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The Bitter Side of Sugar, Substitutes, SSBs and Sports Drinks: Essential or Avoidable?

Director Cardiology, Fortis Escorts Hospital
Feb 10, 2019 5:32 AM 5 min read

How do Energy Drinks like Monster, and sugar free drinks like Diet Coke measure up as fitness drinks? Are they a “must-have” or just overhyped marketing stunts?


Sugar is often regarded as one of the most addicting, as well as harmful substances available to mankind. High intake of sugar is often associated with obesity, and related lifestyle diseases like diabetes, heart disease, high triglycerides, high blood pressure, dementia and even cancer. An average American consumes over 100 pounds of sugar in a year, highlighting the urgent need for recognition of this risk (US tops the list of per capita sugar consumption globally, followed by Germany and Netherlands). India finds itself at at the bottom of these sugar consumption charts, which could probably be attributed to the fact that a large chunk of the population living in villages does not have access to sugar-sweetened beverages (SSBs) or desserts.

The Bitter Side of Sugar, Substitutes, SSBs and Sports Drinks: Essential or Avoidable?


Largely, our continued obsession with the sweet taste stems from the myth that sugar calories are nothing but “empty calories”, a rather benign indulgence. Nothing could be further from the truth.


A study in Circulation 2015 estimated the number of deaths attributed to consumption of sugar-sweetened beverages (colas, sweetened juices, energy drinks, etc.) alone at approximately 184,000 in the year 2010, nearly 3/4th of it due to diabetes and the rest due to heart disease and cancer. Now add into the mix cakes, pastries, pies, sweets, ice creams, cereals, sweetened yogurts, and other sugar-laden goodies. The impact is mind-boggling. Hence it comes as no surprise that we not only continue to hog on these foods, we addict our kids to sugar as soon as they can eat or drink anything other than mother’s milk.


The addiction potential of sugar is linked to brain reward mechanisms. Rats are likely to work much harder to get sugar rather than cocaine. Leading health organizations such as the WHO recommend restricting added sugars in diet to under 10% of total calories consumed per day (6 tsp per day for females, 9 tsp for males). Presently, the average American eats over twice as much daily. These recommendations are based on the fact that reducing consumption or avoiding sugars altogether have shown beneficial changes in the blood pressure, body weight, blood sugar and lipid levels.


It’s also necessary to understand that sweets aren’t our sole source of sugars. These have invaded all modern diet - found in most unexpected foods such as soups, sauces, ketchup, crackers, and even in bacon and most salad dressings. And despite the prevalent belief that sugar doesn’t lead to diabetes, the occurrence of diabetes has gone up 4 times globally from 1980 to 2015, 1980 being the year when US Govt. Restricted saturated fats and promoted a compensatory increase in carbohydrate intake.


The Bitter Side of Sugar, Substitutes, SSBs and Sports Drinks: Essential or Avoidable?


Realizing the adverse effects of added sugars, sugar substitutes were welcomed with open arms by the people as well as the Food industry. There are around five approved substitutes including saccharin, acesulfame, aspartame (Equal), sucralose (Splenda) and stevia. The first influence of these agents is to make one hungrier, with people consuming Diet Cokes ending up eating more than those drinking Coke. Sweeteners like these are known to worsen insulin resistance- increasing the risk for developing diabetes, they may be carcinogenic, and could even disrupt the normal gut microbes. Furthermore, they cause neurologic imbalances leading to hyperactivity, sleep disturbances and glucose intolerance. Studies done by independent researchers (i.e., not funded by industry) found no proof to suggest significant weight loss with the use of artificial sweeteners. Acceptable sweeteners include limited amounts of stevia, date sugar, maple syrup and honey.


The next question is: What is the best beverage then, considering the ill effects of sugar and its substitutes?


The answer is of course, plain clean water. Perhaps the best source would be an RO plant installed in your kitchen.


But as people get tired of drinking water, we need to know about other safe beverages. Black or green tea are probably the best. They have a great flavor, and are loaded with healthy anti-oxidants. Additionally they carry no calories if taken without milk and sugar. 


The Bitter Side of Sugar, Substitutes, SSBs and Sports Drinks: Essential or Avoidable?


Once considered harmful, coffee has seen a resurgence of late. Its consumption has been associated with health benefits like reduction in heart disease, dementia, cancers and in some cases even improved survival. Coffee is the largest source of anti-oxidants for the average American. However, it has large amounts of caffeine (a stimulant), usually with big helpings of milk and sugar, adding to its calorie content (the average Starbucks cappuccino without sugar has 120 kcal, while a latte has 190 and a mocha 290; cold coffees are even worse). So while coffee is not a health hazard as it was once feared, it’s also not a source of healthy nutrition either, a reasonable consumption (1-4 cups a day) is advised.


Fruit juices aren’t any different either. They lack the useful fiber found in fruits, have a much higher glycemic index and glycemic load, and are likely to cause high triglycerides, uric acid, body weight and visceral fat, if consumed in large amounts regularly. It’s much better to consume fruits instead.


Sports drinks are another great myth. Red Bull is the king of all energy drinks, with an estimated 6.8 billion cans sold worldwide in 2018. It contains caffeine, taurine, sucrose and other chemicals. Its competitors Mutant has over twice as much sugar, while Gatorade has much higher quantities of sodium. To put it simply, these provide a kick which is not really needed by most athletes. But these companies use extensive marketing-even having competitions named after their energy drinks in order to create a huge brand, leading to unnecessary consumption.


In summary, sugar is best avoided, as are sweeteners: water is the best beverage for most people who exercise and definitely for those who don’t. Among others, black/green tea is the best, followed by coffee (both unsweetened). Sports drinks are over-hyped. There is no evidence to prove their benefits, and instead add several potentially toxic chemicals to our diet.


This is a recurring column published every Sunday under the title: What is Nutrition.


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