The latest on sugary drinks, heart health and weight loss
There's little question that sugary drinks are not just randomly associated with obesity, but actually contribute to it in a big way. Dozens of studies continue to prove this point, and the only so-called "research" that tries to introduce doubt to this sad conclusion is industry-sponsored.
Nevertheless, this accumulated evidence is seeping in quite slowly into consumers' consciousness. The average American still takes in more than a fifth of their daily calories from beverages . Perhaps constant, very effective and entertaining advertising (yeah, I do love these ads; they're the major Super Bowl viewing attraction for me-but don't tell my kids!) weighs heavier on our minds than evidence and medical advice.
I'm therefore glad to see further evidence presented about the effects of sugary drinks on health, and that leading institutions and scientific bodies are devoting their pulpit to the important public health issue of overhauling in the way we drink.
So here's a glimpse at some of the recent research on sugary drinks and health from the April '09 crop, just in time before warmer weather sets in and increases our hydration needs.
(Full disclosure: I'm vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I'm also a pediatrician and have been promoting good nutrition and healthy lifesyle for many years.)
Sugary drinks and cardiac health
Harvard researchers looked at the relationship between sugary drinks and heart disease in a recent paper published in the American Journal of Clinical Nutrition. Sugary drinks are associated with obesity and type 2 diabetes-both of which are risk factors for coronary heart disease-and the researchers set out to check if sugary drinks would be associated with heart disease. They also wanted to see whether sugary drinks would be a risk factor for heart disease independent of obesity and diabetes.
The data was taken from the Nurses' Health Study cohort of almost 90,000 women aged 34-59 years. The study group had no heart disease, stroke or diabetes at the beginning of the study. The group was followed for 24 years, and food questionnaires were administered seven times between the years 1980 and 2004.
In a study such as this one, it's very important to adjust for potential confounders; therefore non-dietary factors such as age, smoking status, alcohol intake, family history of heart disease, fitness, aspirin use, hypertension and blood cholesterol were taken into consideration in the statistical analysis.
The researches went further in their attempt to isolate the effect of sugary drinks on heart disease, and because drinking sugary drinks may be a marker of unhealthy eating patterns, they adjusted for overall dietary influences on heart disease using the Alternate Healthy Eating Index (AHEI). This index gives points to several key aspects of healthful eating, such as fruits and veggies, cereal fiber, polyunsaturated to saturated fat ratio, trans fat, legumes and soy etc.
Here's what they found:
• There was a significant positive association between sugary drink intake and coronary heart disease-the higher the intake, the greater the risk. • After adjusting for the non-dietary factors (age, smoking, etc.), women who consumed more than two servings of sugary drinks a day had an almost 40 percent higher risk of heart disease than those that had them less than once a month. • After adjusting for dietary healthfulness using the AHEI score, drinking more than two servings of sugary drinks a day still had an a 35 percent increased risk of heart disease compared to those that had them less than once a month. • Even after adjusting for Body Mass Index , or BMI, caloric intake and diabetes, the risk of heart disease in sugary drink heavy users was still significantly higher (drinking more than two servings of sugary drinks a day still added about a 20 percent increased risk of heart disease compared to those that had them less than once a month.) • There was a weak but marginally significant association between intake of artificially sweetened soft drinks and heart disease after adjustment for dietary and non-dietary factors.
• During the 24 years of follow up there were 3,105 ascertained incidences of coronary heart disease (heart attacks).
And they conclude:
"We found that consumption of SSB (sugar-sweetened beverages) is associated with a higher risk of CHD (coronary heart disease) in women, even after other risk factors for CHD or an unhealthful diet or lifestyle are accounted for. This finding provides further rationale for limiting the consumption of SSBs."
Sugary drink reduction as a weight loss strategy
Johns Hopkins Bloomberg School of Public Health researchers published an interesting prospective study in the American Journal of Clinical Nutrition that looked at whether liquid calories are more obesogenic (tending to cause obesity) than solid calories, and whether reduced consumption of different beverages does indeed change weight.
The study included 810 adults aged 25-79 years, who had pre-hypertension or mild hypertension, and were receiving several types of information and advice about weight loss, physical activity and salt reduction as a means to address their elevated blood pressure. No specific advice was given regarding beverage consumption, and the diet advice was rather general.
The researchers looked at dietary recall questionnaires and compared them to weight loss outcomes after 6 and 18 months.
Here's what they found:
• The study group as a whole decreased its intake of sugary drinks (as well as coffee and tea) over the 18 months of study. • A reduction of 100 calories/day of liquid calories was associated with weight loss of about half a pound at 6 months, and about half a pound at 18 months across the study group. • Reduction of 100 calories/day of solid calories was associated with weight loss of about one-tenth of a pound at 6 months, and about two-tenths of a pound at 18 months across the study group. • Looking at individual beverages, the researchers saw that reducing one serving of a sugary drink a day (12 ounces) was associated with weight loss of more than one pound at 6 months, and about one and a half pounds at 18 months.
• At the beginning of the trial, the average daily caloric intake from beverages was over 350 calories, or almost 20 percent of total caloric intake. Most of these beverage calories were from sugary drinks.
"Our study supports policy recommendations and public health efforts to reduce intakes of liquid calories, particularly from SSBs, in the general population"
Recent advice from experts
•April's Archives of Pediatric and Adolescent Medicine is devoted to childhood obesity papers, and also includes an advice for parents page titled "Sugary drinks and childhood obesity" .
Their recommendations:
2. Offer healthy eating choices at home, including healthy snacks.
"1. Eliminate sugary drinks at home. Just don't buy them. Replace sugary drinks with water, milk or real fruit and vegetable juices. Encourage your child to drink lots of water.
3. Remember: Small changes every day can lead to success. "
• Harvard's School of Public Health's website says it's high time to address America's hidden drinking problem-the astounding amounts of sugary soft drinks, juices and other beverages we guzzle daily. This informative and referenced (really good references by the way!) source calls for a retraining of America's palate away from heavily-sweetened drinks, and is a call to action for all of us: consumers and parents, beverage manufacturers, government, schools and worksites.
I'd like to end with a little bright spot of news: Mintel reports that the soda market lost almost 16 million adult drinkers in the last five years. But while many consumers did move on to lower- calorie drinks and water, the availability of high-calorie energy and sport drinks has expanded dramatically too, a shift that's not likely to benefit us in the fight against obesity.
Our eating habits may well be moving slowly towards healthier options, but progress is ever so slow. That's why there's a call by many experts for policy changes--such as creating standards for beverages sold in schools, and taxing sugary drinks --which may impact public health and improve the diet of the population as a whole. This might be the only way to encourage healthier choices and especially reach less-advantaged and informed groups, whose rates of obesity and diet-related illness continue to rise.
Are you and your family members consuming fewer sugary drinks than you did a few years ago?
Dr. Ayala
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