essay on drinking soda

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• Am J Public Health
• v.97(4); Apr 2007

Effects of Soft Drink Consumption on Nutrition and Health: A Systematic Review and Meta-Analysis

Lenny r. vartanian.

The authors are with the Department of Psychology, Yale University, New Haven, Conn.

Marlene B. Schwartz

Kelly d. brownell.

In a meta-analysis of 88 studies, we examined the association between soft drink consumption and nutrition and health outcomes. We found clear associations of soft drink intake with increased energy intake and body weight. Soft drink intake also was associated with lower intakes of milk, calcium, and other nutrients and with an increased risk of several medical problems (e.g., diabetes).

Study design significantly influenced results: larger effect sizes were observed in studies with stronger methods (longitudinal and experimental vs cross-sectional studies). Several other factors also moderated effect sizes (e.g., gender, age, beverage type). Finally, studies funded by the food industry reported significantly smaller effects than did non–industry-funded studies. Recommendations to reduce population soft drink consumption are strongly supported by the available science.

Soft drink consumption has become a highly visible and controversial public health and public policy issue. Soft drinks are viewed by many as a major contributor to obesity and related health problems and have consequently been targeted as a means to help curtail the rising prevalence of obesity, particularly among children. Soft drinks have been banned from schools in Britain and France, and in the United States, school systems as large as those in Los Angeles, Philadelphia, and Miami have banned or severely limited soft drink sales. Many US states have considered statewide bans or limits on soft drink sales in schools, with California passing such legislation in 2005. A key question is whether actions taken to decrease soft drink consumption are warranted given the available science and whether decreasing population consumption of soft drinks would benefit public health.

The issue is not new. In 1942 the American Medical Association mentioned soft drinks specifically in a strong recommendation to limit intake of added sugar. 1 At that time, annual US production of carbonated soft drinks was 90 8-oz (240-mL) servings per person; by 2000 this number had risen to more than 600 servings. 2 In the intervening years, controversy arose over several fundamental concerns: whether these beverages lead to energy overconsumption; whether they displace other foods and beverages and, hence, nutrients; whether they contribute to diseases such as obesity and diabetes; and whether soft drink marketing practices represent commercial exploitation of children. 3 – 5

The industry trade association in the United States (the American Beverage Association, formerly the National Soft Drink Association) counters nutrition concerns with several key points: (1) the science linking soft drink consumption to negative health outcomes is flawed or insufficient, (2) soft drinks are a good source of hydration, (3) soft drink sales in schools help education by providing needed funding, (4) physical activity is more important than food intake, and (5) it is unfair to “pick on” soft drinks because there are many causes of obesity and there are no “good” or “bad” foods. Similar positions have been taken by other trade associations such as the British Soft Drinks Association and the Australian Beverages Council.

Legislative and legal discussions focusing on soft drink sales often take place on political and philosophical grounds with scant attention to existing science. Our objectives were to review the available science, examine studies that involved the use of a variety of methods, and address whether soft drink consumption is associated with increased energy intake, increased body weight, displacement of nutrients, and increased risk of chronic diseases.

We focused on research investigating the effects of sugar-sweetened beverages; diet and artificially sweetened beverages are noted only in certain cases for comparison purposes. We conducted a computer search through MEDLINE and PsycINFO using the key terms “soft drink,” “soda,” and “sweetened beverage.” We identified articles that assessed the association of soft drink consumption with 4 primary outcomes (energy intake, body weight, milk intake, and calcium intake) and 2 secondary outcomes (nutrition and health). We identified additional articles by searching each article’s reference section and the Web of Science database. Finally, we contacted the authors of each included article with a request for unpublished or in-press work, and we asked each author to forward our request to other researchers who might have relevant work. Our searches yielded a total of 88 articles that were included in the present analysis.

There is a great deal of variability in research methods in this literature. Studies vary in their design (i.e., cross-sectional, longitudinal, or experimental studies), sample characteristics (e.g., male vs female, adults vs children), and operational definitions of independent and dependent variables. Because such heterogeneity of research methods is likely to produce heterogeneity of effect sizes across studies (an effect size represents the magnitude of the relationship between 2 variables), we took 2 steps to assess the impact of research method on outcome.

Initially, for each primary outcome (energy intake, body weight, milk intake, and calcium intake), we assessed the degree of heterogeneity of effect sizes by testing the significance of the Q statistic, which is the sum of the squared deviations of each effect size from the overall weighted mean effect size. We did not assess the degree of heterogeneity for secondary outcomes (nutrition and health) because there were relatively few studies in these domains. Our analysis of primary outcomes revealed a significant degree of heterogeneity of effect sizes in each case, and thus we separated the studies according to research design. This procedure reduces the likelihood of aggregating effect-size estimates across heterogeneous studies. Moreover, some research designs are viewed as more powerful than others. Cross-sectional studies represent the weakest design, because such studies cannot determine causality. Longitudinal designs are considered stronger, but experimental designs are the strongest test of causal relationships. Thus, separating studies according to type of design allowed us to examine effect magnitudes as a function of strength of research design.

We further explored variability in effect sizes by examining a number of potential moderator variables, including (1) population studied (children and adolescents vs adults), (2) gender of participants (only male, only female, or male and female combined), (3) type of beverage (sugar-sweetened carbonated soft drinks vs a mix of sugar-sweetened and diet beverages), (4) whether the reported results were adjusted for covariates (e.g., age, gender, ethnicity, activity level), (5) assessment method (self-reports vs observations or measurements), and (6) presence or absence of food industry funding. A study was coded as “industry funded” if the authors acknowledged support from food companies, beverage companies, or trade associations. Articles that did not report a funding source or cited support from other sources (e.g., pharmaceutical industry, university, foundation, or government grants) were coded as “non–industry funded.”

We calculated average effect sizes ( r values) using Comprehensive Meta-Analysis version x2 (Biostat, Englewood, NJ). In most cases, we entered data in the form in which they appeared in each individual study, including group means and standard deviations, correlation coefficients, t values, P values, and odds ratios and confidence intervals. In certain cases, it was necessary to manually calculate effect sizes. For example, when means for more than 2 groups were presented (e.g., low, moderate, and high soft drink consumption), we used the formulas for 1-way contrasts described by Rosenthal et al. 6 In other cases, odds ratios were reported with uneven confidence intervals (as a result of rounding), and effect sizes were calculated directly from the odds ratio according to the method described by Chinn. 7

When data from different subgroups were presented separately (e.g., data for male and female participants were presented independently), we calculated effect sizes separately for each subgroup. In the case of studies that reported multiple measures of a particular construct (e.g., both body weight and body mass index [BMI]), we computed the average effect size of the reported measures. When there was extraordinary variability in sample sizes across studies, we employed the conservative approach of limiting the sample size of the largest study in a particular domain (e.g., cross-sectional studies of energy intake) to the maximum sample size of the other studies in that domain. This approach ensured that the calculated average effect size would not be dominated by a single study. We considered an effect size of 0.10 or less as small, an effect size of 0.25 as medium, and an effect size of 0.40 or above as large. 8

To assess the presence of publication bias, we computed a “fail-safe N” for each of the main outcomes; this value is an estimate of the number of unretrieved or unpublished studies with null results that would be required to render the observed effect non-significant. Rosenthal 9 suggested that a fail-safe N greater than 5 k + 10 (with k being the number of studies included in the analysis) indicates a robust effect; in the present analyses, each fail-safe N far exceeded Rosenthal’s recommendation, suggesting a low probability of publication bias.

Soft Drink Consumption and Energy Intake

The overall effect size ( r ) across all studies for the relation between soft drink consumption and energy intake was 0.16 ( P < .001, Q 46 = 715.46, fail-safe N = 9726). Because there was a significant degree of heterogeneity among the effect sizes, we separated studies according to type of research design. Effect sizes for soft drink consumption and energy intake are shown in Table 1 ▶ .

