Brace yourself, lovers of diet sodas and sugary drinks. It's more bad news and yet another reason to consider ditching your favorite soda or soft drink.
A new study followed more than 450,000 people from 10 European countries for up to 19 years and found those who drank two or more glasses of any type of soda a day had a higher risk of dying from any cause of death than people who drank less than a glass each month. None of the people had cancer, diabetes, heart disease or stroke before their participation.
The study, published Tuesday in the journal JAMA Internal Medicine , found men and women who drank two or more glasses a day of sugar-sweetened soft drinks had a higher risk of dying from digestive disorders, while those who drank the same amount of diet drinks had higher risks of dying from cardiovascular disease.
The link to digestive disease in the study is interesting, said Dr. Sharon Horesh Bergquist, an assistant professor of medicine at Emory University School of Medicine in Atlanta.
"Experimental evidence suggests that high blood sugar and high sugar intake can impair the gut barrier, leading to a 'leaky gut' and access to the gut immune system causing intestinal inflammation, alter gut microbiota and increase susceptibility to gut infections," she said. "These pathways may increase susceptibility to digestive diseases."
Total soft drink consumption in the study was also associated with an increased risk for Parkinson's disease, but not with Alzheimer's or cancer.
Soft drinks were defined as "low calorie or diet fizzy soft drinks", "fizzy soft drinks," such as cola and lemonade, and "fruit squash or cordials," which are non-alcoholic concentrated syrups typically mixed with sugar and water. In this study, one glass of soft drink was 8 fluid ounces, or 250 milliliters; the typical can of soda around the world holds 12 fluid ounces or 355 milliliters
The end of a love affair?
This large, long-term study is yet another in a growing list of research that is sounding the alarm on our love affair with carbonated soft drinks.
In February, the American Heart Association released a study that found drinking two or more of any kind of artificially sweetened drinks a day is linked to an increased risk of clot-based strokes, heart attacks and early death in women over 50. The risks were highest for women with no history of heart disease or diabetes and women who were obese or African-American.
In March, a study published in the journal Circulation used data from 80,500 women enrolled in the Nurses' Health Study and nearly 40,000 men from the Health Professionals study. It found that women who drank more than two servings a day of sugary beverages -- defined as a standard glass, bottle or can -- had a 63% increased risk of premature death compared to women who drank them less than once a month. Men who did the same had a 29% increase in risk.
Those who consumed more than one sugary beverage per month but fewer than two per day seemed to experience a dose effect: The more they drank, the greater the risk.
Substituting one sugary beverage per day with an artificially sweetened one was found to lower the risk of premature death, but drinking four or more artificially sweetened beverages increased the risk of premature death from cardiovascular disease in women. The same effect was not seen for men, and it was not seen for the risk of dying from cancer.
While the studies above didn't see an association between soft drinks and cancer, another study published in the BMJ in July did . The research followed more than 100,000 French adults and found drinking just a small glass of a sugary drink per day -- 100 ml, about a third of a typical can of soda -- to an 18% increase in overall cancer risk and a 22% increase in risk for breast cancer.
Only an association
This study, as well as other research on the connection between diet and sugary beverages and health risks, is observational and cannot show cause and effect. That's a major limitation, researchers say, as it's impossible to determine whether the association is due to a specific artificial sweetener, a type of beverage, obesity or another hidden health issue.
"The cause behind these associations isn't clear," said Bergquist. "Other potential biological causes could be attributed to experimental evidence linking consumption of artificial sweeteners to sugar cravings, appetite stimulation and glucose intolerance."
Robert Rankin, president of the Calorie Control Council, a trade group for low-calorie and diet foods and beverages, said in a statement that "low- and no-calorie sweeteners have a long safety record and are important tool for weight management and those managing diabetes. This study paints an inaccurate picture of the important role of these products for consumers.
Surviving a broken heart
Association or not, you've decided to end the fling with your soft drink du jour (and avoid future infidelities). Good for you, literally. Here are some tips on how to do it with the least heartache.
Cut back correctly
Going cold turkey is tough and may set you up for failure. Instead, registered dietitian and CNN contributor Lisa Drayer suggests a gradual approach.
"Cut back by one serving per day until you're down to one drink per day," Drayer said. "Then aim for one every other day until you can phase out soft drinks entirely.
"Alternate with seltzer/sparkling water can help you cut back," she added. "Eventually you can replace soft drinks with seltzer or sparkling water if you are craving carbonation."
Find a different fizz
Speaking of carbonation, for a lot of folks, the fix is the fizz. Find a carbonated seltzer water or mix a healthy fruit alternative with sparkling water. You can't go wrong with blueberry or pomegranate juice, said registered dietitian and nutritionist Rahaf Al Bochi, a spokesperson for the Academy of Nutrition and Dietetics.
"The recommendation for fruit juice is usually 4 ounces a day, Al Bochi said.
One caution: Try to drink your bubbly with food, not alone, experts advise. Any type of carbonated water can erode the enamel on your teeth . That's because the carbon dioxide that turns water bubbly turns into carbonic acid in the mouth, which can be detrimental to the health of your teeth.
Stomp the sweet tooth
Bergquist suggests satisfying your sugar cravings by substituting naturally sweet foods such as fruits and dates, which contain "health-promoting vitamins, minerals and bioactive chemicals called phytonutrients."
"They package sugar with fiber which leads to a slow and steady, rather than sharp, rise in blood sugar," Bergquist said.
She also suggests committing to a no-sugar challenge for at least two weeks.
"Our taste buds turn over every two weeks," she said. "That means that if you can get past the intense sugar cravings the first two weeks, your taste buds will adjust to find natural foods with sugar more satisfying."
Hinder the habit
We are creatures of routine and ritual. Just like when a person might crave smoking (say after eating), figure out what your habitual trigger is and try to replace it. Bored at your desk? Call a friend before you reach for a soda.
Counter the caffeine
If you've not been drinking caffeine-free soda, then a good part of your addition to that soft drink is the caffeine buzz you're getting. Try substituting green or black tea instead, Al Bochi said.
"You'll get the caffeine boost you're looking for without the added sugar and you'll also be getting a good dose of antioxidants," she added.
"Herbal teas like hibiscus, passion fruit, berry, peppermint are flavorful and pleasing without contributing any sugar or calories," suggested Drayer.
Woo the water
Carry a water bottle with you or have a pitcher of ice cold water near your desk. If it's easily accessible to you, you are more likely to grab the water than a sugary beverage.
If you're not a fan of plain water, Drayer suggested adding a little sparkle.
"Try infusing fruit into water -- you can purchase a pitcher, fill it with water, then add slices of oranges, lemons, strawberries, watermelon or whatever fruit you like so the water will become infused with the fruit flavor and provide sweetness to your palate," she said.
Embrace the effort
And finally, allow yourself a slip now and then.
"Remember that drinking a sugary beverage every once in a while will not directly cause adverse health effects," said Al Bochi. "Providing yourself permission to enjoy all beverages while being mindful with how it fits into your overall healthy eating pattern is the key to a healthy relationship with food."