In 2006, Australia was ranked internationally in the top 10 countries per capita for soft drink consumption.1 The dramatic increase in soft drink consumption in recent times has generated concern from all medical disciplines. 2,3 Recently, research presented to the Public Health Association of Australia during an annual conference illustrated that one fifth (22%) of West Australian adults are consuming soft drinks daily. Within this group, consumption of only diet soft drinks or standard and diet beverages combined was found at 12.5% and 1.4% respectively. Studies conducted within West and South Australia found that roughly half of those soft drink consumers had on average half a litre daily,4 as well as greater soft drink consumption from men than women.5
The principal source of sugar in Australians’ diets comes from sugar based beverages (e.g. fruit juices and soft drinks). The worst of these beverages may contain up to 10 teaspoons (40g) of sugar per serving.6,7 Research in recent years has established a strong association between obesity and varying degrees of soft drink consumption, a view supported by research fellow Christina Pollard of Public Health at Curtin University.8 The rate of obesity and other co-morbidities was found to be even greater in individuals who consume soft drinks as well as fast foods.9,10,11,12
Numerous health organisations and prominent figures have blamed and focused on fast food chains for this health crisis due to their exceptionally low cost beverages.13,14,15 Former New York City mayor Michael Bloomberg proposed a ban on the sale of sugary drinks larger than 473ml (16 ounces) in restaurants, theatres, arenas and stadiums in 2012. Unfortunately, the proposition was eventually ruled against by the state’s high court in June of 2014.16,17 These concerns were also raised by Craig Sinclair of the ‘Rethink Sugary Drink’ campaign and Director of Prevention at Cancer Council Victoria, stating that “…actively promoting excessive consumption of such high-sugar products is completely irresponsible.”.18
Aside from fears of the ever increasing rate of obesity in the Australian population, the associated co-morbidities of soft drink consumption must also be taken into consideration as links between diet and health conditions become more evident.19 Daily soft drink consumption has been linked with numerous negative health outcomes, including high blood cholesterol levels, type 2 diabetes, metabolic syndrome, kidney disease, osteoporosis and bone fractures, and dental caries.20,21
Moreover, a generalised misconception has developed in recent times that substituting standard soft drinks for diet soft drinks can reduce the burden of oral and general health outcomes.22 The increased acidity within diet soft drinks attacks the protective enamel layer of the tooth23, leading to irreversible tooth erosion in cases of more frequent and prolonged consumption. A similar effect is also noted in cases of drug addiction (e.g. crack, cocaine and methamphetamine use), usually as a combination of a dry mouth also developing and reducing the flow of saliva which is crucial in reducing damage to and repairing teeth.24 Regular acid attacks from diet soft drinks can result in dental caries and exposure of underlying and weaker layers of the teeth which eventually cause them to become symptomatic, painful and eventually break down completely.25,26
Recent research published in the Journal of The American Geriatrics Society established that individuals who consumed diet soft drinks on a daily basis on average gained more than 7cm around their midsection in one decade.27 Researchers involved with the study cautioned that carrying excess weight in this region could be an indication of escalated fat around vital organs, a risk factor for diabetes, stroke, heart disease and several forms of cancers.28
‘That Sugar Film’ (directed by Damon Gameau) documents a 60 day experiment where Gameau commits to a diet consisting of a daily intake of 40 teaspoons of sugar – considered under the average teenagers daily consumption.29 Due to his altered diet, Gameau experienced numerous negative physical and psychological health outcomes including lethargy, lack of motivation, weight gain and fatty liver disease.30,31
During filming, Gameau travelled to the US state of Kentucky where he met Edwin Smith, a dentist who explained the term ‘Mountain dew mouth’ and introduced him to one of his patients, a 17 year old boy in the process of having all his decayed adult teeth removed and replaced with dentures. This patient stated that he consumes “at least a 12 pack” if not “four or five bottles” of Mountain Dew daily and that his mother now regrets giving him Mountain Dew instead of Juice as a child.32,33
Another common misconception is of fruit juice being less detrimental to oral health than soft drinks. However, similar to soft drinks, fruit juice is a combination of glucose and fructose and attacks the enamel of teeth.34 It is important to note the general lack of awareness and knowledge among the public about this fact. In addition to the negative effects of sugar in the diet, new research is illustrating the benefits of consuming less processed food and drinks for the caloric value.36
Until recently, there was a belief that ‘a calorie is a calorie’. New evidence suggests that unprocessed and raw food, or foods that necessitate a longer digestive process in the gut, burn more calories and satiate a person longer than processed or ‘soft’ foods.37,38,39,40,41 It has been proposed that a diet higher in unprocessed foods may help reduce the rate of obesity and associated co-morbidities.