TABLE 1—

Average Energy Intake Effect Sizes, by Type of Research Design

Note. CI = confidence interval. Because some studies reported both cross-sectional and longitudinal data, and because long-term experimental studies are not displayed, the numbers for the Overall column do not necessarily equal the sum of the numbers for the other columns.

a Number of studies included in the analysis.

* P < .0056 (adjusted for multiple comparisons) for differences in effect sizes within each column and research design variable.

Of the 12 cross-sectional studies examining the relation between soft drink consumption and energy intake, 10 reported a significant positive association, 10 – 19 1 reported mixed results, 20 and 1 reported no statistically significant effect. 21 Two studies showed that the increase in energy intake associated with soft drink consumption was greater than what could be explained by consumption of the beverages alone, 11 , 17 suggesting that such beverages might stimulate appetite or suppress satiety, perhaps because of a high glycemic index (foods with a high glycemic index produce a rapid rise in blood sugar). 22 The average effect size of the association between soft drink consumption and energy intake across all cross-sectional studies was 0.13 ( P < .001; Q 15 = 433.67, P < .001).

The 5 longitudinal studies that we identified all reported positive associations between soft drink consumption and overall energy intake. 17 , 23 – 26 The average effect size for these studies was 0.24 ( P < .001; Q 6 = 109.11, P < .001).

Four long-term experimental studies in which participants consumed soft drinks for between 3 and 10 weeks showed that individuals failed to compensate for the extra energy consumed in the form of sugar-sweetened beverages in that they did not reduce the rest of their food energy intake, resulting in a greater total daily energy intake. 27 – 30 One study revealed that participants consumed 17% more energy than in their typical diet even after the energy from the soft drinks they consumed had been taken into account, 27 suggesting again that soft drinks may influence other aspects of dietary intake. The average effect size was 0.30 ( P < .001; Q 4 = 2.37, P = .667). Because the Q statistic was not statistically significant, we did not investigate moderators for long-term experimental studies.

Findings from short-term experimental studies (i.e., those examining energy intake over the course of a subsequent meal or a single day) were mixed. Of 12 studies, 5 reported that individuals who consumed soft drinks consequently took in a greater amount of total energy (food energy plus beverage energy) than did those who consumed water. 31 – 35 One study also revealed higher-than-expected energy intakes among participants given the energy they consumed from soft drinks. 34 By contrast, 5 other studies reported that participants compensated at a subsequent meal for energy consumed from beverages. 36 – 40 Still others reported mixed results, depending, for example, on how long before lunch participants consumed soft drinks. 41 , 42 The average effect size for short-term experimental studies was 0.21 ( P < .001; Q 18 = 37.92, P = .004).

These results, taken together, provide clear and consistent evidence that people do not compensate for the added energy they consume in soft drinks by reducing their intake of other foods, resulting in increased total energy intakes. Not only do people fail to compensate for the energy consumed in soft drinks, but there is also some evidence that the increase in energy intake associated with soft drink consumption is even greater than what can be accounted for by the beverages alone, suggesting that food energy intake is also higher. The largest effect sizes were observed in long-term experimental studies, followed by short-term experimental and longitudinal studies. The smallest effects were found in cross-sectional studies. Further testing of moderators revealed significantly larger effect sizes among (1) women, (2) adults, (3) studies focusing on sugar-sweetened soft drinks, and (4) studies not funded by the food industry (Table 1 ▶ ).

Soft Drink Consumption and Body Weight

Research evaluating the relationship between soft drink consumption and body weight is complicated by the fact that researchers operationalize body weight in a number of different ways, even within the same study. When multiple measures of weight were provided in a single study, we calculated the average effect size across those measures. The overall effect size for studies examining the link between soft drink consumption and body weight was 0.08 ( P < .001; Q 47 = 337.73, P < .001, fail-safe N = 3173). Because there was a significant degree of effect size heterogeneity, we examined effect sizes separately for each research design. Effect sizes for soft drink consumption and body weight are shown in Table 2 ▶ .

TABLE 2—

Effect Sizes for Average Body Weight, by Type of Research Design

Note. CI = confidence interval. Because some studies reported both cross-sectional and longitudinal data, the numbers for the Overall column do not necessarily equal the sum of the numbers for the other columns.

In cross-sectional studies, outcomes varied depending on how body weight was operationalized. When the focus was on the association between soft drink consumption and BMI, 2 studies reported a significant positive association, 43 , 44 whereas 9 did not. 10 , 16 , 17 , 45 – 50 Two studies revealed a positive association between soft drink consumption and body fat percentage, 21 , 43 but 1 study did not. 51 In addition, 4 studies showed that people’s risk of being overweight or obese was positively associated with their soft drink consumption. 43 , 46 , 52 , 53 Other studies reported a positive association between soft drink consumption and body weight 54 , 55 and ponderal index 18 but not skinfold thickness. 55 Averaged across the different methods of operationalization, the mean effect size was 0.05 ( P <.001; Q 23 =64.36, P <.001; 1 study 50 was excluded from this analysis because an effect size could not be computed from the available data).

There was some evidence from the longitudinal studies examined that soft drink consumption is associated with weight gain. 11 , 17 , 23 , 54 , 56 One study showed that soft drink intake was significantly related to 1-year change in body weight among boys but that the association was no longer statistically significant when the analyses controlled for total energy intake. 11 This finding suggests that the association between soft drink consumption and weight change was because of the increase in daily energy intake caused by soft drink consumption. Two other studies reported mixed results depending on how body weight was operationalized, 57 , 58 and 4 studies reported no association between soft drink intake and BMI or change in BMI. 15 , 25 , 26 , 59 The overall effect size for longitudinal studies was 0.09 ( P <.001; Q 15 =177.76, P <.001; 1 study 57 was excluded from this analysis because an effect size could not be computed from the available data).

We found 7 studies that examined the connection between soft drink intake and body weight in an experimental or intervention context. Five reported a positive association. 27 – 29 , 60 , 61 In 3 of these studies, participants who were given soft drinks to consume gained weight over the course of the experiment. Two intervention studies aimed at decreasing soft drink consumption among high school students showed that students in the intervention groups essentially maintained their weight over the treatment period, whereas those in the control groups exhibited significant weight gain. Two studies reported no statistically significant effect of soft drink consumption on weight gain. 30 , 62 The average effect size for experimental studies was 0.24 ( P < .001; Q 7 = 24.57, P = .001).

Larger effect sizes were observed in experimental studies than in cross-sectional or longitudinal studies. Also, further testing of moderators revealed that effect sizes were larger among (1) women, (2) adults, (3) studies focusing on sugar-sweetened soft drinks, and (4) studies not funded by the food industry (Table 2 ▶ ).

Soft Drink Consumption and Milk and Calcium Intake

The overall effect size for milk intake was −0.12 ( P < .001, Q 33 = 300.43, P < .001, fail-safe N = 4048). The overall effect size for calcium intake was −0.04 ( P < .001; Q 28 = 368.65, P < .001, fail-safe N = 418). Effect sizes for soft drink consumption and milk and calcium intake are shown in Tables 3 ▶ and 4 ▶ , respectively.

TABLE 3—

Average Milk Intake Effect Sizes, by Type of Research Design

Note. CI = confidence interval.

TABLE 4—

Average Calcium Intake Effect Sizes, by Type of Research Design

Fifteen cross-sectional studies examined the association between soft drink consumption and milk intake; 13 reported that soft drink consumption was associated with lower intakes of milk and dairy products, 10 , 14 – 16 , 19 , 20 , 51 , 54 , 63 – 67 1 reported no statistically significant association, 68 and 1 reported a small positive association between milk intake and soft drink consumption. 69 One study showed that a 1-oz decrease in soft drink consumption was related to approximately a 0.25-oz increase in milk consumption. 63 In other words, reducing soft drink consumption by one 16-oz serving per day would be associated with an increase of approximately 4 oz of milk per day. The average effect size for milk intake was −0.11 ( P <.001; Q 27 =268.33, P <.001).

