by Marion Nestle

Currently browsing posts about: Diet-and-energy-drinks

May 3 2017

Do sweet drinks have anything to do with dementia? 

Two studies suggest—but most definitely do not prove—that they might.

A press release from Boston University says that daily consumption of either sugary or artificially sweetened drinks affect the brain.

Data from the Framingham Heart Study (FHS) has shown that people who more frequently consume sugary beverages such as sodas and fruit juices are more likely to have poorer memory, smaller overall brain volumes and smaller hippocampal volumes–an area of the brain important for memory. Researchers also found that people who drank diet soda daily were almost three times as likely to develop stroke and dementia when compared to those who did not consume diet soda.

The American Heart Association sent out its own press release on the stroke and dementia results. 

Framingham study participants who reported drinking one or more artificially sweetened beverage daily compared to less than one a week had almost three times the risk of developing either stroke or dementia.

The data are impressive.  This is the survival curve for dementia (the one for stroke looks much the same). Green = 0 drinks per week.  Red = 6 per week.  Blue = 7 or more per week.

Caveat: These are correlational studies showing an association between sweet drinks and loss of brain function.  They do not demonstrate that sweet drinks cause these problems—these could be due to some other dietary or behavioral factor.

As you might imagine, the studies got as lot of press attention.  One useful analysis comes from Business Insider:

First, both studies were done by some of the same researchers, including the lead scientist, Boston University neurologist Matthew Pase…For the sweet drinks and brain health research, the scientists drew from a large set of observational data taken from thousands of people from the town of Framingham, Massachusetts who were initially recruited beginning back in the 1940s as part of a study designed to learn more about heart disease called the Framingham Heart Study…of all the people in the study, the percentage of those who did go on to develop stroke or dementia was small — about 3% for stroke and about 5% for dementia.

The Guardian asks “Should link between dementia and artificial sweeteners be taken with a pinch of salt?”  It discusses some of the methodological issues, of which there are many.

The bottom line?  While waiting for researchers to sort all this out, water is an excellent choice.

Sugary drinks study

Diet drinks study


Sep 25 2011

Energy shots: what will marketers dream up next?

 A few months ago, the Committee on Nutrition of the American Academy of Pediatrics published  a position paper on sports and energy drinks in the diets of children and adolescents.

The committee distinguished sports from energy drinks:

Sports drinks: beverages that may contain carbohydrates, minerals, electrolytes, and flavoring and are intended to replenish water and electrolytes lost through sweating during exercise.

Energy drinks: also contain substances that act as nonnutritive stimulants, such as caffeine, guarana, taurine, ginseng, l-carnitine, creatine, and/or glucuronolactone, with purported ergogenic or performance-enhancing effects.

The operative word is “purported.”  The committee’s tough conclusion: 

The use of sports drinks in place of water on the sports field or in the school lunchroom is generally unnecessary.

Stimulant-containing energy drinks have no place in the diets of children or adolescents.

For the record, PepsiCo spent $113 million to market Gatorade in 2010 (says Advertising Age). 

The committee was concerned about the effects of high-dose caffeine on kids.  Although its report did not distinguish energy drinks from energy shots, its conclusion undoubtedly applies to those too.  Energy shots are more concentrated versions of energy drinks.

This is a big issue because pediatricians are concerned about the marketing of all of these caffeine-laden drinks to kids.   Marketers, the Nutrition Committee says, are pushing energy drinks to kids as low-calorie “healthier” alternatives. asked Red Bull, the leading energy shot seller, about its marketing practices.  The company denies marketing its shots to kids.

We do not market our product to children and other caffeine sensitive people…The authors of this report seem to be unaware that the American Beverage Association (ABA) and also the European Beverage Association (UNESDA) have already agreed codes of practice for the marketing and labelling of energy drinks.

Maybe, but energy shots are the new hot product, so hot that has just devoted a special report to them.  Sales are booming.  The only concern?  Can they continue?  Or, will they be replaced by the even hotter new thing: energy strips?

