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Do You Drink Soda Every Day?

Replace sugary drinks with healthier beverages

Lately, soda pop has been losing some of its fizz.

Concerns are building about sugary beverages and their association with obesity, diabetes, high blood pressure, high cholesterol and heart disease.

These concerns have fueled heated debate in New York City. In June 2012, New York Mayor Michael Bloomberg proposed a citywide ban on super-sized sodas. Then, in March 2013, a judge struck down the proposed limits, one day before they were to take effect.

One can a day?

A recent, high-profile study in the journal PLoS Medicine found that soda-pop marketers, taking a cue from the cigarette industry, are trying to subvert soda’s health risks with public-service campaigns promoting exercise and worthy community projects.

But what’s the harm in drinking soda in moderation—say, a can a day?

According to Adam Bernstein, MD, DSc, of Cleveland Clinic’s Wellness Institute, even that amount—even if it’s diet soda—can hurt your health.

“You need to try to taper off as best you can,” he says. “If you’re drinking a 20-ounce bottle of soda a day, try a 12-ounce bottle instead. If you’re drinking two sodas a day, try one.”

Daily soda linked to stroke risk

Dr. Bernstein is the lead author of a study recently published in the American Journal of Clinical Nutrition that found that daily soda consumption is directly linked to an increased risk of stroke. Consuming one can of soda per day, either sugar-sweetened or diet, increased a person’s risk of stroke over time by 16 percent.

The increase occurred regardless of whether subjects were overweight, exercised regularly, or were smokers or non-smokers. And the stroke risk increased for each additional can of soda per day that a subject drank.

With that data in hand, Bernstein recommends that all regular soda drinkers start cutting back.

Dr. Bernstein suggests “swapping out” sugar-sweetened or diet sodas for healthier beverages.

Water is best, but “we know that people drink soda for taste and a pick-me-up,” says Dr. Bernstein. “They need to find alternative beverages that have an energy boost. Some kinds of coffees or teas or seltzers or flavored waters may fill those needs.”

The science behind the soda study

Below, Dr. Bernstein explains the study’s scientific findings, noting that multiple mechanisms may explain the relationship between soda and stroke:

  • The sugar in sugar-sweetened sodas may increase blood glucose and increase insulin. Over time, these may lead to glucose intolerance, insulin resistance and inflammation. Those changes in turn influence atherosclerosis (plaque buildup in arteries), plaque stability and thrombosis (clot formation), a risk factor for strokes caused by blockage of an artery.
  • The fructose in sugar-sweetened soda can be converted to visceral (belly) and liver fat. This enhances lipogenesis (fat buildup and triglyceride synthesis in the blood stream). Fructose also increases uric acid in the blood, which can reduce nitric oxide in the vessel lining and increase blood pressure, a risk factor for strokes caused by blockages or hemorrhages.
  • Because the body does not regulate our consumption of sugar-sweetened beverages in the same manner as foods, drinking them may lead to excess caloric intake. This is unlikely to explain our study findings, however, because controlling for energy intake in our models did not change results.
  • The caramel coloring in sugar-sweetened and low-calorie colas contains advanced-glycation end products. These have been linked to inflammation, which has been linked to the initiation, growth and unstable plaques that can break off and cause strokes. An inverse (U-shaped) association has been reported between high blood pressure and caffeine, while a linear association has been reported between high blood pressure and increased soda intake. This suggests that ingredients other than caffeine in soda affect blood pressure.
  • The ways in which diet or low-calorie soda may influence stroke risk are less clear than those for sugar-sweetened soda. Diet soda has recently been linked to an increased risk of vascular events (Journal of General Internal Medicine, 2012); diabetes (Diabetes Care 2009, European Journal of Nutrition, 2013) and kidney function decline (Clinical Journal of the American Society of Nephrology, 2011).
  • Researchers have also begun to look at ways in which diet soda may affect “reward processing” in different parts of the brain (Physiology & Behavior, 2012) and hormone levels (Diabetes Care, 2012). Both mechanisms may help to explain the epidemiologic findings.
  • For additional information, see a PDF of the study: http://ajcn.nutrition.org/cont…”
Tags: cholesterol, heart disease, high blood pressure, soda, stroke
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  • Bsaleh48

    it seems that that research will not please soda’s businessmen

  • freddye3

    So, WHY does soda increase the risk of stroke? The caffeine?

    • Susan

      But if it were the caffeine, which not all sodas have, they wouldn’t be recommended coffee or tea among the possible replacement beverages.

  • Ed

    Research the ingredients in soda and you will understand. No one in big health organizations will come out and say it because of all the money involved. Soda and food health risks are the most under-reported in mainstream, gee.. wonder why

  • Jack Findlay

    Are you aware of, and taking a position on, The Great Cholesterol Myth (book)? It challenges long-standing conventional wisdom on causes of heart disease.

  • Tim

    This is not enough information. I’d like to know why a sugar-free, caffeine-free, low sodium soda is unhealthy. The information will help me make healthy choices – but the article doesn’t make that clear.

    • sweetchillies

      I agree! It’s so frustrating when writers make these kinds of flat statements with no supporting information whatsoever. Why is sugar-free soda so harmful? Tell me why and I might consider stopping it.

      It’s also kind of curious that they recommend seltzer water as a possible replacement for soda?????? Seltzer is nothing more than carbonated water – JUST LIKE SUGAR-FREE SODA. Is someone talking through his hat?

