Soft drinks, hard facts

A new study confirms that one serving of sugar-sweetened beverages is enough to imperil your health

People regard me as a bit of a freak. I do not drink tea, coffee, soft drinks (except a rare swig of Coke with rum) or beer. I do not like them. I suppose I am lucky, particularly when it comes to “soft drinks"—everything from aerated drinks to packaged juices—because it is clear now these sugar-sweetened beverages are likely to increase your weight, put you at risk of developing type-2 diabetes—the chronic, progressive and most common version—and cardiovascular disease.

“Sugar-sweetened beverages are the single greatest source of calories and added sugar intake in the US, and consumption is increasing in low- and middle-income countries," Vasanti Malik, co-author of a review paper published this week in the Journal of American College of Cardiology, told me in an email interview. The paper, described as the most comprehensive review of evidence on the health effects of sugar-sweetened beverages, reveals that one or two servings—about a cup—of such beverages a day is linked to: a 35% rise in the risk of heart attack or fatal heart disease; a 26% rise in the risk of developing type-2 diabetes; and a 16% rise in the risk of stroke.

The paper’s findings are as valid for India as they are for the US, said Malik, a research scientist at the Harvard School of Public Health. “Based on our updated account of the literature, we now know that the data (are) consistent across populations and study designs," she said.

The health effects of sugar-sweetened soft drinks further explain India’s skyrocketing incidence—one of the world’s highest—of cardiovascular conditions. Last time, this column discussed how four factors are responsible—genetic predisposition, sedentary living, stress and air pollution. Add to that our eating and drinking habits and ignorance, wilful or otherwise.

The new paper explains how sugars act on the body, particularly fructose (from corn syrup and table sugar), the main sugar added to soft drinks. In the liver, fructose is converted into triglycerides, compounds that could put you at risk of diabetes and cardiovascular disease, specifically by sparking insulin resistance. Fructose can also cause fatty liver disease and a painful arthritis called gout.

Fructose is also present in many fruits, such as apple, banana and mango, but Malik explained why fructose in fruit does not have significant health effects unlike its presence in beverages. “Fructose in beverages is absorbed more quickly than fructose in whole foods such as fruit and vegetables, which are absorbed more slowly due to their fibre content," she said.

Malik’s colleague and lead investigator, Frank Hu, a professor of nutrition and epidemiology at Harvard, has been pushing for a reduction in sugar-sweetened beverage consumption to bring down the prevalence of obesity and obesity-related diseases. “Although reducing the consumption of sugar-sweetened beverages or added sugar alone is unlikely to solve the obesity epidemic entirely, limiting intake is one simple change that will have a measurable impact on weight control and prevention of cardio-metabolic diseases," Hu and his team write in the new paper.

What helps India is that the average Indian consumes about 4 litres of sugar-sweetened beverages every year, far less than even the Thais and Pakistanis and more than 20 times less than the average American, whose consumption of soft drinks this year was the lowest in 19 years, according to various industry estimates that I consulted. The Indian market has been growing at 6% every year (the Chinese market grew by 16%), noted one analyst, while soft drink growth rates are typically twice the rate of GDP growth.

Younger people, especially children, are more likely to take to soft drinks—as I notice, with disquiet, in my family—and in a prospering country with the world’s largest population of people under 30, that is not good news. The most worrisome aspect of soft drinks, Malik confirmed, is “the frequency and large quantities consumed, especially by children and adoloscents". It is also cause for concern that consuming soft drinks is “socially acceptable in many communities", she said.

If you have young children, the easy solution is to restrict access to—or preferably eliminate—soft drinks, which are generally devoid of calcium and other nutrients. So, ensuring children drink lots of milk is a good idea. Studies in the West have showed how milk consumption goes up when soft drink consumption goes down (and vice versa).

Hu, Malik and colleagues make a strong case for government intervention to limit consumption of soft drinks, given the widespread and debilitating effects and costs of obesity-linked diseases. Among the actions Malik recommends: higher taxation (leading to a 10% price increase); a ban in soft drink sales in schools and workplaces; ensuring healthy alternatives and safe drinking water; front-of-package labelling (as on cigarette packs); public campaigns spotlighting the health risk of soft-drink over-consumption; and national and international dietary recommendations with specific guidelines for healthy beverages.

Samar Halarnkar is editor of IndiaSpend.org, a data-driven, public-interest journalism, non-profit organization. He also writes the column Our Daily Bread in Mint Lounge.

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To read Samar Halarnkar’s previous columns, go to www.livemint.com/frontiermail

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