 Energy shots special edition: Flash in the pan or the runaway success story of the decade?  Cynics said they would never catch on. Who would cough up $2.99 for a mouthful of caffeine, taurine and vitamins when you can enjoy a coffee and a snack – or a whole can of your favourite energy drink – for the same price?.. Read 

Energy shot market still has significant growth potential, say researchers: While it might not be able to sustain its early “meteoric” growth rates, the energy shots market still has significant growth potential and can potentially target a far wider audience than energy drinks, market researchers have predicted… Read 

5-hour Energy increases grip on energy shots market: 5-hour Energy’s grip on the US energy shot market has tightened further in the past year, with the brand now accounting for nine out of every $10 spent in the burgeoning category… Read

 Hain Celestial scores industry first with refrigerated energy shot: Hain Celestial will break new ground in the burgeoning shots market this fall with the launch of the first refrigerated energy shot… Read 

Does the energy shot market have room for a new player?  A David vs Goliath battle is set to be waged in the US energy shots sector as two ex-Marines seek to carve out a niche in a market so competitive that even Red Bull has thrown in the towel and made a sharp exit… Read 

5-Hour Energy ramps up from seven to nine million bottles a week: 5-Hour Energy is now selling nine million bottles of its energy shots a week compared with seven million last year, a 28% rise in volume, the firm has revealed… Read 

Monster Energy maker: Continued growth of energy drinks ‘remarkable’: The US energy drinks sector is continuing to generate “quite remarkable” growth despite the depressing economic climate and high gas prices, according to the owner of Monster Energy drinks and Worx Energy shots… Read 

Red Bull cans energy shots and Cola in US (but not Europe): Global energy drink leader Red Bull has taken a rare step back by withdrawing Red Bull Cola and Red Bull Energy Shots from the US market – but says it has no plans to withdraw the products from the other 20 markets where they are sold… Read 

Entrepreneur: Energy strips could be worth $1bn in 3-5 years: The entrepreneur behind Sheets Energy Strips – novel dissolvable strips delivering an instant hit of caffeine and B vitamins – says the category could be worth $1bn in the next three-to-five years… Read

These products are about making a fortune selling potentially harmful beverages under the guide of “healthy” to anyone wanting a quick caffeine fix.

They are about marketing, not health.

Water anyone?


Feb 10 2011

Do diet sodas really cause stroke? I’m dubious.

I’ve been asked repeatedly this week to comment on the huge press outcry about a study that links diet sodas to an increased risk of stroke and heart disease.

I have not seen the study and neither has anyone else. It is not yet published.

It was presented at the American Stroke Association’s International Stroke Conference 2011.  The American Heart Association has a short summary on its website.  And Rosie Mestel has an excellent account in the Los Angeles Times.

Here’s what I can glean from the limited information available:

  • The study started in 2003.  It was designed to determine risk factors for heart disease and stroke in a multi-ethnic New York City population.
  • It used a food frequency questionnaire to ask about 2,500 people how often they drank diet sodas (among many other questions).
  • Nine years later, it assessed rates of stroke and heart disease.
  • The result: people who said they habitually drank diet sodas had a 60% higher rate of stroke and heart attacks.
  • They had a 48% higher rate when the data were controlled for contributing factors: age, sex, race, smoking, exercise, alcohol, daily calories, and metabolic syndrome.

That is all we know.

Does this study really mean that “diet soda may not be the optimal substitute for sugar-sweetened beverages for protection against vascular outcomes,” as the lead author is quoted as saying?

As Rosie Mestel puts it:

It’s worth noting, as some scientists did, that this is a link, not proof of cause and effect. After all, there are many things that people who slurp diet sodas every day are apt to do – like eat a lousy diet — and not all of these can be adjusted for, no matter how hard researchers try. Maybe those other factors are responsible for the stroke and heart attack risk, not the diet drinks. (Those who drink daily soda of any stripe, diet or otherwise, are probably not the most healthful among us.)

Leaving questions about the accuracy of dietary information obtained by questionnaire, the study raises more important questions:

  1. Could this finding simply be a statistical result of a “fishing expedition?”  The food frequency questionnaire undoubtedly asked hundreds of questions about diet and other matters.  Just by chance, some of them are going to give results that look meaningful.  The increase in stroke risk seems astonishingly high and that also suggests a need for skepticism.
  2. What is the mechanism by which diet sodas lead to stroke or heart disease?  I can’t think of any particular reason why they would unless they are a marker for some known risk factor for those conditions.