Calcium intake was also negatively associated with soft drink consumption in several cross-sectional studies, 14 , 16 , 19 , 44 , 64 , 65 , 67 – 71 but the effect sizes were generally small. In addition, 4 other studies reported positive associations between soft drink consumption and calcium intake, 51 , 63 , 69 , 72 and 1 reported mixed results. 20 Across all studies, the average effect of soft drink consumption was −0.02 ( P = .006, Q 23 = 275.51, P < .001).

Results from longitudinal studies were similar to those from cross-sectional studies, but the magnitude of the effects was larger. Five longitudinal studies reported a negative relationship between soft drink intake and intakes of milk and dairy products, 26 , 59 , 73 – 75 and 5 reported a negative relation between soft drink consumption and calcium intake. 23 , 73 , 74 , 76 , 77 The average effect sizes for milk and calcium intakes were −0.21 ( P < .001; Q 5 = 23.09, P < .001) and −0.13 ( P < .001; Q 4 = 15.22, P = .004), respectively.

For milk intake, significantly larger effect sizes were observed in longitudinal studies and in studies that included a variety of beverages, provided adjusted values, and were not funded by the food industry (Table 3 ▶ ). For calcium intake, larger effect sizes were observed among adults and among studies that included a variety of beverages. In addition, studies funded by the food industry exhibited slight positive effects, whereas studies not funded by the food industry exhibited small negative effects (Table 4 ▶ ).

Soft Drink Consumption and Nutrient Intake

Soft drink consumption also has been examined in relation to a variety of other foods, macronutrients, and micronutrients. In the case of many of these outcomes, there were only a small number of studies (and sometimes only a single study). We therefore aggregated effect sizes across all studies without examining the impact of research design or any other potential moderator variables. Thus, these aggregated effects should be interpreted with caution. A complete list of the nutritional variables investigated is available from the authors.

Several studies reported a positive association between soft drink consumption and carbohydrate intake, 13 , 14 , 17 , 19 , 20 , 24 , 27 , 28 , 31 , 35 , 39 whereas 1 study reported a negative relation 54 and 2 others reported no relation 16 , 38 (average r = 0.13; 4 studies 33 , 34 , 41 , 42 were excluded from the analysis because effect sizes could not be computed from the available data). A few studies highlighted the specific sources of carbohydrate related to soft drink consumption. One study reported that children and adolescents in the highest quartile of soft drink consumption consumed between 122 and 159 g of added sugar, approximately 4 to 5 times the US Department of Agriculture’s recommended maximum of added sugar (32 g). 64 Overall associations ( r values) of soft drink consumption with added sugar, fructose, and sucrose were 0.18, 0.36, and 0.23, respectively. Other studies revealed a negative association of soft drink consumption with intake of both dietary fiber ( r = −0.31) and starch ( r = −0.27). Thus, these findings indicate that the increased carbohydrate intake associated with soft drink consumption primarily reflects greater consumption of added sugars.

Soft drink consumption also was associated with decreased intakes of protein ( r = −0.14), fruit juice ( r = −0.17), fruit ( r = −0.09), and riboflavin ( r = −0.12), among others. Overall, there was no evidence of an association between soft drink consumption and fat intake, nor was there an association with intake of certain vitamins, including A and B 12 (all r s < 0.01). One study 16 reported a negative association between soft drink consumption and an overall “healthy eating index,” and another study 74 reported an overall negative association between soft drink consumption and average adequacy of intake of a variety of vitamins and nutrients.

Soft Drink Consumption and Health Outcomes

A number of studies examined links between soft drink consumption and various health outcomes. We report average effect sizes only when there was more than a single study for a particular outcome.

Perhaps the most striking link between soft drink consumption and health outcomes was the prospective evidence obtained for type 2 diabetes. In a study of 91249 women followed for 8 years, those who consumed 1 or more servings of soft drink per day were twice as likely as those who consumed less than 1 serving per month to develop diabetes over the course of the study. 17 These effects were only slightly attenuated when various potential confounds, including BMI and energy intake, were controlled. When diet soft drinks replaced sugar-sweetened soft drinks in the analysis, the increased risk was no longer present, suggesting that the risk was specific to sugar-sweetened soft drinks. Another study reported a positive association between soft drink consumption and number of risk factors for metabolic syndrome. 78 These effects also remained when BMI and energy intake were controlled.

Smaller associations were found with a number of other health outcomes. For example, 2 studies linked soft drink consumption with hypocalcemia (average r =0.38), 79 , 80 and a 30-day follow-up involving a group of patients with hypocalcemia who were asked to refrain from consuming soft drinks revealed a significant increase in serum calcium. 80 In addition, 2 studies reported a small but statistically significant negative association between soft drink consumption and bone mineral density, 51 , 75 whereas 2 others did not 44 , 68 (average r =−0.03). An association was also reported between soft drink consumption and increased risk of bone fracture (average r =0.06). 68 , 81 – 83 Some research has shown no effect of soft drink consumption on calcium metabolism and urinary excretion of calcium, and it has therefore been suggested that the role of soft drinks in calcium deficiency and reduced bone mineral density is that of displacing other sources of calcium, such as milk. 84 , 85

A small positive association was found between soft drink consumption and dental caries 86 – 89 ( r = 0.03; 2 studies 90 , 91 were excluded from the analysis because effect sizes could not be computed from the available data). The association between soft drinks and dental caries was not observed for diet soft drinks. 86 Also, 5 studies reported that soft drink consumption was positively associated with urinary or kidney stones, but 2 studies reported no association (average r = 0.05). 76 , 77 , 92 – 96 Two of the 5 studies that found positive associations 76 , 77 revealed that the effect of soft drink intake was no longer significant after other risk factors such as calcium, potassium, and sucrose intake had been controlled, suggesting that the effect of soft drink consumption on urinary stones may be a consequence of its influence on these other risk factors.

A 10-week experimental study showed that individuals who consumed sucrose-sweetened beverages exhibited an increase in both systolic and diastolic blood pressure over the course of the study, whereas individuals who consumed artificially sweetened beverages exhibited a decrease in blood pressure. 28 Also, a cross-sectional study reported an association between caffeinated soft drink consumption and systolic blood pressure among African Americans but not European Americans. 97 By contrast, another cross-sectional study revealed small negative correlations between soft drink intake and both systolic and diastolic blood pressure. 18 Finally, 1 study reported a positive association between soft drink consumption and risk of hypertension. 98

Intake of soft drinks and added sugars, particularly high fructose corn syrup, has increased coincident with rising body weights and energy intakes in the population of the United States. Yearly US per capita consumption of nondiet soft drinks rose 86% between 1970 and 1997 alone (22 gal [83.6 L] vs 41 gal). 99 The prevalence of obesity increased 112% during that approximate time. 100 US per capita energy consumption from added sugar rose from 984 kJ (235 kcal) per day in 1977 through 1978 to 1331 kJ (318 kcal) in 1994 through 1996, with soft drinks contributing far more to the total (440 kJ [105 kcal]) than foods such as fruit drinks (130 kJ [31 kcal]) and desserts (251 kJ [60 kcal]). 101

Although informative, the data just described represent only broad correlations. A true test of links between an environmental agent such as soft drinks and various health outcomes requires a robust literature with studies involving different methods, populations, and outcomes, but most important is a critical mass of studies with strong methods and sufficient sample sizes. These conditions now exist, and several clear conclusions are apparent.

