Sugar-Sweetened Beverages

Definition

Sugar-sweetened beverages (SSBs) are drinks that include added sugar. These beverages include nondiet soft drinks and sodas, flavored juice and milk drinks, sports drinks, sweetened tea and coffee drinks, energy drinks, and electrolyte replacement drinks. The calories in sugar-sweetened beverages can contribute to weight gain and provide little to no nutritional value.

Purpose

The body utilizes sugar as glucose for energy. Excess sugar from the diet is stored in the liver and muscles in the form of glycogen. Naturally occurring sugar is present in fruits, vegetables, milk, and some grains. Sugar added to drinks is usually in the form of refined sugar obtained from plants such as sugar beet or sugar cane, which is added to beverages for a variety of purposes including:

Description

SSBs make a significant contribution to calorie and sugar intakes for many people, particularly children and adolescents. A 330-ml can of cola alone provides 35 grams of sugar and 139 calories.

Added sugar is often table sugar or sucrose. Sucrose is a disaccharide of glucose and fructose that comes from sugarcane or sugar beets. Raw sugar is evaporated sugarcane juice or syrup. Further processing yields solid brown or white cane sugar. Granulated white sugar is processed from either cane or beets. Brown sugar may be crystallized molasses (the residue from sugarcane processing) or white granulated sugar with molasses added back. Invert sugar, a food additive that is sweeter than sucrose, is produced by splitting sucrose into glucose and fructose.

Once digested, both naturally occurring sugar, such as that from pure fruit juice or milk and added sugar from SSBs enter the bloodstream where they are converted to glucose. As blood glucose levels rise, the pancreas releases the hormone insulin to help cells absorb the glucose for fuel or storage. When blood glucose levels fall, the pancreas releases the hormone glucagon, which signals the liver to release stored sugar to maintain blood sugar levels. All sugar, regardless of the source, has the same energy value of 3.75 calories per gram. Naturally occurring sugars in drinks such as milk and apple juice are converted to glucose at a slower rate than added sugars and, therefore, raise blood sugar levels more gradually. For this reason, these drinks have a lower glycaemic index (GI) than sugary drinks such as cola, and thus are thought to be less likely to contribute to health problems such as obesity and type 2 diabetes.

High-fructose corn syrup (HFCS) is the most common sweetener in SSBs because it is easy and inexpensive to manufacture. HFCS is made from processed corn syrup and is almost the same as sucrose, with about 55% fructose and 45% glucose. The United States is the world's largest manufacturer and consumer of HFCS.

A study that followed more than 200,000 adults for up to 38 years found that regular consumption of beverages sweetened with either added sugar or artificial sweeteners, especially carbonated and cola drinks, but not beverages with naturally occurring fructose, was associated with a 13% risk for developing high blood pressure. In contrast, high consumption of fructose from fresh fruit and other foods lowered the risk of developing high blood pressure. Because fructose is metabolized via a different pathway compared to glucose, it is thought that an excess consumption of fructose from juice and processed foods may contribute to metabolic syndrome.




The amount of sugar (65 grams, equivalent to roughly 14 teaspoons of sugar) in a 20 oz. bottle of Coke.





The amount of sugar (65 grams, equivalent to roughly 14 teaspoons of sugar) in a 20 oz. bottle of Coke.
(Science Source)

Most experts, including the American Heart Association, recommend that sugary fizzy drinks be swapped for water (including sparkling water), lower-fat milks, or sugar-free, diet, and no-sugar-added drinks. Some research has suggested that diet drinks themselves may not offer any benefit for weight loss and may even be linked to weight gain. Cohort studies, which look at what people consume and follow them over time, have shown mixed results. Some have indeed linked low-calorie drinks with obesity. The problem with relying on findings from this particular study design is that the results may have been affected by other factors. For example, overweight people may be more likely to choose low-calorie beverages. Studies that have compared the effects of sugary drinks and low-calorie drinks on calorie intake and weight over time have found that the low-calorie drinks lead to a lower calorie intake and weight loss.

Precautions

SSBs generally have fewer nutrients than drinks with only naturally occurring sugar such as pure juice, which contains vitamin C, potassium, and folate, or milk, which provides protein, calcium, and B vitamins. As well as increasing risk of tooth decay due to the presence of sugar, frequent consumption of fizzy drinks can lead to dental erosion due to the acids present, which is why these types of drinks are not advised for children. Concern about soda's contribution to energy intakes has led various countries including Denmark, Norway, South Africa, and the United Kingdom to impose a levy on SSBs.

KEY TERMS
Added sugar—
Sugar that is added to foods during processing, preparation, or meals.
Disaccharide—
A sugar, such as sucrose, that is comprised of two sugar units.
Fructose—
A sugar similar to glucose that is found in fruit and honey.
Glucose—
The form of sugar that the body assimilates and utilizes.
Glycemic index (GI)—
A measure of the speed at which the body converts carbohydrates in foods to glucose in the blood; the more rapidly carbohydrates in a food are converted to glucose, the higher the GI of the food.
High-fructose corn syrup (HFCS)—
Sugar made from corn that is added to many processed foods and soft drinks.
Insulin—
A hormone required for the metabolism of carbohydrates, fats, and proteins, and which regulates blood sugar levels; lack of insulin or insulin insensitivity results in high blood-sugar levels and diabetes.
Metabolic syndrome—
Insulin-resistance syndrome; syndrome X; a condition characterized by at least three factors such as high blood pressure, abdominal obesity, high triglyceride levels, low HDL cholesterol levels, and high fasting-blood-sugar levels that are linked to an increased risk for heart disease and type 2 diabetes.
Monosaccharide—
A simple sugar, such as glucose or fructose, comprised of a single sugar unit.
Naturally occurring sugars—
Sugars that occur naturally in foods such as fruits, vegetables, and grains.
Sucrose—
Table sugar; a disaccharide comprised of glucose and fructose, usually derived from sugarcane or sugar beets.
Type 2 diabetes—
A condition in which the body does not properly utilize glucose due to insulin resistance or decreased insulin production.

