WHAT ARE SUGAR-SWEETENED BEVERAGES?

Quenching thirst with something smooth and sweet like soda, coca cola, or juice can be very satisfying, especially when thirsty. Sugar-sweetened beverages (SSBs) have become increasingly popular worldwide over the past few decades. SSBs are non-alcoholic beverages that contain added caloric sweeteners such as sucrose (table sugar), high-fructose corn syrup, or other forms of sugar.

However, some authorities have developed more specific definitions based on sugar content per volume, which have been used for regulatory initiatives. For example, the New York City Board of Health defines SSBs as having ≥25 calories or 6.25 g of added sugar per ~237 ml, whereas in the UK, the definition for taxation is ≥5 g of added sugar per 100 ml.  These beverages are widely available in many forms, such as soda, energy, sports, fruit, and sweetened tea or coffee.

SSB may offer a unique and dangerously easy mechanism of sugar ingestion. For example, one 360 ml serving of soda contains about 36 grams of sugar. Daily ingestion of that one serving could add five pounds of weight gain in one year if the diet does not accommodate any additional sugar load.

Trends of a plateauing of SSB intake have been observed in high-income countries. By contrast, the intake of SSBs is increasing in many low-income and middle-income countries (LMICs) as widespread urbanization and economic development have increased their availability. However, high SSB consumption has been linked to various adverse health outcomes, including obesity, type 2 diabetes, cardiovascular diseases, and dental caries.

HOW DANGEROUS IS SUGAR-SWEETENED BEVERAGE TO ONE’S HEALTH?

Obesity is one of the most prominent health problems associated with SSB consumption. Several studies have found a significant association between SSB consumption and weight gain or obesity, particularly in children and adolescents. The increasing prevalence of obesity has paralleled the rising intake of sugar-sweetened beverages.

For example, a longitudinal study of over 5,000 children in the United States found that those who consumed SSBs regularly had a significantly higher risk of becoming overweight or obese than those who did not consume SSBs. Similarly, a systematic review and meta-analysis of 88 studies concluded that higher intake of SSBs was significantly associated with weight gain and increased risk of overweight and obesity.

SSBs add calories to the diet, and adjusting for total energy intake is equivalent to assessing SSB-induced effects on body weight independent of total energy intake. Studies found that each serving per day increment of SSB consumption was associated with a weight gain of 0.12 kg (0.26 lb.) within a year among adults and an increase in BMI of 0.05 kg/m2 within a year among children.

The association between SSB and body weight gain is supported by dietary intervention studies in which subjects exhibited increased body weight when they consumed SSB. Some suggest this relationship is not unique to SSB and is simply the consequence of consuming any source of palatable energy in excess.

Yet, for more than 20 years, it has been generally accepted that there is a causal relationship between SSB and body weight gain mediated by the homeostatic system’s failure to recognize the energy in SSB. This results in inadequate satiation, decrease consumption of other foods to compensate for the SSB energy and weight gain. SSB may have a unique role in activating brain reward centers compared with other foods. Its position in the obesity crisis may involve being one of our hyper-palatable food environment’s most available, popular, and promoted components.

It has been proposed many times that sustained SSB consumption may promote body weight gain because energy-containing beverages elicit inadequate dietary compensation. Dietary energy compensation is the adjustment of energy intake produced by the previous ingestion of energy as a drink, snack, or meal.

In the context of SSB intake, a failure to compensate is the failure to adjust for the SSB energy consumed as prior snacks or with last meals, resulting in energy intake that exceeds the daily requirement. Sustained failure to compensate fully for the energy in SSB, without significant adjustments to physical activity, ultimately leads to weight gain.

In addition to obesity, a high intake of any drink filled with added sugar puts much stress on the liver causing liver diseases.  A study by Papadopoulos et al. (2023) published in the Journal of Metabolism in Elsevier concluded that High-Fructose Corn Syrup (HFCS), a sweetener rich in glucose and fructose, is nowadays widely used in beverages and processed foods; its consumption has been correlated to the emergence and progression of Non-Alcoholic Fatty Liver Disease (NAFLD). This conclusion was supported by a separate study that appeared in Nutrients Journal and found that drinking soda, energy drinks, and heavy juices in sugar increased the risk of developing nonalcoholic fatty liver disease.

Consuming too much sugar can lead to sugar addiction, a recognized mental health side effect that can seriously affect physical health. Sugar addiction is linked to the overconsumption of sugary foods and drinks, leading to the accumulation of sugar in the bloodstream. When we eat sugar, the brain releases dopamine, a neurotransmitter associated with pleasure and reward. This process reinforces the behavior, making us want to eat more sugar to experience the same pleasurable sensation.

Over time, the brain can become desensitized to dopamine, leading to a need for even more sugar to achieve the same effect. This vicious cycle can lead to an addiction to sugar, with individuals experiencing intense cravings, withdrawal symptoms, and difficulty controlling their sugar intake. Such a phenomenon can profoundly affect mental health, leading to depression, anxiety, and other mood disorders, further highlighting the importance of limiting sugar intake for a healthy mind and body.

