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You are what you drink

By Jane Brody
NY TIMES NEWS SERVICE, NEW YORK
Saturday, Mar 31, 2007, Page 9

What worries you most? Decaying teeth, thinning bones, heart disease, stroke, diabetes, dementia, cancer or obesity? Whatever tops your list, you may be surprised to know that all of these health problems are linked to the beverages you drink -- or do not drink.

Last year, with the support of the Unilever Health Institute in the Netherlands (Unilever owns Lipton Tea), a panel of experts on nutrition and health published the Beverage Guidance System in hopes of getting people to stop drinking their calories when those calories contribute little or nothing to their health and may actually detract from it.

The panel, led by Barry Popkin, a nutrition professor at the University of North Carolina, was distressed by the burgeoning waistlines of people in the US and the contribution that popular beverages make to weight problems.

But the experts also reviewed 146 published reports to find the best evidence for the effects of various beverages on health. I looked into a few others, and what follows is a summary the combined findings.

Topping the list of preferred drinks is -- you guessed it -- water. No calories, no hazards, only benefits. But the panel expressed concern about bottled water fortified with nutrients, saying that consumers may think they do not need to eat certain nutritious foods, which contain substances like fiber and phytochemicals lacking in bottled water (you can just imagine what the panel would have to say about vitamin-fortified sodas, which Coca-Cola and Pepsi plan to introduce in the coming months).

About 21 percent of calories consumed by people in the US over the age of 2 come from beverages, predominantly soft drinks and fruit drinks with added sugars, the panel said in its report. There has been a huge increase in sugar-sweetened drinks in recent decades, primarily at the expense of milk, which has clear nutritional benefits.

The calories from these sugary drinks account for half the rise in caloric intake since the late 1970s.

Not only has the number of servings of these drinks risen, but serving size has ballooned as well, as have free refills.

Add the current passion for smoothies and sweetened coffee drinks (there are 240 calories in a half-liter Starbucks Caffe Mocha without the whipped cream), and you can see why people are drinking themselves into XXXL sizes.

But calories from sweet drinks are not the only problem.

The other matter cited by the panel, in its report in The American Journal of Clinical Nutrition, is that beverages have "weak satiety properties" -- they do little or nothing to curb your appetite -- and people do not compensate for the calories they drink by eating less.

Furthermore, some soft drinks contribute to other health problems. The American Academy of General Dentistry says that non-cola carbonated beverages and canned (sweetened) iced tea harm tooth enamel, especially when consumed apart from meals.

A study of 2,500 adults in Framingham, Massachusetts, also linked cola consumption (regular and diet) to the thinning of hip bones in women.

If you must drink something sweet, the panel suggested a no-calorie beverage like diet soda prepared with an approved sweetener, though the experts recognized a lack of long-term safety data and the possibility that these drinks "condition" people to prefer sweetness.

Fruit juices are also a sweet alternative, although not nearly as good as whole fruit.

With coffee, tea and caffeine, the news is better. Several good studies have linked regular coffee consumption to a reduced risk of developing Type 2 diabetes, colorectal cancer, and, in men as well as women who have not taken postmenopausal hormones, Parkinson's disease.

Most studies have not linked a high intake of either coffee or caffeine to heart disease, even though caffeinated coffee raises blood pressure somewhat and boiled unfiltered coffee (French-pressed and espresso) raises harmful LDL and total cholesterol levels.

Caffeine itself is not thought to be a problem for health or water balance in the body at levels up to 400mg a day, the amount in a bit less than a liter of brewed coffee. But pregnant women should limit their intake because more than 300mg per day might increase the risk of miscarriage and low birth weight, the panel said.

Mice prone to an Alzheimer's-like disease were protected by drinking water spiked with caffeine equivalent to what people get from five cups of coffee per day. A study of more than 600 men also suggested that drinking three cups of coffee a day protects against age-related memory and thinking deficits.

For tea, the evidence on health benefits is mixed and sometimes conflicting. Tea has been shown in experiments to lower cancer risk in animals, but the effects in people are unknown. It may benefit bone density and help prevent kidney stones and tooth decay. And four or five cups of black tea daily helps arteries expand and thus may improve blood flow to the heart.

Alcohol is a classic case of "a little may be better than none, but a lot is worse than a little."

Moderate consumption -- one drink a day for women and two for men -- has been linked in many large, long-term studies to lower mortality rates, especially from heart attacks and strokes, and may also lower the risk of Type 2 diabetes and gallstones.

The panel found no convincing evidence that one form of alcohol, including red wine, was better than another.

However, even at moderate intakes, alcohol raises the risk of birth defects and breast cancer, possibly because it interferes with folate, an essential B vitamin. And heavy alcohol consumption is associated with several lethal cancers, cirrhosis of the liver, hemorrhagic stroke, hypertension, dementia and some forms of heart disease.

When it comes to dairy and soy drinks, my reading of the evidence differs slightly from that of the panel, which rated low-fat and skim milk third, below water and coffee and tea, as a preferred drink and said dairy drinks were not essential to a healthy diet. The panel acknowledged the benefits of milk for bone density, while noting that unless people continue to drink it, the benefit to bones of the calcium and vitamin D in milk is not maintained.

Other essential nutrients in milk include magnesium, potassium, zinc, iron, vitamin A, riboflavin, folate and protein -- about 8g in a 250mg glass.

A 10-year study of overweight individuals found that milk drinkers were less likely to develop metabolic syndrome, a constellation of coronary risk factors that includes hypertension and low levels of protective HDLs.

To me, this says you may never outgrow your need for milk.

The panel emphasized the need for children and teenagers to drink more milk and fewer calorically sweetened beverages.

"Fortified soy milk is a good alternative for individuals who prefer not to consume cow milk," the panel said, but it cautioned that soy milk cannot be legally fortified with vitamin D and provides only 75 percent of the calcium the body obtains from cow's milk.
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