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What The American Beverage Association wants you to think
When I am asked to speak or give an interview about health, diet, and nutrition, I am very careful to make it clear that I am an evidence-based physician. In the last thirty-plus years there has been an explosion of high quality research into diet and nutrition, and when I say "high quality research" I mean that it is well-designed, of an appropriate size, funded by disinterested parties, and published in a reputable, peer-reviewed medical journal.
Soft Drinks and Gout
Contrary to popular belief, gout is not a disease of the past. It actually is the most common inflammatory arthritis in men, and its prevalence has actually doubled in the past few decades. Those who suffer from gout are often told to limit their intake of purine and alcohol to help minimize attacks. However, in a recent study released in the British Medical Journal (2008 336: 309-312), two researchers note that the rise in the incidence of gout coincides with the increased consumption of sugared or fructose-sweetened soft drinks. Should gout sufferers be avoiding soft drinks, as well?
Bending the Truth with "Experts"
I am interviewed by the media fairly regularly. Often the topic is something controversial, and that makes sense. It's difficult for news organizations to get people to pay attention and contentious topics do stand out. Stories about high fructose corn syrup (HFCS), fast food and kooky weight loss products are popular, as you might expect, and these almost always result in emails or comments criticizing me for one reason or another.
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My brother thinks that drinking Fresca is the same as drinking water. He is diabetic and takes pills to control his numbers. He is about 30 or more pounds overweight and he drinks about 6 cans of Fresca each day. I told him he could drop at least 15 pounds if he didn't drink so much Fresca. His doctor told him that drinking fresca is the same as drinking water. Is that True?
Worried in Louisville, Donna
According to the Coca Cola Company, Fresca products have about 2 calories in an eight ounce serving. A can of Fresca is 12 ounces so 6 cans per day would be only 18 calories.
While this is more than water at zero calories it is not insignificant. 18 calories is slightly more than a single teaspoon of sugar.
Of course we know that drinking sugar sweetened soft drinks causes weight gain and leads to an increase in the risk of diabetes. This is well established.
There's not a lot of research about whether drinking calorie free sodas will contribute to weight gain or not. What we do have is not encouraging for those who drink any type of soda, however. As part of the San Antonio Heart Study researchers in Texas looked at all soft drink consumption in a group followed for eight years (Scientific Sessions American Diabetic Association 2005 Abstract 1058-P). Of the 1,550 people who started the study, they looked at the 622 who were normal weight at the beginning.
The data showed that the more soft drinks of any kind that a person consumed, the more likely they were to be overweight or obese. The risk is actually pretty high. For each can per day of soda (on average) the risk of obesity is increased by 41%.
The table posted on the website is an easy way to look at their findings. The numbers represent the percentage chance of being overweight or obese depending on the type of soft drink consumed. For instance, 54% of those drinking 1 to 2 cans per day of diet drinks had become overweight during the eight years of the study.
While I am not a fan of automatically interpreting studies in animals as applying to humans, there is an interesting study where researchers at Purdue showed that rats fed artificially sweetened juices were more likely to eat more calories when presented with "regular" food (Int J Obesity 2004; 28: 933-935). Their feeling is that the manipulation of sweet tastes reduced the natural ability of the rats to use sweet taste to judge the caloric content of snack they were given.
Keep in mind that humans are not rats (although we do react in similar ways to food). Whether drinking more sugar free sodas impairs the ability of humans to judge other food consumption has not been shown. There are studies, however, that show people who consume more artificial sweeteners tend to gain more weight.
Keep in mind, also, that such studies as these don't prove that consuming diet drinks or artificial sweeteners causes weight gain -- it simply shows that there is a link.
I am not a fan of diet soft drinks and don't recommend them to my patients. Drink water. We know tea, green tea and coffee are good for you and even cocoa is a good choice. While diet sodas do have about the same calories as water, I don't feel that we have enough information to say that they are as good for you as water. Research such as that noted above is enough to make me consider that they might impair the ability to make good choices about other foods.
First posted: April 17, 2007