Type 2 diabetes is another serious health issue linked to SSB consumption. A meta-analysis of 17 prospective studies involving over 300,000 participants found that higher consumption of SSBs was associated with an increased risk of developing type 2 diabetes. The high sugar content in SSBs is believed to contribute to insulin resistance, a complex condition in which the body does not respond adequately to insulin, a hormone secreted by the pancreas with an essential role in the regulation of blood sugar levels and can lead to the development of type 2 diabetes over time.

Cardiovascular diseases like heart disease and stroke have been linked to SSB consumption. Recent research has explored the association between SSB consumption and cardiovascular diseases (CVD). A meta-analysis of prospective studies involving more than 200,000 participants found that higher consumption of SSBs was significantly associated with an increased risk of coronary heart disease.

Another systematic review and meta-analysis of 22 studies found that SSB consumption was associated with higher levels of blood pressure, total cholesterol, triglycerides, and LDL cholesterol, all risk factors for cardiovascular diseases. Research has shown that SSB consumption is positively associated with CVD worldwide and has been reported to contribute to cardiometabolic-related deaths significantly.

Although much uncertainty remains as to the mechanisms responsible for the link between SSB consumption and CVD, some studies evaluating potential tools, such as vascular function, coronary artery calcification, triglyceride involvement, inflammatory processes, changes in arterial wall compliance, and genetic variation, present compelling information for review and possibly highlight future research opportunities.

Regular consumption of sugar-sweetened soft drinks is linked to a significantly increased risk of developing gout, a type of arthritis caused by a buildup of uric acid crystals in the joints. People who consume two or more servings of sugary drinks daily have an 85% higher risk of developing gout than those who consume less than one serving per month.

These findings highlight the negative impact of sugary drinks and high fructose intake on joint health and underscore the importance of reducing their consumption.

Leptin Resistance is another side effect of consuming too many sugar-sweetened beverages. Leptin resistance is a conversation many people have yet to hear about leptin’s role in the human body. Leptin comprises many chemicals that also normalize the immune system and metabolism.  According to the British Journal of Nutrition, consuming too much sugar significantly contributes to leptin resistance, which has detrimental effects on the immune system and metabolism.

Leptin is a hormone that controls hunger and body weight. Obesity interferes with its production and processing. This emphasizes how crucial it is to cut back on sugar if you want to keep your metabolism and immune system functioning normally.

Pancreatic Cancer is another effect SSB caused due to the stress the pancreas goes through to process all the excess sugars the body doesn’t need.  A prospective cohort analysis examined the association between soft drink and juice consumption and the risk of pancreatic cancer in 60,524 Singapore Chinese Health Study participants.

Over 14 years, it found that individuals who consumed two or more soft drinks per week had almost twice the risk of developing pancreatic cancer compared to those who did not consume any soft drinks. The study took into account other factors that could have affected the results. These findings highlight the potential dangers of consuming sugary drinks and the importance of reducing their intake to improve overall health.

Studies suggest that the high sugar content in soft drinks may lead to increased insulin resistance and elevated levels of insulin in the body, which could promote the growth of cancer cells. Additionally, soft drinks may contain other potentially harmful ingredients, such as artificial sweeteners and preservatives, that could also affect cancer development.

Finally, SSBs are also known to cause dental caries because they contain large quantities of sugar and are highly acidic. The high sugar content in SSBs promotes the growth of bacteria in the mouth, which can lead to tooth decay and cavities. Among many consequences, these conditions may lead to pain, discomfort, disfigurement, acute and chronic infections, eating and sleeping disruption, and higher risk of hospitalization, high treatment costs, and lost work/school days. The World Health Organization has estimated that dental caries affects between 60% and 90% of school children and most adults. For children, caries affects nutrition, growth, and weight gain.

IN A NUTSHELL?

In conclusion, there is strong evidence linking the consumption of SSBs to a range of adverse health outcomes; obesity, type 2 diabetes, cardiovascular diseases, and dental caries. Public health campaigns aimed at reducing SSB consumption should be enforced while promoting healthier alternatives such as water, unsweetened tea, and low-fat milk should be enforced.

WHO’s Global Action Plan for NCDs recommends restrictive regulations or mandatory limits on food sugar content using fiscal policies, such as taxing sugar-sweetened beverages; revenue from taxation should be used for Health Promotion activities and food marketing regulations, such as an obligatory nutrient declaration by manufacturers, promoting healthier foods for older infants and young children. It is believed that implementing such policies to regulate the food environment will bring a lot of gains in achieving a healthier food environment.

The Advocating for Health (A4H) Coalition, a team of Public Health Advocates consisting of Academia, Civil Society Organizations, Public Health Associations, and Nutrition/Dietetic Professional Groups, has recognized the urgent need to create a favorable environment and garner stakeholder support for food-related fiscal policies especially sugar tax in Ghana.

Source: Dr. Charles Apprey-Nutritional Biochemist

Department of Biochemistry and Biotechnology, KNUST

appreycharles@gmail.com/capprey.cos@knust.edu.gh

Email: info@advocating4health.org

Twitter: @A4H_Project