To improve oral and general health, all sugary/acidic beverages and processed food groups should be reduced significantly or eliminated from the diet. While compliance with such a proposition is often low, the following actions may be taken to minimise the damage caused by these beverages and foods.
- Attempt to replace sugary soft drink with fluoridated water.
- Reduce how often you consume sugary or acidic beverages and avoid holding and swishing them in the mouth for extended periods. This will aid in decreasing acid exposure to teeth.
- Decrease acid exposure to teeth by drinking through a straw and try to finish beverages in one sitting.
- Do not brush teeth immediately after drinking sugary or acidic beverages. This could lead to further damage as tooth enamel is still soft and can be brushed away. Delay brushing for one hour.
- As an alternative to brushing, water should be used to clear the mouth of acid. This will aid in rehydration and increasing salivary flow.
- Chewing on sugar free gum can help to neutralise and re-harden tooth surfaces and will stimulate saliva production.
- Visit your dentist every 6 months for a check-up.
- Buy fresh, unprocessed food rather than processed products.
- Reduce fruit consumption to two pieces per day.
- Beverage Digest, “The Green Sheet- 2005 all-channel carbonated soft drink corporate shares in 95 countries”, http://politics.ucsc.edu/undergraduate/chicago%20style%20guide.pdf (accessed February, 13, 2015).
- Rangan, A., Hector, D., Louie, J., Flood, V., & Gill, T. (2009). Soft drinks, weight status and health: Health professional update. Sydney: NSW Centre for Public Health Nutrition, http://sydney.edu.au/medicine/public-health/panorg/pdfs/HealthProf_softdrinks_update.pdf.
- Hector, D., Rangan, A., Louie, J., Flood, V., & Gill, T., (2009). Soft drinks, weight status and health: a review. Sydney: NSW Centre for Public Health Nutrition. http://www0.health.nsw.gov.au/pubs/2009/pdf/soft_drinks_report.pdf.
- Cathy O’Leary, “Soft drinks give sugar overload,” The West Australian, September 16, 2014, p.5.
- Australian Associated Press, Obese Australians drink roughly 152ml of soft drink per day… and one in four people regularly sip on fizzy beverages, http://www.dailymail.co.uk/news/article-2756650/Obese-Australians-drink-roughly-152ml-soft-drink-PER-DAY-one-four-people-regularly-sip-fizzy-beverages.html, (accessed October 24, 2014).
- Better Health Channel, Food to have sometimes, http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/food_to_have_sometimes?open (accessed October 23, 2014).
- Hector, D., et al., Soft drinks, weight status and health.
- Australian Associated Press, Soft drinks linked to obesity: study, https://au.news.yahoo.com/thewest/a/24997487/soft-drinks-linked-to-obesity-study/ (accessed October 24, 2014).
- Eric Schlosser, Fast food nation: The dark side of the all-American meal (New York: Houghton Mifflin Company, 2001), p. 54
- Ann M. Coulston, Cheryl L. Rock and Elaine R Monsen, eds., Nutrition in the prevention and treatment of disease (San Diego: Academic Press, 2001), p. 525-526.
- The Age, “Scientists tag sodas as cigarettes of obesity,” The Age, March 10, 2006, http://www.theage.com.au/news/world/the-big-evil-of-sweetness/2006/03/10/1141701644562.html, (accessed November 18, 2014).
- Robert P. Murphy, “Soda and the sin tax,” Ludwig Von Mises Institute, March 29, 2006, http://mises.org/daily/2095, (accessed November 18, 2014).
- O’Leary, Soft drinks give sugar overload.
- R.L. Whitehead, “Fast food chains slammed for ‘cashing in’ on high-sugar frozen drinks,” Foodnavigator-Asia.com, January 30, 2014, http://www.foodnavigator-asia.com/Policy/Fast-food-chains-slammed-for-cashing-in-on-high-sugar-frozen-drinks (accessed November 14, 2014).
- Cancer Council Victoria, “Super sugar shockers: summer frozen drinks contain up to 30 teaspoons of sugar.”, January 28, 2014, http://www.cancervic.org.au/about/media-releases/2014-media-releases/january-2014/frozen-drinks-30-teaspoons-sugar.html, (accessed November 14, 2014).
- Grynbaum, M. Michael, “New York’s ban on big sodas is rejected by final court,” The New York Times, June 26, 2014, http://www.nytimes.com/2014/06/27/nyregion/city-loses-final-appeal-on-limiting-sales-of-large-sodas.html?_r=1.
