John, a 42-year-old man with a body mass index (BMI) of 30 kg/m, is beginning to struggle with several lifestyle changes he made recently in an attempt to get healthier. He is finding it particularly hard to quit his previous habit of drinking 2 sugar-sweetened sodas in the afternoon. Rather than giving them up completely, he asks if it would still be “healthier” to switch to diet sodas instead.
How do you advise your patient?
Answer: Both sugar-sweetened and artificially sweetened beverages have their share of associated health risks.
Previous research has shown that sugar-sweetened soft drinks contribute to weight gain and even diet (non-caloric) soft drinks are implicated in weight gain for reasons we have yet to fully understand.
Recently, an international team of researchers published the results of their analysis of data from a multi-national, long-term observational study known as EPIC (European Prospective Investigation into Cancer and Nutrition). Their analysis focused on soft drink consumption overall as well as differentiating between sugar-sweetened and artificially sweetened soft drinks.
The EPIC study recruited over 500,000 participants in 10 European countries between 1992 and 2000 and follow-up is ongoing. These participants responded to demographic and dietary questionnaires and gave permission for the researchers to access their medical information, including cause of death if necessary, often through the individual countries’ health systems.
For their analysis, the authors excluded any participant who reported having cancer, heart disease, diabetes, or history of stroke of any kind. Similarly, they excluded those with unrealistic or incomplete dietary questionnaires. This left them with over 450,000 participants when they performed their analysis in 2018.
The researchers defined “total soft drinks” as “a combination of soft drinks, carbonated and isotonic drinks, and diluted syrups,” then further broke down those soft drinks into “sugar-sweetened” and “artificially sweetened.” How much people drank was measured in glasses per day, with one glass being about 250ml (about 8.5 ounces), then grouped into increasing amounts: less than 1 glass per month, 1-4 glasses per month, 1-6 glasses per week, 1-2 glasses per day, and 2 or more glasses per day.
After an average of just over 16 years of follow-up, the authors correlated the soft drink consumption of those who passed away with those who did not, taking into account such variables as BMI; alcohol consumption; smoking status; age, gender, and education level; total caloric intake and intake of red and processed meats, coffee, fruits and vegetables (and their juices); and physical activity levels.
Their results are concerning.
Those who consumed at least 2 glasses of artificially sweetened soft drinks every day were 26% more likely to die of any cause compared to those who drank less than 1 glass per month of a soft drink of any kind.
Those who drank the same amount of sugar-sweetened soft drinks were only 17% more likely to die of any cause, but the results were worse for those clinically classified as obese (with a BMI over 30) than those clinically classified as overweight (with a BMI between 25 and 30).
Those with a BMI over 30 who drank 2 or more glasses of sugar-sweetened soft drinks per day were at a 23% greater risk of death from all causes as compared to those who drank less than 1 glass of sugar-sweetened soft drinks per day, while the risk for those with a BMI between 25 and 30 was the same as those who were of clinically normal weight.
More specifically, drinking any soft drinks was associated with the participants’ risk of death from circulatory diseases like heart disease or cerebrovascular diseases, while drinking sugar-sweetened soft drinks alone did not appear to affect that risk. On the other hand, drinking at least 1 sugar-sweetened soft drink every day meant a 59% greater risk of dying from a digestive disorder that includes liver, esophageal, and gall bladder disorders.
Consuming more soft drinks, whether sugar-sweetened or not, also appeared to contribute to a participants’ risk of death from colon cancer, but not breast cancer or prostate cancer.
Finally, although Alzheimer disease did not appear to be linked to soft drink intake, the authors found that drinking at least one glass per day of any type of soft drink was linked to a 59% greater risk of death from Parkinson disease, with similar associations for both sugar-sweetened and artificially-sweetened soft drinks.
What’s the Take-Home?
Sure, sugar-sweetened beverages might be “worse” for you with respect to one type of illness while artificially-sweetened beverages might be “worse” for you with respect to another, but the point is that neither is good for you. Ditch the soft drink habit and stick to water, coffee, or tea (and don’t worry about whether the tea or coffee is caffeinated or not).
Mullee A, Romaguera D, Pearson-Stuttard J. Association between soft drink consumption and mortality in 10 European countries. JAMA Intern Med. 2019;179(11):1479-1490. doi:10.1001/jamainternmed.2019.2478