One of the most consistent and powerful findings is the link between soft drink intake and increased energy consumption. Fully 10 of 12 cross-sectional studies, 5 of 5 longitudinal studies, and all 4 of the long-term experimental studies examined showed that energy intake rises when soft drink consumption increases. The effect sizes for these studies, respectively, were 0.13, 0.24, and 0.30.

The available literature also supports the observation that people do not adequately compensate for the added energy they consume in soft drinks with their intake of other foods and consequently increase their intake of sugar and total energy. Noteworthy are findings from several studies that soft drink intake is associated with a higher level of energy consumption than can be accounted for by the soft drinks themselves. 11 , 17 , 27 , 34 These findings raise the possibility that soft drinks increase hunger, decrease satiety, or simply calibrate people to a high level of sweetness that generalizes to preferences in other foods.

Bray et al. 102 noted that the average American older than 2 years consumes 553 kJ (132 kcal) per day from high fructose corn syrup (the sole sweetener in US soft drinks) and that intake of this sweetener rose 1000% between 1970 and 1990. These authors proposed that fructose is digested, absorbed, and metabolized differently than glucose in ways that favor de novo lipogenesis and do not stimulate insulin secretion or enhance the production of leptin, both afferent signals in the regulation of food intake and body weight.

One would expect a weaker relationship of soft drink consumption with body weight than with energy intake because soft drinks are not the only source of energy in the diet. In addition, higher intake of diet drinks among people with elevated BMIs could reduce or cancel out a relationship between intake of soft drinks overall and body weight. Indeed, cross-sectional and longitudinal studies showed only small positive associations between soft drink consumption and BMI ( r s=0.05 and 0.09, respectively). More impressive, however, is the fact that a moderate effect size ( r =0.24) was observed for experimental studies that controlled for many extraneous variables.

In addition to effects on energy intake and weight, it is important to know whether soft drinks displace essential nutrients and contribute to overall poorer diets. Our review showed that increased soft drink intake is related to lower consumption of milk and calcium, but average effect sizes were small. Soft drink consumption was also related to higher intake of carbohydrates, lower intakes of fruit and dietary fiber, and lower intakes of a variety of macronutrients in cross-sectional, longitudinal, and longer-term experimental studies.

Interpreting the association between soft drink consumption and nutrient intake is complex. Soft drink intake could be a marker for poor nutrition, with individuals who consume more sweetened beverages eating poorer diets in general. Soft drinks might also stimulate people’s appetite for other nonnutritious foods. One study showed that individuals who consumed more soft drinks consumed diets with higher overall glycemic indexes, 17 supporting the prediction that consumption of foods with high glycemic indexes (such as soft drinks) might stimulate intake of other such foods. 22 Other studies showed that soft drink consumption is positively related to the consumption of foods such as hamburgers and pizza 54 and negatively related to an overall healthy eating index. 16

A number of studies suggest links between soft drink intake and medical problems. The issues of greatest concern are elevations in blood pressure and increased risk of diabetes. The most striking finding, in a study of 91 249 women followed for 8 years, was that those who consumed 1 or more servings of soft drinks per day (less than the US national average) were at twice the risk of developing diabetes as those who consumed less than 1 serving per month. 17 This result alone warrants serious concern about soft drink intake, particularly in light of the unprecedented rise in type 2 diabetes among children.

Methodological Considerations

There is a great deal of variability in the methods employed in research on the effects of soft drink consumption, and some of these methodological factors have considerable effects on study outcomes. First, we found that effect magnitudes were consistently larger when studies involved more powerful designs (i.e., findings from experimental studies were consistently stronger than those from cross-sectional studies). Second, effect sizes varied significantly depending on other methodological variables such as participant gender, participant age, and beverage type. This heterogeneity not only influences research outcomes but also influences the conclusions that can be drawn from a given study. Different research methods and different definitions of key variables such as body weight further complicate interpretation of findings across studies. Future research with more uniform methodology (ideally experimental designs) would help clarify the impact of soft drink consumption on nutrition and health outcomes.

Industry Funding

The issue of industry funding has been the focus of considerable scrutiny in several areas of medical research, particularly pharmaceutical studies. 103 Our analyses revealed that the overall pattern of results differed significantly when studies funded and not funded by the food industry were compared. As illustrated in Tables 1 ▶ through 4 ▶ ▶ ▶ , the average overall effect size for industry-funded studies was significantly smaller than the average effect size for nonfunded studies. This discrepancy was particularly striking in studies examining the effects of soft drink consumption on energy intake; effect sizes were moderate ( r = 0.23) for nonfunded studies and essentially nil ( r = 0.05) for funded studies.

Similar results have been reported in other food research. Among studies supportive of the fat substitute olestra, for instance, 80% have been funded by the food industry; by contrast, 21% of neutral studies and 11% of studies critical of olestra have been funded by the industry. In addition, all of the authors disclosing an affiliation with the maker of olestra have published studies supportive of the product. 104

Conclusions

Available data indicate a clear and consistent association between soft drink consumption and increased energy intake. Given the multiple sources of energy in a typical diet, it is noteworthy that a single source of energy can have such a substantial impact on total energy intake. This finding alone suggests that it would be prudent to recommend population decreases in soft drink consumption. The fact that soft drinks offer energy with little accompanying nutrition, displace other nutrient sources, and are linked to several key health conditions such as diabetes is further impetus to recommend a reduction in soft drink consumption.

Acknowledgments

This work was supported in part by the Rudd Foundation.

We thank all of the authors who responded to our request for unpublished and in press research.

Note. Personnel from the Rudd Foundation were not involved in this work in any way. All of the authors of the present article had full access to the data.

Peer Reviewed

Contributors L. R. Vartanian co-originated the project, retrieved and coded the relevant articles, conducted the analyses, and cowrote the article. M. B. Schwartz assisted in the coding and analyses and cowrote the article. K. D. Brownell co-originated the project and cowrote the article.

• Diet & Weight Management
• Feature Stories

Sodas and Your Health: Risks Debated

Experts debate the research on potential health risks of soft drinks.

Just about every week, it seems, a new study warns of another potential health risk linked to soft drinks.

The most recent headlines have raised concerns that diet sodas boost stroke risk. Diet and regular sodas have both been linked to obesity, kidney damage, and certain cancers. Regular soft drinks have been linked to elevated blood pressure .

Several hundred soda studies have been published over the last two decades, but most of the ones done in humans (as opposed to mice or rats) relied on people’s memories of what they drank.

Observational studies like these can point to possible concerns, but they can't prove that sodas do, or don’t, pose a health risk.

If you drink sodas -- especially if you drink a lot of them -- what are you to make of all the headlines? Do you dismiss them, as the beverage industry does, as bad science and media hype? Or is it time to put the can down and take a hard look at what you're drinking?

Another Day, Another Soda Study

In the past six months alone, dozens of studies examining the health impact of drinking sugary beverages or diet soda have been published in medical journals. Some suggested a relationship; others did not.

Sometimes, the media coverage of these studies took the researchers by surprise.

That was the case for epidemiologist Hannah Gardener, PhD, of the University of Miami. In February, she presented early results from her ongoing research at a health conference, and was completely unprepared for the media attention it received.

The story appeared on all the major networks, in most major newspapers, and on the Internet, including WebMD.

The early findings showed a 48% increase in heart attack and stroke risk among daily diet soda drinkers, compared to people who did not drink diet sodas at all or did not drink them every day.

Most reports cautioned that the findings were preliminary and did not prove that diet sodas cause stroke.

But Gardener says many media reports overstated the findings. And even when the stories got it right, she says the headlines often got it wrong by leaving the impression that her research proved the diet soda- stroke connection.

“It was just an abstract presented at a meeting. It hasn’t even been published yet,” Gardener tells WebMD. “We are still working on the analysis. I don’t think the level of press attention it received would have been warranted even if it was a published paper.”