  • truthbeknown

    the reason why diet sodas are unhealthy is because aspartame.aspartame cause all kinds of problems like high blood pressure high risk of diabetes headaches all kinds of stuff aspartame is basically e coli feces

  • http://www.facebook.com/jeff.goodman.LA Jeffrey Goodman

    The following is from Dr. Bernstein’s article which I accessed (through subscription service):

    Our finding of an association between low-calorie
    soda intake and stroke risk should be interpreted with caution,
    because we previously did not find an association between lowcalorie beverages and weight gain (42), diabetes (9), or CAD (6),
    and there is not a clear biologic mechanism between low-calorie
    soda consumption and incident stroke. Finally, there were few
    cases of hemorrhagic stroke among men, especially among men
    consuming 1 sugar-sweetened soda/d; therefore, our analysis
    of the association between sugar-sweetened soda consumption
    and hemorrhagic stroke among men must also be interpreted

    So the “article” here truly is not giving the full picture when it comes to sugar free sodas or even a minimal consumption. the full journal article did call into question the caramel coloring agents but again – no clear data exists.

  • SugarStick

    Diet soda too? I want more details. Makes no sense. Doesn’t coffee with sugar defeat the purpose? Article should focus on soda cause, not sugar cause. Or is caffeine the issue? Confusing read for me. The diet soda eliminates the sugar. Diet 7-up and Ginger Ale have no caffeine.

  • Carl Colaizzi

    This is incomplete info..there is no WHY!!??? I’m a diet soda affeccionado! It’s 90% water. What exactly is there to be afraid of?????

  • Health Hub Team

    We appreciate your comments and questions. We are reaching out to our experts on this particular topic and will have more information soon. Thank you for your interest.
    Health Hub Team

    • Gordo

      Water is the only good replacement. Coffee and tea not only have caffeine, but they have tannic acid in them. Tannic acid is used in the process of leather tanning. That doesn’t sound like a good replacement to me!

  • Health Hub Team

    Thank you for your interest.

    The article mentions multiple mechanisms which may explain the study findings.

    For instance, in sugar-sweetened sodas, the sugar may lead to increases in blood glucose and insulin which, over time, lead to glucose intolerance, insulin resistance, and inflammation; these changes in turn influence atherosclerosis, plaque stability, and thrombosis—a risk factor for ischemic stroke (reference 3).

    Fructose can be converted to visceral and liver fat (reference 30) and enhances lipogenesis and triglyceride synthesis (reference 31). Fructose also increases uric acid in the blood, which can reduce endothelial nitric oxide and increase blood pressure—a risk factor for ischemic and hemorrhagic stroke (reference 32).

    Because consumption of sugar-sweetened beverages is not regulated by the body in the same manner as foods, drinking them may lead to excess caloric intake (reference 33); however, this is unlikely to explain our study findings because control for energy intake in our models did not alter results.

    The caramel coloring in sugar-sweetened and low-calorie colas has advanced-glycation end products, which have been linked with inflammation, and which in turn has been linked with the initiation, growth, and destabilization of atherosclerotic lesions (references 3, 26). An inverse U-shaped association has been reported between caffeine and high blood pressure; however, a linear association has been reported between increasing soda intake and hypertension, suggesting that constituents in soda other than caffeine affect blood pressure (reference 34).

    The ways in which diet or low-calorie soda may influence stroke risk are less clear than those for sugar-sweetened soda. It may be noted that diet soda has recently
    been linked with an increased risk of vascular events (Journal of General Internal Medicine, 2012); diabetes (eg, Diabetes Care, 2009 and European Journal of Nutrition, 2013), and kidney function decline (Clinical Journal of the American Society of Nephrology, 2011).

    Researchers have also begun to look at ways in which diet soda may affect reward processing in different parts of the brain (Physiology & Behavior, 2012) and hormone levels (Diabetes Care, 2012), two mechanisms which may help explain the epidemiologic findings.

    We appreciate your interest in this topic. Thank you for your comments and questions. Here is a link to the PDF of the study which shares more details and references mentioned. http://ajcn.nutrition.org/content/early/2012/04/03/ajcn.111.030205.full.pdf+html

    Adam Bernstein, MD, DSc

  • LiberaNos

    Okayyy–good to know (?) Your subscribers, obviously intellectuals, want more data.

  • http://www.facebook.com/jeff.goodman.LA Jeffrey Goodman

    Thank you Dr. Bernstein for making your full article available here so readers can get a full picture of the strengths and limitations of your research. To be clear I have no issue with your research and in fact strongly support further research to allow us to evaluate whether, indeed, non-sugared sodas, present risk and to find out what the causal mechanisms are. My issue revolves around the summary presented in this forum which implied that a danger and definite link exists between diet sodas events such as stroke. You are very clear in your article that the association must be interpreted with caution. By framing it in the way this summary did, there is a great risk of people dismissing what is possible OR reacting in fear or otherwise becoming desensitized to reports on research. My other concern is from a perspective of harm reduction. While I doubt anyone at this point in time would argue that sugared sodas are “good” for us due to the overwhelming solid evidence, there are many who need to transition to healthier beverages (as you point out). Diet sodas, even if not perfect, may be a suitable stop-gap on the way to achieving true health potential — and the benefits of that transition may certainly outweigh the still yet to be determined risks of diet soda. I truly look forward to your continued investigations in this area!!

    For full disclosure, I was a soda junkie for many years, who did transition to diet sodas and have been ultimately able to sharply reduce even that intake. But for that step-down option, I may not have been able to shake my own addiction.

    Thank you.
    Jeff Goodman, MPH

  • amster777

    More science is needed, but I will say that seltzer water with a splash of juice is an awesome alternative to soda.

  • Gunnar

    i drink ONE can (355Ml or 12OZ) a day but i also drink 2 or 3 waterbottles a day too am i okay?

  • Elise

    I’ll stick to moderate consumption of Coke-a-Cola. 3-4 cans per week is enough. If it was up to the health Nazi’s, we would be eating nothing but organic lettuce and carrots for life. No thank you.