also include food and beverage companies, that when it comes to diet, moderation is a key factor. Whether you’re looking to manage or prevent metabolic syndrome or type 2 diabetes, everything including sugar-sweetened beverages can be consumed, as long as it’s in reasonable quantities. Also, most people do not get enough physical activity on a typical day. Many studies have pointed to the preventative power of exercise when it comes to a multitude of diseases.
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Chas53
05:12 PM on 12/15/2010
Sorry, you need to go back to school and read the studies. Better yet, just watch "Sugar The Bitter Truth" on Youtube by Dr. Robt. Lustig of UCSD. Moderation kills.
12:40 AM on 12/16/2010
Fanned and faved.
05:43 PM on 12/15/2010
You are telling your clients what they want to hear, and they can cleverly argue against regulation. Read the reports, HFC fructose sweetened drinks has a direct link to increased fatty deposits around your organs. This is dangerous.
08:04 PM on 12/15/2010
So correct in fact all drinks containing fructose contribute to the problem. HFCS being the worse. Sugar is so predominate in food today because of the demonetization of saturated fat . Ever notice how flat no-fat foods taste . No problem compensate with sweetness and what better source than cheap HFCS which is metabolized just like alcohol . See 'Sugar the bitter truth" on Youtube. meanwhile several studies have found no correlation between saturated fat and heart disease but the substitutes ;margarine think trans fat and HFCS appear to be a problem.
02:40 PM on 12/15/2010
in context sugar should be consumed in context of its natural matrix not so extremely isolated

even pure organic fruit juice is somewhat isolated

use raw organic sugar but dont eat straight sugar by itself from a bowl. most important , sugar substitutes are not neccessary . dont buy diet socalle ddiet pop either unless its sweetened with stevia
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eLucida
Liberate Fitzwalkerstan, defeat A.L.E.C.
03:08 PM on 12/15/2010
>>use raw organic sugar

Huh?

Sorry, sucrose is sucrose.

Maybe the pancreatic islet cells are sitting around saying:
"Oh, wait, this is RAW ORGANIC sugar, that is healthy so we don't need to release any insulin!"

Or maybe NOT.
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AmigaMan
Your micro-bio will never meet our guidelines.
10:41 PM on 12/15/2010
A God-send for those that are diabetics...

http://www.zevia.com/

You can order all seven flavors on Amazon with Subscribe & Save™.
01:17 PM on 12/15/2010
Dr Harlan..in case you haven't noticed juices sold that are 100% from fruit sources have THE SAME SUGAR CONTENT AS SWEETENED ONES..the fact that they are from natural fruit sources does not minimize the sugar problem, we need to reduce ALL sugars to more moderate levels no matter what the source!
03:38 PM on 12/15/2010
I think the issue with juices is that it's digested as a whole food. Now, no one knows how the complexities of each single nutrient and chemical interacts with one another, but the idea goes that in whole foods, like fruits or juices (for the sake of argument, just grant me that one), the complex matrix of nutrients actually changes the way we digest and use each nutrient. So it's plausible that the sugar from fruits and vegetables, while not different per se from isolated sugar, could be absorbed more slowly, used more effectively, etc. by the body. Not that you're wrong, but I just want to shed some light on the whole-food logic.
07:29 AM on 12/16/2010
sonny088, You're right!

I tell my patients that ALL the time. I am not a fan of juices as they aren't satisfying. The best moderate source for sweets is the fruit itself. An apple has about 125 calories, takes time to eat, is delicious, fills you up and comes packed with vitamins and fiber that's not in the 200 calorie bottle of juice.
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CHMB
What's long and brown and sticky? A Stick.
12:07 PM on 12/15/2010
The other problem is that this kind of food is incredibly cheap. Those on a fixed income are, generally, going to buy what is cheap not what is healthy.
11:41 AM on 12/15/2010
I teach 8th graders who are very responsive to this kind of information.

I find that their parents are open to changing lifestyle when kids bring this information home to parents. We should empower our kids in this way constantly - not just health class. (I do nutrition teaching through math).
07:30 AM on 12/16/2010
Excellent! That's so smart.
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VanessaFas
11:26 AM on 12/15/2010
@robinhood1: Good to know! We should have a double sales tax on all candy and chocolate, that way it would limit what we buy. I don't buy soda, junk food, snacks, or candy unless there's a birthday party. My kids drink water and milk, and herbal teas only. No juice, only real fruits and vegetables. The sad fact is that Americans are suckers for soda, candy, and fried foods. And now we're trying to undo 3-4 generations worth of learning to love bad food. It won't happen overnight, but I know we can undo it. We just have to set the example as adults.
02:31 PM on 12/15/2010
When attacking the idea of "fats" you are generalising far too much. Saturated and monounsaturated fats are the best foods we can eat. Polyunsaturated fats and trans fats are very bad for us. We need to start being more specific when we mention fats.
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organicconnect
11:21 AM on 12/15/2010
This is most certainly a factor in childhood obesity. The vast number and array of these products on the market shows " appeal" and profit generation capability from every market segment, including our kids. http://organicconnectmag.com/wp/2010/09/the-problem-behind-childhood-obesity/
09:57 AM on 12/15/2010
If we want to fix the sugary drink problem, a good place to start would be changes in tax policy: a Federal tax on unhealthy food and drink. In California, candy bars are exempt from the state sales tax but vitamins and other food supplements are taxed. To its credit, the state does tax sodas and subjects them to a recycling fee as well. In the meantime, mother nature is catching up with the unhealthy living habits of the baby boomers. You can read about it in the obituary columns.
12:17 PM on 12/15/2010
I should get a tax rebate for my exercise program.
IMOPINIONH8D
because I want it empty...
11:40 AM on 12/19/2010
Tax policy? How about self control?
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eLucida
Liberate Fitzwalkerstan, defeat A.L.E.C.
09:55 AM on 12/15/2010
Learn more from this video lecture:

Sugar: The Bitter Truth
"Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology, explores the damage caused by sugary foods. He argues that fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic through their effects on insulin. (#16717)"

http://www.uctv.tv/search-details.aspx?showID=16717