Gardener's team attempted to control for known heart attack and stroke risk factors, such as poor diet and lack of exercise, but she concedes that these factors could have influenced the findings.

Purdue University behavioral sciences professor Susan Swithers. PhD, had a similar experience in 2004, following the publication of her study in rats suggesting that no-calorie sweeteners like those in diet sodas increase appetite.

Swithers says she was shocked by the amount of news coverage her study received.

“Frankly, we were stunned,” she tells WebMD. “It really was a small study.”

Weighty Issue

The nonprofit Center for Science in the Public Interest (CSPI) sees sugary drinks as a major factor in the obesity epidemic and favors taxing them.

CSPI executive director Michael Jacobson, PhD, says sugary soft drinks deserve to be singled out in the battle against obesity because they are the biggest single source of empty calories in the American diet.

“According to the USDA, 16% of calories in the typical American’s diet come from refined sugars and half of those calories come from beverages with added sugar,” Jacobson says. “Sodas used to be an occasional treat, but now they are part of the culture.”

New York University professor of nutrition and food studies Marion Nestle, PhD, says there is plenty of evidence that sodas have contributed to America's growing girth, especially among children.

Nestle says pediatricians who treat overweight children tell her that many of their patients take in 1,000 to 2,000 calories a day from soft drinks alone.

“Some children drink sodas all day long,” she says. “They are getting all of the calories they need in a day from soft drinks, so it’s no wonder they are fat.”

“The first thing that anyone should do if they are trying to lose weight," Nestle says, "is eliminate or cut down on soft drinks."

Obesity Culprit or Scapegoat?

The American Beverage Association (ABA) argues that sodas are taking too much of the blame for obesity.

“A calorie is a calorie, and what the data clearly show is that Americans are eating too much and taking in too many calories, period,” says Maureen Storey, PhD, the ABA's senior vice president of science policy.

Not everyone agrees with that. Sugary soft drinks, in particular, have been shown in many studies to be associated with overweight and obesity, as in a review of 30 studies published in 2006 by researchers from the Harvard School of Public Health. Many of the studies included in that review showed that overweight children and adults drink more sugary beverages than normal-weight kids and adults, and several studies found that the more sugar-sweetened drinks people drank the greater their likelihood of becoming overweight.

At the time, the ABA criticized the review, claiming in a news release that the Harvard researchers “chose to ignore critical articles and studies that contradicted their hypothesis,” such as a 2005 study finding no link between soda and obesity in Canadian children.

Yale University researchers also examined the obesity issue, combing through 88 studies.

They found that people tend to eat more calories on days when they drink a lot of sugar-sweetened drinks, and that soda drinkers tend to be heavier than people who don't drink soft drinks.

The researchers hypothesized that the body does not easily recognize calories derived from beverages, so people end up eating more. But the Yale study wasn't designed to prove that.

As for diet sodas, nutrition researcher David L. Katz, MD, who directs the Yale Prevention Research Center, told WebMD in November 2010 that the research as a whole suggests sugar substitutes and other non-nutritive food substitutes have little impact on weight . “For every study that shows there could be a benefit or harm, there’s another that shows no ‘there’ there,” Katz says.

Patterns of Bias?

The ABA says the vast majority of studies supporting a soda-obesity link were done by researchers with strong anti-soda biases. Storey also says many of these biased or poorly done studies are covered by news media, while studies showing no link don't get the same attention.

“All too often, studies that don’t show a relationship between sugar-sweetened beverages and obesity or other health concerns are not reported, while the ones that show even a very weak relationship are,” she says.

Obesity researcher Kelly Brownell, PhD, who led the Yale study and supports taxing sugar-sweetened beverages, sees bias on the other side of the debate.

“Studies that do not support a relationship between consumption of sugared beverages and health outcomes tend to be conducted by authors supported by the beverage industry,” Brownell wrote in a 2009 New England Journal of Medicine article supporting a soda tax.

One such study, funded by the British sugar industry group The Sugar Bureau, examined sugar and soft drink consumption among 1,300 children in the U.K. The study found no evidence that soft drinks alone affected children’s weight.

Rachel K. Johnson, RD, PhD, MPH, is a professor of nutrition at the University of Vermont and an American Heart Association spokeswoman. She served on the American Heart Association's 2009 panel that recommended limiting added sugars , including those in drinks.

Johnson says she does not believe the science linking sodas to obesity and other health issues has been misrepresented or over-reported.

“I don’t think anyone would say that limiting sugar-sweetened drinks is the only solution,” she says. “But to me, it is an important step in the right direction.”

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Can Drinking Soda Really Kill You?

The bottom line on all those scary health studies you’ve heard lately.

Hallie Levine,

Whether you call it a soft drink, soda or pop, you’ve probably noticed that every few months one study or another comes out detailing their health risks. Now, new research published earlier this month in JAMA Internal Medicine offers an even more sobering message: Just two glasses per day of these drinks, whether they’re sweetened with sugar or artificial sweeteners, raises the risk of premature death by 17 percent, compared to those who sip them less than once a month.

But studies on soft drinks can be confusing because some of them aren’t well controlled, says Bonnie Liebman, director of nutrition at the Center for Science in the Public Interest. “Many of these studies are observational studies, which means researchers are relying on people’s memories and recall, which can be problematic,” she explains. In addition, it’s often impossible to tease out whether the effects are due to reverse causation — that is, study subjects “may be drinking diet drinks because they are already overweight, and thus many of their health problems can stem from that,” Liebman notes.

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Here’s a look at what the research shows, and a bottom line for you.

Stay away from sugary drinks, period

A study published earlier this year in the journal Circulation followed over 118,000 men and women for 30 years and concluded that each daily 12-ounce serving of a sugar-sweetened beverage — including soft drinks, lemonade and other sugary fruit drinks — raised the risk of death by 7 percent, including a 5 percent increased risk for cancer death, and a 10 percent increased risk for death from cardiovascular disease. “Sugary drinks lead to weight gain, and anything that leads to weight gain increases risk of conditions such as heart disease, type 2 diabetes and even certain cancers,” explains Liebman. There are also other ingredients that may come into play. “Soft drinks are made up of carbonated water, and there is some preliminary research that suggests carbonated water may increase levels of the hunger hormone ghrelin, thereby making one hungrier, and that may lead to weight gain,” adds Nancy Farrell Allen, a spokesperson for the Academy of Nutrition and Dietetics and a registered dietician in Fredericksburg, Virginia.

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Bottom line: Indulge in these drinks once a month, or less. “We know now that added sugars can cause inflammation in bodies, and we already have a high sugar diet to begin with,” points out Erin Coates, a nutritionist at the Cleveland Clinic. One can of Coca-Cola, for example, contains 39 grams of added sugar, well above the American Heart Association’s maximum recommendations of 25 grams for women and 36 for men.

Limit diet drinks

You can’t live without your afternoon Diet Coke, or you crave that Diet Sprite at dinner. But research shows diet soft drinks may carry health issues, too. The  JAMA  study, for example, found that while drinking two or more sugar-sweetened beverages a day raised the risk of death by 8 percent, those who drank artificially sweetened drinks had a 26 percent higher risk.

One reason may be that diet sodas, instead of satisfying our sweet tooth, leave us craving for even more. “They are 300 to 500 times sweeter than sugar, increasing our desire for more and more sweet foods or beverages,” says Farrell Allen. “We would never add 300 sugar cubes to our cup of coffee. But non-nutritive sweeteners give this false sense of what I call ‘caloric security.’” In other words, you don’t think twice about pairing a cheeseburger with your Diet Coke because, after all, you’re sipping zero calories. “In my experience, clients who drink diet soft drinks almost always aren’t satisfied with the drink alone — they want a sweet or salty food to go along with it,” adds Coates.