Side effects

Some experts believe that SSBs can cause increased sugar cravings, often likened to an addiction, because the high levels of sugar in SSBs disrupts hormones that signal satiety and satisfaction. Some people argue that SSBs are the biggest contributing factor to the obesity epidemic and should be regulated through different methods such as taxation and controlled portion sizes. In the United States, some cities and states have proposed sugar taxes and the outlawing of super-sized sugary sodas.

Interactions

Individuals on medications should check with their healthcare providers to see if certain foods may interact with their prescriptions or over-the-counter medications. Ingredients in some SSBs also might cause problems with medications. Sports drinks, for example, can interact with hypertension and heart drugs.

QUESTIONS TO ASK YOUR DOCTOR

See also Sugar ; Sugar tax .

Resources

PERIODICALS

Dietitians of Canada. Taxation and Sugar-Sweetened Beverages. Toronto: Dietitians of Canada, 2016.

Williams, Simon N., and Marion Nestle. Big Food: Critical Perspectives on the Global Growth of the Food and Beverage Industry. Abingdon, England: Routledge, Taylor, & Francis, 2016.

PERIODICALS

Atkins, Janice L., R. W. Morris, and L. T. Lennon, et al. “High Diet Quality Is Associated with a Lower Risk of Cardiovascular Disease and All-Cause Mortality in Older Men.” Journal of Nutrition 144, no. 5 (May 2014): 673–80.

Brady, Dennis. “Artificial Sweeteners Could Cause Spikes in Blood Sugar.” Washington Post (September 18, 2014): A3.

Campbell, Andrew. “The Brain: What Can Affect It and What Can Improve It.” Advances in Mind-Body Medicine 27, no. 3 (Summer 2014): 4–5.

Deierlein, Andrea L., Kimberly B. Morland, Kathleen Scanlin, et al. “Diet Quality of Urban Older Adults Age 60 to 99 Years: The Cardiovascular Health of Seniors and Built Environment Study.” Journal of the Academy of Nutrition and Dietetics 114, no. 2 (February 2014): 279–87.

Ellin, Abby. “Closing a Gateway to Sugar.” New York Times (September 16. 2014): D4.

WEBSITES

MedlinePlus. “Carbohydrates.” U.S. National Library of Medicine. http://www.nlm.nih.gov/medlineplus/carbohydrates.html (accessed May 29, 2018).

Couzin-Frankel, Jennifer. “Sugar Helps Fuel Bitter Nutrition Debate in U.S., U.K.” Science. http://news.sciencemag.org/health/2014/06/sugar-helps-fuel-bitter-nutritiondebate-u-s-u-k (accessed May 29, 2018).

Flaherty, Julie “Sipping toward Disaster.” Tufts University. http://sites.tufts.edu/nutrition/winter-2016/sippingtoward-disaster (accessed May 29, 2018).

Goldman, Gretchen, Christina Carlson, Deborah Bailin, et al. “Added Sugar, Subtracted Science: How Industry Obscures Science and Undermines Public Health Policy on Sugar.” Center for Science and Democracy at the Union of Concerned Scientists. http://www.ucsusa.org/assets/documents/center-for-science-and-democracy/added-sugarsubtracted-science.pdf (accessed May 29, 2018).

American Heart Association. “Sugar 101.” Heart.org . http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Sugars-101_UCM_306024_Article.jsp (accessed May 29, 2018).

American Heart Association. “Sugars, Added Sugars, and Sweeteners.” Heart.org . http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Sugars-Added-Sugars-and-Sweeteners_UCM_303296_Article.jsp (accessed May 29, 2018).

ORGANIZATIONS

Academy of Nutrition and Dietetics, 120S. Riverside Plaza, Ste. 2190, Chicago, IL, 60606-6995, (312) 899-0040, (800) 877-1600, amacmunn@eatright.org, http://www.eatright.org .

American Society for Nutrition, 9211 Corporate Blvd., Ste. 300, Rockville, MD, 20850, (240) 428-3650, Fax: (240) 404-6797, http://www.nutrition.org .

British Nutrition Foundation, New Derwent House, 69-73 Theobalds Rd., London, UK, WC1X 8TA, +44 20 7557-7930, postbox@nutrition.org.uk, http://www.nutrition.org.uk .

Center for Food Safety and Applied Nutrition, Food and Drug Administration, 5001 Campus Dr., HFS-009, College Park, MD, 20740-3835, (888) 723-3366, https://www.fda.gov .

Sarah Schenker

  This information is not a tool for self-diagnosis or a substitute for professional care.