Please understand that I am no fan of diet sodas.  I don’t like the metallic taste of artificial sweeteners and they are excluded by  my “don’t eat” rule: never eat anything artificial.

But before I believe that this study means that artificial sweeteners cause cardiovascular problems, I want to see a study designed to test this particular hypothesis and a plausible biological reason for how diet sodas might cause such problems.

Dec 15 2009

Sodas, sweetened and not

The research demonstrating the not-so-great effects of sodas just pours in, as it were.  The Robert Wood Johnson Foundation has two new research reports, one on justification for taxation of soft drinks, and the other on the negative effects of soft drinks on kids’ health.

David Ludwig writes in JAMA that artificially sweetened drinks are unlikely to help the situation.  They just make people want sweeter foods.

And the New York City Health Department has put its anti-soda campaign online.   This is its controversial “drinking fat” campaign designed to make the point that excess calories from sugary soft drinks will put on the pounds.  Why controversial?  Take a look at the cute guy demonstrating the drinking-fat point on the YouTube video.

What’s your take on this?

May 22 2008

Baskin-Robbins’ Heath Bar shake: yum?

Thanks to Hugh Joseph for alerting me to this remarkable beverage from Baskin-Robbins: a large “Heath Shake.” This energy drink weighs in at 2310 calories and, according to his count (I didn’t bother), 73 ingredients! Unless this is a joke? I can never tell with the Internet…

Feb 10 2008

The diet soda puzzle

Diet sodas, which are just water plus one or more artificial sweeteners, ought to save tons of calories and help people manage weight and metabolic imbalances, right? You might think so, but that’s not how the research is turning out. A big, complicated study of the effects of diet on “metabolic syndrome” (meaning multiple risk factors for heart disease, diabetes, etc) finds diet soda to be one of the factors associated with predisposition. OK. The study was based on food frequency questionnaires and other results are also hard to interpret but this isn’t the first study to find diet sodas coming out on the wrong side. The artificial sweeteners might be at fault but my guess is that diet sodas are a marker for some of the less healthful dietary practices. You know my rule from What to Eat: never eat anything with anything artificial in it.

Jan 22 2008

Pepsi’s energy drink for the masses

Thanks to Ellen Fried for sending the latest info on energy drinks. I will never cease to be amazed by the money and effort that goes into designing “energy drinks,” in quotes because energy comes from calories and that usually means sugars of one kind or another accompanied by lots of caffeine.

So here’s Amp, in line to become PepsiCo’s “energy drink of the masses” or at least  “goal-oriented males 18-34.” Would you like to see what $10 million in advertising buys? Take a look. One of the draws will be a line extension of the drink that contains L-theanine. This compound, new to me, is an amino acid of some kind, but one that has nothing to do with body proteins.  It is something found in tea leaves. Will it give those guys energy? Only if they think so.

Ellen also points out that kids with $199 can buy Mountain Dew and Amp jackets. Cool.

Aug 19 2007

Do Artificial Sweeteners Induce Sugar Cravings?

This is an interesting follow-up question on post #83: Diet Sodas and Metabolic Risks: “I have heard that the intense sweet flavor of artificial sweeteners signals the body that there are a lot of carbohydrates coming. Since the diet soft drink provides none, a craving for them may be stimulated – hence the weight gain associated with sodas, diet or not. Have you heard this explanation before?”

Indeed, I have. I’ve seen a couple of studies suggesting that artificial sweeteners encourage the taste for sweet. I think these are preliminary and need further confirmation but the idea is consistent with trends. As I explain in the chapter on diet drinks in What to Eat, rates of overweight have risen in parallel with the increase in use of artificial sweeteners, so on a population basis, the chemicals don’t seem to do any good for weight trends. Individuals may find them helpful to control calorie intake, but on average most people seem to compensate–and overcompensate–for calorie savings from artificial sweeteners. After all, a teaspoon of sugar is only 16 calories and it doesn’t take much to compensate. When it comes to food, I don’t like anything artificial and I don’t like the way artificial sweeteners taste, so they are pretty low on my recommended list. I much prefer sugar, especially the brown crystalline kind.