Another concern may be some of the chemicals, including the artificial sweeteners, found in diet soft drinks, adds Liebman. Aspartame — found in drinks like Diet Coke — has in the past been linked to cancers such as lymphoma and leukemia in lab animals. While later research has been more reassuring, a 2012 study published in the  American Journal of Clinical Nutrition  did find that men who drank at least one diet soda a day had a higher risk of two cancers, multiple myeloma and non-Hodgkin lymphoma, than men who didn’t drink any at all. Some other diet soft drinks contain sucralose (Splenda), which has also been linked to cancer in animals.

Bottom line:  It’s time to wean yourself from your Diet Coke habit. An occasional diet soft drink won’t kill you, but a daily — or even an every-other-day — habit may wreak havoc on your taste buds, making it harder for you to lose or maintain a healthy weight, points out Coates. If you are considering a diet drink, try to stick to ones that contain the artificial sweetener Stevia, which appears right now to be the safest of the bunch, adds Liebman. Examples of drinks that contain Stevia include Coca-Cola Life, Pepsi True and Zevia Zero Calorie soda.

Be judicious with juice

Although soft drinks themselves are quick to get a bad rap, they’re not the entire problem. A study published this past July in the  British Medical Journal   found that along with sugary soft drinks, 100 percent fruit juice can also raise the risk of cancer. But in these cases, portion size may be the main problem. “A serving size of juice is four ounces, but nobody just drinks that amount,” says Farrell Allen. Instead, she says, they down an entire 20-ounce bottle, which contains a whopping 52 grams of sugar per serving.

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Bottom line:  If you want a small glass of OJ in the morning, that’s absolutely fine, especially if the rest of your diet is healthy, says Farrell Allen. But keep in mind more than that just provides extra sugar and calories, and since juice has little fiber, it won’t provide the full feeling that comes with eating fruit whole.

Stick to H20 — and spice it up

Water, along with low-fat or fat-free milk and unsweetened coffee and tea, are still the best ways to get your fluids, says Coates. You can replace your soft drinks with infused water: Simply drop fruit like berries, cherries or peaches into your water. (For best results, use frozen fruit, since the flavor will intensify as the fruits thaw.) If you really crave a carbonated beverage, opt for sparkling water. If you opt for a flavored version, choose a brand sweetened with natural fruit rather than regular or artificial sweeteners.

Hallie Levine is a contributing writer and an award-winning medical and health reporter. Her work has appeared in  The New York Times, Consumer Reports, Real Simple, Health  and  Time , among other publications.

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I Gave Up Soda For a Year, and It Changed My Life

Have you ever wondered just how bad soda is for your body ? I didn't either for almost 27 years of my life. I was addicted to the sugary goodness. I would drink it without thought — with lunch, as a snack, with dinner, during movies. I'd consume so many sodas in a day that my doctor warned me it was getting to be hazardous to my health. I had tried to quit soda before, but always came back to it after a week off. But as I was about to turn 28, my body was giving me warning signs of its own that I needed to change my habits. I was always tired — unless fueled with caffeine. Food wouldn't taste good if I didn't have it with a soda. And I was always bloated and gassy, which doesn't help when you're trying to go out on dates.

So two days before my 28th birthday, I decided to give up the drink for a year. Yep, 365 days without soda — would I be able to do it? I wasn't confident with myself, but I wanted to try. Here are the things that I learned.

It's not easy, but it is possible.

Giving up soda would not be something that would come easy for me. I was dependent on soda. I would drink at least two to three cans a day, sometimes more. The first few weeks were the worst. I would get really bad cravings and had to figure out ways to keep from drinking it. We have a fridge at work that is full of free soda — this was the worst because it was so readily available. It's like it was staring at me, tempting me to drink it every time I would need to go past the kitchen. So I stopped going past the kitchen. If I wasn't near it, I didn't have to fight as hard not to drink it. I would stock up on multiple bottles of water in the morning and avoid the kitchen at all costs.

The longer you go without it, the easier it gets.

One of my greatest accomplishments was making it one month without soda. It felt good because I knew I didn't NEED the drink in my life. When I started, I knew I had to find an alternative. You can't just cut it out cold turkey when you're used to having that much caffeine every day. I began to try different drinks; I switched to teas — iced tea, lemonade, green tea, and hot tea — any type of tea worked. It was how I still got flavor in my life. But after a while, I began to enjoy the tea. Unsweetened tea began to have a flavor, and I actually wanted to drink it. This led to me also wanting to drink more water.

It's not about a number on a scale, but your clothes will fit better.

Your clothes will start to fit better.

It's not about a number on a scale, but your clothes will fit better. They may even get so big that you have to go down a size or two. I went from a size 12/14 to a size 10/12. I had to invest in a belt, which, as time went on, I had to go from two holes to three to four. I now can buy medium shirts again instead of large and XL, and overall, I feel better and more confident.

Stress dreams are real, and they will happen.

I would often wake up in the middle of the night in a panic. I had such vivid dreams that I drank soda and I would wake up feeling like I had failed only to realize I was asleep. The dreams only lasted about six months, but they were intense. I'm not sure what caused these dreams, but I like to think it was because my brain was trying to acclimate to life without such high amounts of sugar and caffeine.

You will have urges to work out.

I can't begin to tell you how much I hate working out. It seems like a chore, I get bored very easily, and I honestly have no idea if I'm even doing the exercises correctly. But when I stopped drinking soda, I had to get my energy elsewhere because the sugar rushes were no longer there. I felt really sluggish and like my body wasn't being used, and I began to want to go on runs and move around and be active. I started taking classes because they seemed fun. The classes turned into a routine, and now I've even stepped up my game and started taking Muay Thai.

You will notice food begins to have more flavor and taste better, and you'll crave healthy food.

The amount of sugar I was consuming in soda would make everything taste bland unless it was coated in sugar. As time went on, I started to develop my sense of taste again. This has also given me cravings for healthier foods. I am not one to preach about a healthy lifestyle. I love pizza — it's my favorite food group — but I also found myself not wanting to eat it once a week along with burgers and fries. I started to crave salads and vegetables (my mom would be thrilled for this to have happened as a child). I popped open a cookbook and began experimenting with recipes and wanted to take more chances and reward my body for the great job it was doing.

You have to make the conscious decision every day to not drink it until it becomes a habit.

That's right. YOU have to actively think about not drinking soda and force yourself not to do it. If you aren't in it 100 percent, you will lapse and go back to it. I have now been soda-free for a little over two years and, honestly, don't even register it as an option anymore. I drink mostly water now, and if I need a little flavor in my life, I have an iced tea or lemonade. I even have milkshakes every now and then. You don't have to deprive yourself of things you love to be healthy; you just have to be aware of what is in certain things and how they are adversely affecting your body and health. Your body will thank you if you take care of it.

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Public Health Concerns: Sugary Drinks

Americans consume on average more than 200 calories each day from sugary drinks ( 58 , 59 )—four times what they consumed in 1965 ( 60 )—and strong evidence indicates that our rising thirst for “liquid candy” has been a major contributor to the obesity and diabetes epidemics. ( 41 , 46 , 52-54 , 61 )

Taking action against sugary drinks

Research shows that sugary drinks are one of the major determinants of obesity and diabetes, and emerging evidence indicates that high consumption of sugary drinks increases the risk for heart disease , the number one killer of men and women in the U.S.

Reducing our preference for sweet beverages will require concerted action on several levels—from creative food scientists and marketers in the beverage industry, as well as from individual consumers and families, schools and worksites, and state and federal government.

We must work together toward this worthy and urgent cause: alleviating the cost and the burden of chronic diseases associated with the obesity and diabetes epidemics in the United States.

