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Another reason to avoid added sugar
Because I'm an advocate of avoiding processed foods and sugary drinks, I don't spend a lot of time talking specifically about added sugars. Yet the average American drinks enough soda - between 45 and 50 gallons of it per person - to consume about 39 pounds of sugar a year.

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.

Ditch the diet soda
For years I've been telling people to stop drinking sugar-sweetened beverages and sodas in favor of tea, coffee, or water, or at least to switch to the diet version of the beverage. Last year a study funded by the American Beverage Association suggested that drinking diet sodas would actually help you lose more weight than if you drank water.


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Are you sabotaging yourself with your choice of beverage?

a glass of cola with ice and a straw

It's clear that sugary sodas are bad for you: the calories they contain come from nothing but an appalling amount of sugar (about 10 teaspoons per can), and unlike foods with the same number of calories, evidence suggests that their liquid form leads your body to treat those calories as not nearly as satisfying as the same number of calories in a form that requires chewing, making those who drink more sugar-sweetened sodas at a greater risk of weight gain.

For that reason one of the first things physicians tell their patients who are looking to lose weight is to switch from sugar-sweetened beverages to sugar-free beverages or water, along with cutting portion sizes. A group of researchers in Bristol, UK, noted that when folks are eating out in a casual setting, they often choose their food first, followed by their beverage. Might their choice of beverage - specifically whether it is sugar-sweetened, artificially sweetened, or plain water - be affected by what and how much they eat?

The authors theorized that given a familiar food, people would be more likely to choose a sugar-sweetened beverage when that portion size of that food was smaller. Inversely, they believed people would be more likely to choose to drink water when the portion size of the same food was larger. (Appetite 2019;136(1):103-113)

Through previous pilot studies and published research the authors identified three meals that would be familiar to most British consumers and came from three different cuisines: Spaghetti Bolognese, Chicken Chow Mein, and Chicken and Prawn Paella. To prepare for the study the authors had high-quality photographs taken of 50 different portion sizes of each meal, ranging from 50-calorie portions to 1000-calorie portions, all taken on the same size plate and under identical lighting conditions.

One hundred sixty-six men and women between the ages of 23 and 47 participated in the research, which was carried out through an online survey format.

For the study itself, each participant was first shown a picture of Spaghetti Bolognese. Using the left and right arrow keys, the participant could make the serving larger or smaller (recall that the amounts were shown on a standardized plate). They were instructed to adjust the amount of food on the pictured plate until it reached the amount they would choose to eat for lunch provided that no other food was available and no snacks would be available until dinner time.

After choosing that "ideal portion size," the participant was next shown a series of 15 pictures, depicting in random order the three test meals in 5 different portion sizes. For each meal and portion size the participant was instructed to choose one of three beverages to consume with the imagined meal: "Please click on the beverage that you would have with this meal, knowing that you must consume [at least half] of the beverage."

The three beverages were water, a common sugar-sweetened beverage (called Ribena), and a sugar-free version of the same beverage.

The authors correlated the participants' choice of beverages with the portion sizes of the different meals, finding that the larger the portion size, the more likely the participants were to choose water. Inversely, smaller portion sizes meant the participants were more likely to choose the sugared drink. With small variations, this was true regardless of which meal the participants were presented with.

Potential participants who were dieting, had a history of eating disorders, were vegan or vegetarian, or expressed dislike for any of the test meals were excluded from the research. The authors theorize that the participants were consciously or unconsciously compensating for the smaller meals that they believed would be less satisfying with the added satisfaction of the sugary drinks.

What this means for you

If you're working on your weight, be aware of what you're choosing to drink with your meals. Sweetened drinks, whether sugared or sugar-free, aren't as satisfying as real food - and the sugary drinks still have plenty of calories. Regardless of whether you're working on your weight or not, water is the best choice for your beverage, followed by tea or coffee (caffeinated or decaffeinated).

First posted: March 27, 2019