My article here is a translation, for the layperson, of the medical article, “Soft Drink Consumption and Risk of Developing Cardiometabolic Risk Factors and the Metabolic Syndrome in Middle-Aged Adults in the Community” *

Although it may not make any sense, diet soda may contribute to the development of diabetes. This study did not look at diabetes specifically, but looked at “Metabolic Syndrome.” Some of you may remember Metabolic Syndrome as “Syndrome X”. The name was changed a few years ago.

Metabolic Syndrome is a cluster of metabolic abnormalities: 1) prediabetes or diabetes, 2) large waist size (dreaded belly fat) 3) hypertension or prehypertension, 4) high triglycerides (a form of fat in the blood) and 5) low HDL (HDL is good cholesterol). Someone with 3 of the 5 abnormalities is considered to have Metabolic Syndrome. All the components run together: diabetes, hypertension and a bad cholesterol profile. They are part of the same disease process. People with Metabolic Syndrome are at high risk, over time, to suffer heart attacks and strokes.

In order to answer the question of whether diet soda is associated with Metabolic Syndrome, the authors looked at people participating in the Framingham Offspring Study. You may remember the original Framingham Study: people living in Framingham, Massachusetts were followed for years starting in 1948, to look at risk factors for heart disease. The Framingham Offspring Study is following the children of the original Framingham Study volunteers.

The researchers weren’t only looking at diet soda in this study. They were looking at regular and diet soda both, as well as other risk factors for Metabolic Syndrome. To answer the soda question, people were asked to estimate their daily soda consumption for the prior year on a questionnaire. The researchers looked at the question of diet versus regular soda through a separate questionnaire called a “Food Frequency Questionnaire”. These Food Frequency Questionnaires ask people to document everything they eat or drink for a few days in a row.

As you can imagine, when you have so many volunteers, and so much data from the various questionnaires, the numbers were sliced and diced in a variety of ways. In broad brush-strokes, soda is associated with the development of Metabolic Syndrome, regardless of whether the soda was regular or diet.

Let’s look at the data more carefully. If you just do a cross-sectional slice, there was 48% more Metabolic Syndrome in those who drank one or more soft drinks every day when compared to those who drank less than one a day. Cross-sectional studies are when you take the next 100 people walking down the street, and count how many have Metabolic Syndrome. Cross-sectional studies give you numbers on prevalence. Metabolic Syndrome is 48% more prevalent in frequent soda drinkers than in infrequent soda drinkers.

Next, let’s look at “incidence”. Take the next 100 people walking down the street and follow them for 4 years to see how many develop Metabolic Syndrome. The 4-year incidence (the chance of developing Metabolic Syndrome over 4 years) is 44% percent higher in soda drinkers. That 44% number was in the news. Impressive! If you look at the actual numbers, it is not so impressive: 18.7% versus 22.6% I was actually surprised that the risk over time was so low, until reading the article more carefully. First of all, from the original 5000 offspring in 1971, 900 were excluded from this study because they already had cardiovascular disease. Of the remainder, 1/3 of the volunteers were excluded from the study because they already had Metabolic Syndrome. Close to half of the initial volunteers were excluded from the study because they already had Metabolic Syndrome!

What this tells me is the risk of developing Metabolic Syndrome is much higher than 22.6%. No one starts drinking soda at age 50. It starts much earlier. Then all those soda-drinkers are excluded from the analysis because they already developed Metabolic Syndrome. This study underestimates the risk of developing Metabolic Syndrome from soda.

Regardless of whether the risk is underestimated, soda, diet and regular, is associated with the development of Metabolic Syndrome.

The researchers had a few ideas as to why this is so. Regular soda is obvious. Extra calories leads to weight gain which leads to Metabolic Syndrome. Sweet liquids don’t turn off our hunger center in the brain the way food does. Plus, there may be something about high fructose corn syrup, which our body can’t digest as well, so it causes more metabolic abnormalities than cane sugar. Diet soda is not so obvious as to why it is associated with the development of Metabolic Syndrome. One theory is called “conditioning”. From drinking sweet drinks all day long, our bodies become accustomed to the sweet flavor and when it is time to eat food, we go for sweets. You know this is true. Think of all your lucky friends who don’t have a taste for sweets, and your other friends with a sweet tooth. To digress a moment, I read an article about the CEO of Applebee’s. She said that through the years, they have needed to change the recipes for their desserts. They can’t make desserts sweet enough to satisfy their customers!

Another theory has to do with something called advanced glycation end products (AGE’s), which are in the caramel coloring of cola’s. AGE’s may be involved in the development prediabetes. See the separate article on AGE’s coming soon. Reducing AGE’s in your diet is important, especially for diabetics.

Lastly, the researchers noticed that the soda drinkers were not as health-conscious as their non-soda-drinking counterparts. The soda drinkers tended to eat more calories, more saturated fat, more trans-fats, and were more likely to smoke. The researchers adjusted their numbers to account for the fats, and the calories and the smoking. Even then, whether diet or regular, soda was strongly associated with the development of Metabolic Syndrome.

Whatever the reason, the advice is clear. Don’t drink soda. Don’t drink regular soda. Don’t drink diet soda.

* Dhingra R, et al. Soft Drink Consumption and Risk of Developing Cardiometabolic Risk Factors and the Metabolic Syndrome in Middle-Aged Adults in the Community, Circulation 2007; 116; 480-488

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