Wednesday, November 10, 2010

The Dangers of Carbonated Soft Drinks - The Fizz, The Phos, & Other Variables.

It's called "soda" in the south and "pop" up north and it's the favorite beverage of many to chug down as they make their way through the day.  In fact, we consume an average of just over 53 gallons per year per person of soft drinks¹.  That's 530 gallons per person over a ten year period which is enough to fill up a 6-person luxury hot tub.  That's a lot of soda pop!

It's no secret that these fizzy beverages contain no actual nutritional benefit but what exactly is it that makes them so dangerous?  Let's take a closer look at this topic so you can understand why you may just want to give up your favorite beverage.

1)  Sugar or Artificial Sweetners

     -  The average American consumes 22.2 teaspoons (355 calories) of sugar per day².  One 
        16-oz bottle of soda contains approximately 10 teaspoons of sugar so it doesn't take long 
         for this to add up.
     -  The Nurses Health Study followed 90,000 women for 8 years and found that those who 
         consumed one or more sugar-sweetened soft drinks per day added 10 lbs of body 
         weight over a 4-year period and doubled their incidence of developing type 2 diabetes³. 
     -  Research following subjects in the Framingham Heart Study found that for those who 
        consumed one or more soft drinks (both diet and regular) per day there was a 48% 
        increased incidence of metabolic syndrome, 31% higher rate of obesity, 25% higher 
        chance of developing high blood sugar and high triglycerides, and 18% increased 
        incidence of high blood pressure⁴.
     -  Aspartame (artificial sweetner used in diet sodas) has actually been shown to trick your 
        body into thinking it's getting a sugar fix and can lead to increased consumption of food 
        and weight gain⁵.  It has also been shown to increase the risk of cancer⁷.  Artificially 
        sweetened soda consumption has also been linked to a decline in kidney function⁶.

2)  Phosphorus/Calcium imbalance

     -  Concerns have been raised about the effect of carbonated beverages on our calcium 
        stores and our resulting bone health.  There is definitely an increased incidence of 
        osteoporosis due to soda consumption but this is not due to the carbonation itself and 
        rather to the imbalance of the phosphorus/calcium intake in soda drinkers⁸.  Soda 
        contains a high amount of phosphorus and little to no calcium.  Our diets should ideally 
        contain an intake ratio of phosphorus to calcium of 1:1.  But most western diets contain a 
        very large intake of phosphorus and not enough calcium.  This phosphorus comes mainly 
        from meats, dairy products, and our beloved soda beverages.  It's not that phosphorus is 
        a bad mineral to obtain in our diet but not in the amounts we are currently consuming in 
        the Standard American Diet (SAD).
     -  Both diet and regular sodas contain phosphoric acid which has been shown to increase 
        parathyroid hormone (PTH) secretion⁹.  PTH activity stimulates the breakdown of bone 
        which results in the release of calcium into your bloodstream⁹.  This happens to 
        neutralize the acidic effect of the phosphoric acid but in doing so leads to increased 
        calcium excretion in the urine¹¹, weakened bones, and the resulting increase in 
     -  Acidic beverages such as soda have also been shown to increase the demineralization 
        of tooth enamel compared to mineral water [10].

3)  Caffeine
     -  Caffeine acts as a stimulant and can make it more difficult to get adequate sleep.  The 
        benefit of a good night's sleep has become more evident and widely studied in recent 
     -  Other adverse effects of caffeine consumption include irritability, fast heart rate, 
        restlessness, anxiety, and tremors.
     -  Caffeine intake has also been linked to depression in young children¹².
     -  Caffeine has also been shown to increase the urinary excretion of some very valuable 
        minerals including calcium, magnesium, sodium, and chloride¹³.  Take notice that 
        calcium excretion is increased which is already a problem due to the phosphoric acid 
        content of sodas.

So with all that said you can clearly see how the fizz has become flat for our friends in the soft drink industry.  There are much better and healthier alternatives if you're looking for a way to replace soda in your diet.  The best alternative is good old fashion water.  But if you still crave the carbonation then go for a sparkling water.  Many sparkling waters are even flavored.  Another great alternative is 100% all natural fruit juice such as pomegranate or acai juice.  Both of these have been shown to be a rich source of antioxidants and very beneficial for one's health.

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Clinical Pharmacist

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1 Rodwan, Jr. J.  Carbonated Soft Drinks: Seeking Growth. Beverage Marketing Corporation. 2005.
Johnson RKAppel LJBrands M, et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2009 Sep 15;120(11):1011-20.
Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, Hu FB. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. Journal of the American Medical Association. 2004; 292:927-934.
Dhingra RSullivan LJacques PF, et al. Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation. 2007 Jul 31;116(5):480-8.
Swithers SEMartin AADavidson TL. High-intensity sweeteners and energy balance. Physiol Behav. 2010 Apr 26;100(1):55-62.
American Society of Nephrology (2009, November 2). Diets High In Sodium And Artificially Sweetened Soda Linked To Kidney Function Decline. ScienceDaily. Retrieved November 9, 2010, from
7 Mead MN. Sour Finding on Popular Sweetener: Increased Cancer Incidence Associated with Low-Dose Aspartame Intake. Environ Health Perspect. 2006 March; 114(3): A176.
Tucker KLMorita KQiao N, et al. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. Am J Clin Nutr. 2006 Oct;84(4):936-42.
Kemi VEKärkkäinen MURita HJ, et al. Low calcium:phosphorus ratio in habitual diets affects serum parathyroid hormone concentration and calcium metabolism in healthy women with adequate calcium intake. Br J Nutr. 2010 Feb;103(4):561-8.
10 Parry JShaw LArnaud MJSmith AJ. Investigation of mineral waters and soft drinks in relation to dental erosion. J Oral Rehabil. 2001 Aug;28(8):766-72.
11 NS Larson, et al "Effect of Diet Cola on urine calcium excretion." ENDO 2010; Abstract P2-198.
12 Luebbe AMBell DJ. Mountain Dew or mountain don't?: a pilot investigation of caffeine use parameters and relations to depression and anxiety symptoms in 5th- and 10th-grade students. J Sch Health. 2009 Aug;79(8):380-7.
13 Massey LK, Berg TA. The effect of dietary caffeine on urinary excretion of calcium, magnesium, phosphorus, sodium, potassium, chloride and zinc in healthy males. Nutrition Research. 1985 Nov;5(11):1281-84.

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