Here are steps that each of these groups can take to address the issue:

Beverage manufacturers: Create beverages that have much less sugar.

Beverage manufacturers can make it easier for everyone to drink more healthfully by creating beverages that are less sweet. A good target: Beverages that have no more than 1 gram of sugar per ounce, and are free of non-caloric sweeteners (such as sucralose, aspartame, or stevia). This is about 70 percent less sugar than a typical soft drink.

We also encourage beverage manufacturers to offer smaller (8 ounce) single-serving bottles of sugary drinks, and encourage their sales channels to stock these smaller-sized bottles. If you read the fine print on the Nutrition Facts label, you’ll see that a standard serving of soft drink is 8 ounces, and that each 20-ounce bottle contains 2.5 servings.

Individuals: Make healthy drinking your personal priority.

Start by choosing beverages with few or no calories. Water is best.

You can also:

• Ask food companies to make sugar-reduced beverages, by calling their customer service numbers, or sending them a message on their Web site comment forms.
• Ask schools and workplaces to offer filtered water or functioning water fountains.
• Ask your local stores, schools, and workplaces to carry 8-ounce or 12-ounce containers of sugary drinks, to make it easier for you to choose a smaller serving.

It is also wise to wean yourself off of artificial sweeteners because of the unanswered questions about the relationship between diet drinks and obesity.

Food shoppers for the family: Don’t stock sugary drinks at home.

Nationwide data show that children and teens drink most of their sugary calories at home, so parents can help kids cut back by not stocking soda, fruit punch, or other sugary drinks in the house, and making them an occasional treat rather than a daily beverage.

Schools and workplaces: Offer students and workers several healthy beverage choices.

Healthy choices for school and workplaces include water and reduced-sugar beverages, as well as single-serving or 12-ounce containers. Schools and workplaces should also make sure that they have functioning water fountains or filtered water available.

Government: Require better labeling on sugary drinks, and scrap sugar subsidies.

The FDA should consider requiring companies to list the number of calories per bottle or can—not per serving—on the front of beverage containers. It should also consider creating a new labeling category for low-sugar beverages.

Under current labeling regulations, a beverage can be marketed as “reduced sugar” if it contains 25 percent fewer calories than the standard version of that beverage. ( 62 )

A better threshold for low sugar beverages would be 1 gram of sugar per ounce, which is about 70 percent less sugar than a typical soft drink. Sugar-added beverages with more than 50 calories in an 8-ounce serving should carry a warning label about obesity and diabetes.

Government: Implement a soda tax.

Sugared beverages are categorized as food under the food stamp program and thus not taxed in some states. Yale researcher Kelly Brownell makes a strong argument for taxing sugary drinks in the New England Journal of Medicine . ( 63 ) Since sugared beverages carry no nutritional value and pose health risks to a consumer, many public health advocates have argued that it is logical to tax them like cigarettes or alcohol.

Government: Regulation of marketing to children.

Regulating advertising of sugary drinks targeted towards children – a vulnerable population –  through television, the internet or other media is an important strategy in reducing consumption.

US initiatives to ban sugary beverages

New York City In June of 2012, Mayor Michael Bloomberg of New York City proposed a ban on drinks sweetened with sugar that contain more than 25 calories per 8 fluid ounces. The ban would impact “super-sized” sodas larger than 16 ounces. The mayor cited the staggering rates of obesity in his proposed ban. Many public health officials and health professionals supported the mayor on his bold stand against soda, a major contributor to obesity. Others, however, argued that individuals must take personal responsibility for their beverage choices and their health, and that regulation would be ineffective because large quantities of soda could still be purchased in a few small containers, and the soda ban would not impact all vendors. For example, since the ban would only apply to movie theatres, fast food establishments, and food trucks, a consumer could still purchase an oversized soda at any food mart or grocery store.

Over the course of the summer and fall of 2012, the debate about Bloomberg’s soda ban raged on. In July, protestors of the ban marched – many while sipping large sodas – in City Hall Park. New York City’s Board of Health approved Bloomberg’s plan, and the new rules were set to take effect in March of 2013, but in the meantime the beverage industry and many restaurant owners filed a lawsuit. The proposed law was subsequently struck down in court in March 2013, and Mayor Bloomberg’s subsequent appeal was rejected by a state appeals courts on July 30, 2013.

The large sugary drink ban and subsequent debate raises many important public health questions surrounding access to foods and drinks that have been proven to increase obesity and disease risk. Skeptics remain wary that bans such as Bloomberg’s take away an individual’s right to make personal diet related decisions. Some believe that taking away this right may actually backfire by drawing excess attention to unhealthy items like large sodas and spurring a purchasing spree before they are possibly taken away.

Despite this opposition, there may be significant health benefits to limiting the sale of large sugary drinks. Sugar sweetened beverages are associated with obesity and many related health risks such as type 2 diabetes . New research also suggests that consuming sugar sweetened beverages also amplifies the genetic risk of obesity . We support bans like this because the obesity epidemic causes serious health consequences to individuals and places a large burden – both socially and economically – on aspects of our society such as healthcare. By limiting access to foods and drinks that have been proven to increase obesity and disease risk, individual consumers may be less likely to purchase these items and may instead shift towards healthier foods and drinks.

In a move to trim Boston’s rising obesity rates, Mayor Thomas Menino banned the sale and advertising of sugary drinks from city-owned buildings and city-sponsored events.

• The executive order, signed in 2011, calls for city departments to phase out regular sodas, sports drinks, and other high-sugar beverages from their vending machines, cafeterias, and concessions. ( 64 )
• In their place, the city will offer healthier beverage options—among them, water, flavored seltzer, unsweetened coffee and tea, and diet drinks.
• Sugary drink marketing, from logos on vending machines to banners at events, will also be barred.

Boston, which barred soda and junk food from public school vending machines in 2004, is not alone in its broader beverage ban effort.

• Boston’s Carney Hospital also announced in 2011 that it would ban high sugar beverages from hospital grounds, making it the first hospital in the city to do so. ( 65 )
• Cleveland Clinic banned high sugar drinks from its vending machines and cafeterias in August 2010. ( 66 )
• San Francisco, ( 67 ) Los Angeles County, ( 68 ), and other cities have also curtailed sugary drink sales on municipal property.

The goal of these bans is to make healthy drinks easy choices—and to counter the billions of dollars beverage manufacturers spent each year on soft drink marketing. That’s just the type of environmental support Americans need to curb their taste for sugar-loaded drinks, public health experts say—and in turn, potentially curb the obesity epidemic.

“There is abundant evidence that the huge increase in soda consumption in the past 40 years is the most important single factor behind America’s obesity epidemic,” says Dr. Walter Willett, chair of the Dept. of Nutrition at Harvard School of Public Health, who joined Mayor Menino at the soda ban’s announcement. “These steps will greatly assist in creating a new social norm, in which healthier beverages are the preferred choice.”

The city has also unveiled a “traffic-light” style promotional campaign to help consumers choose healthier beverages based on their sugar and nutrient content. The campaign, which groups beverages into “red” (limit), “yellow” (drink occasionally), and “green” (best choice) categories, is similar to the “How Sweet Is It” beverage guidelines developed by the Harvard School of Public Health’s Department of Nutrition in 2009.

See Boston’s traffic light brochure and poster on how to choose healthy beverages.

41. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health . 2007;97:667-75. 46. Malik VS, Popkin BM, Bray GA, Despres JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care . 2010;33:2477-83. 52. Schulze MB, Manson JE, Ludwig DS, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA . 2004;292:927-34. 53. Palmer JR, Boggs DA, Krishnan S, Hu FB, Singer M, Rosenberg L. Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch Intern Med . 2008;168:1487-92. 54. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr . 2006;84:274-88. 58. Wang YC, Bleich SN, Gortmaker SL. Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004. Pediatrics . 2008;121:e1604-14. 59. Bleich SN, Wang YC, Wang Y, Gortmaker SL. Increasing consumption of sugar-sweetened beverages among US adults: 1988-1994 to 1999-2004. Am J Clin Nutr . 2009;89:372-81. 60. Duffey KJ, Popkin BM. Shifts in patterns and consumption of beverages between 1965 and 2002. Obesity (Silver Spring) . 2007;15:2739-47. 61. Malik VS, Willett WC, Hu FB. Sugar-sweetened beverages and BMI in children and adolescents: reanalyses of a meta-analysis. Am J Clin Nutr . 2009;89:438-9; author reply 9-40. 62. National Archives and Records Administration’s Office of the Federal Register. Electronic Code of Federal Regulations. Title 21: Food and Drugs. Part 101: Food Labeling. Subpart D. Specific requirements for nutrient content claims.  101.60 Nutrient content claims for the calorie content of foods. 63. Brownell KD, Frieden TR. Ounces of prevention–the public policy case for taxes on sugared beverages. N Engl J Med . 2009;360:1805-8. 64. Executive Order of Mayor Thomas Menino. An Order Relative to Healthy Beverage Options (PDF). April 7, 2011. 65. Business Wire. Press Release : Carney Hospital to Ban the Sale of Sugar Sweetened Beverages. April 7, 2011. 66. Cleveland Clinic. Who We are and What We Do: Wellness Timeline. About the Wellness Institute . 67. Office of the Mayor Gavin Newsom. City & County of San Francisco. Executive Directive 10-01: Healthy Food & Beverage Options in Vending Machines. 68. Los Angeles County Board of Supervisors. Los Angeles County Food Policy. Vending Machines, Fund-Raising, and County-Sponsored Meetings. Approved by the Board of Supervisors August 8, 2006 and ammended August 18, 2009.

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Drinking Soda Might Make Period Cramps Worse. Here’s Why

Kevin Twomey / Getty Images

Key Takeaways

• Drinking soda may increase the likelihood of experiencing menstrual cramps by 24%, a new study suggests.
• Experts say that caffeine and sugar in soda could contribute to menstrual cramps by causing vasoconstriction and increasing inflammation.
• Coffee was associated with a lower chance of menstrual cramps in the same study.

Drinking soda might be one of the many triggers for menstrual cramps, according to a new study published in the journal Scientific Reports .

The study analyzed questionnaire data from 1,809 female college students in China. Nearly half of them were diagnosed with primary dysmenorrhea—the medical term for recurring menstrual cramps, with a quarter of those reporting severe pain.

Researchers found that people who drank soda had a 24% higher chance of experiencing menstrual cramps compared to non-drinkers. For students in rural areas, the odds increased to 40.2%. As they consumed more soft drinks, the pain severity also worsened.

Why Might Soda Trigger Menstrual Cramps?

The study only found a link between carbonated soft drinks and menstrual cramps but didn’t examine why there might be a connection. Some experts say that caffeine in soda is a potential culprit.

“Period cramps are caused by prostaglandin release, which are hormone-like substances that can play a role with constriction and dilation of blood vessels in the body,” Sonya Brar, MD , an OBGYN and instructor at the Icahn School of Medicine at Mount Sinai, told Verywell. “Caffeine has a powerful vasoconstriction effect that may increase pain with periods due to a decrease in blood flow to the uterus.”

Previous research has linked caffeine to uncomfortable periods. One study found that people who had caffeinated drinks were more likely to have irregular periods, missed periods, and heavy periods.

However, this new study showed that people who drank coffee were 55% less likely to have moderate to severe cramps. So, is this phenomenon only limited to caffeine in carbonated soft drinks?

The sugar content in soda may also be an issue, said Sherry Ross, MD , an OBGYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, CA.

“Drinking excessive amounts of sugary soda beverages can negatively affect the absorption and function of vitamins, minerals, and prostaglandins, leading to muscle spasms and contractions exacerbating uterine cramping during a period,” Ross said.

Consuming a lot of sugar can also increase the production of the stress hormone cortisol, which is linked to period cramps, Ross added.

According to Brar, inflammation could also trigger painful periods. “Theoretically, sugar can increase inflammation in the body and potentially could worsen symptoms with periods, but more studies are needed to confirm this,” she said.

While the sample in the new study consisted of only women in China, experts say the findings can likely apply to American women, too. Ultimately, more research is needed to confirm the connection.

“This study is good food for thought on exploring how your body would react to anything,” said Christine Greves, MD , an OBGYN at the Winnie Palmer Hospital for Women and Babies in Orlando.

When Should You See a Doctor for Menstrual Cramps?

Brar recommends taking an over-the-counter pain-relieving medication like ibuprofen if you have uncomfortable or painful periods.

“I often will recommend to start taking ibuprofen the day prior to the onset of their period to stay ahead of the prostaglandin release, and continue for the first few days into their period,” Brar said.

However, OTC pain medications may not be enough for everyone.

“If you feel that your quality of life is affected, it’s time to see a doctor,” Greves said.

While painful periods are common, you should see a doctor, especially if your pain is debilitating or disrupts your day-to-day activities every month. Your doctor will likely want to evaluate you for an underlying health condition, like endometriosis , uterine fibroids , or polycystic ovary syndrome (PCOS) .

What This Means For You

If you experience severe menstrual cramps, cutting back on soda could help reduce pain. However, consult with a healthcare provider for personalized advice, especially if cramps are impacting your daily life.

Wang L, Wen S, Li X, et al. Associations between soft drinks intake and primary dysmenorrhea among Chinese undergraduate female students . Sci Rep . 2024;14(1):21210. doi:10.1038/s41598-024-71802-8

Bin Mahmoud AZ, Makhdoom AN, Mufti LA, Alreheli RS, Farghal RG, Aljaouni SE. Association between menstrual disturbances and habitual use of caffeine . J Taibah Univ Med Sci . 2014;9(4):341-344. doi:10.1016/j.jtumed.2014.03.012

Itani R, Soubra L, Karout S, Rahme D, Karout L, Khojah HMJ. Primary dysmenorrhea: pathophysiology, diagnosis, and treatment updates . Korean J Fam Med . 2022;43(2):101-108. doi:10.4082/kjfm.21.0103

By Korin Miller Miller is a health and lifestyle journalist with a master's degree in online journalism. Her work appears in The Washington Post, Prevention, SELF, Women's Health, and more.

Coca-Cola Spiced pulled from shelves less than a year after drink's release

Coca-Cola said Tuesday it would be pulling a product in less time than it takes for a soda to go flat.

The Atlanta-based beverage giant said in a statement to USA TODAY that Coca-Cola Spiced will be discontinued .

The product, previously introduced as a part of the company's permanent offerings, will be pulled from shelves just seven months after it hit them.

"We're always looking at what our customers like and adjusting our range of products," a spokesperson said in the statement. "As part of this strategy, we're planning to phase out Coca-Cola Spiced to introduce an exciting new flavor in 2025."

The drink was launched in February and remains listed on the company's website as of Tuesday.

Coke's Gen-Z drink pulled

Coca-Cola Spiced was the company's attempt to attract a younger audience .

Coca-Cola’s North American marketing chief Shakir Moin said when the drink was revealed that the new flavor was developed in just seven weeks compared to the 12 months plus that it usually takes to develop a new product, adding that the company is "disrupting" the way they are working internally to better meet customer demand.

USA TODAY said the tasting notes of the drink were "(a) raspberry flavor takes dominance while the spices go undetected in the first few sips. You really have to focus on each sip to pick up the spicy notes."

Vice President Marketing Sue Lynne Cha said that the drink was a response to industry trends in an email to USA TODAY when the drink was released.

This story has been updated with new information.