- Young, Lisa, “Court rejects New York City’s portion cap for sugary drinks,” The Huffington Post, June 6, 2014, http://www.huffingtonpost.com/dr-lisa-young/court-rejects-new-york-ci_b_5535621.html
- Sophie Langley, Australian health organisations warn against frozen soft drinks, http://ausfoodnews.com.au/2014/01/29/australian-health-organisations-warn-against-frozen-soft-drinks.html, (accessed October 23, 2014).
- VicHealth, Healthy eating – soft drink consumption, http://www.vichealth.vic.gov.au/~/media/Indicators/Overview%20sheets/16/VH_IO_Healthy%20eating%20-%20soft%20drink%20consumption.ashx, (accessed October 23, 2014).
- R.L. Whitehead, Fast food chains slammed…
- Anna Almendrala, “This might explain why diet soda drinkers are often overweight,” The Huffington Post, September 9, 2014, http://www.huffingtonpost.com/2014/09/18/artificial-sweeteners-gut-bacteria_n_5837646.html?ncid=txtlnkusaolp00000618, (accessed May 14, 2015).
- Australian Government, Australian National Preventive Health Agency, Obesity: Sugar-sweetened beverages, obesity and health, 2014, Evidence Brief, Canberra, ACT, April 2014, p. 5.
- Bennett-Smith, Meredith, “Diet soda’s effect on teeth terrifying similar to effects of meth, crack cocaine,” The Huffington Post, May 28, 2013, http://www.huffingtonpost.com/2013/05/28/diet-soda-teeth-similar-to-meth-photos_n_3348158.html
- Australian Dental Association Inc, Soft Drinks and Your Oral Health, http://www.ada.org.au/softdrinkfaqs.aspx (accessed November 17, 2014).
- Chiyo Shidara, Diet soda, fruit juices are also bad for your teeth, http://cchealth.org/column/2014-0228-healthy-outlook.php (accessed November 17, 2014.
- Michael Koziol, “Diet soft drinks: what they do to your waistline,” The Sydney Morning Herald, March 18, 2014, http://www.smh.com.au/lifestyle/diet-and-fitness/diet-soft-drinks-what-they-do-to-your-waistline-20150318-1m1rqf.html, (accessed May 14, 2015).
- The Australian, “Diet drinks fizzle out into fatter waistlines for older people,” May 18, 2014, http://www.pressreader.com/australia/the-australian/20150318/281943131365272/TextView (accessed May 14, 2015).
- Emma Reynolds, “Damon Gameau goes super size on the sweet stuff in shocking sugar experiment,” News.com.au, November 20, 2014, http://www.news.com.au/lifestyle/health/damon-gameau-goes-super-size-on-the-sweet-stuff-in-shocking-sugar-experiment/story-fneuzkvr-1227127957935, (accessed May 14, 2015).
- Beverley Hadgraft, “Sugar in ‘health foods’ almost killed me,” Body + Soul, http://www.bodyandsoul.com.au/health/health+news/rsugar+in+rhealth+foods+almost+killed+mer+,35575. (accessed May 13, 2015).
- Freya Noble, “Fatty liver disease and on the road to obesity: What happened when Underbelly star Damon Gameau ate a ‘healthy’ low-fat diet for 60 days – proving that sugar is hidden in all the foods you don’t expect,” The Daily Mail Australia, November 19, 2014, http://www.dailymail.co.uk/news/article-2840363/An-Australian-actor-eats-healthy-low-fat-diet-60-day-developed-fatty-liver-disease-mentally-unstable.html, (accessed May 14, 2015).
- Damon Gameau, “Day 38: Mountain dew mouth,” That Sugar Film, January 12, 2015, http://www.thatsugarfilm.com/day-38/, (accessed May 13, 2015).
- Keratin Kehren, “Damon Gameau put his life at risk to make a film that has crystallised with a worldwide audience,” Cairns Post, March 19, 2015, http://www.cairnspost.com.au/entertainment/damon-gameau-put-his-life-at-risk-to-make-a-film-that-has-crystallised-with-a-worldwide-audience-writes-kerstin-kehren/story-fnjput3w-1227268575335, (accessed May 12, 2015).
- Eliza Barclay, “Fruit juice vs. soda? Both beverages pack in sugar, health risks,” National Public Radio, June 9, 2014, http://www.npr.org/blogs/thesalt/2014/06/09/319230765/fruit-juice-vs-soda-both-beverages-pack-in-sugar-and-health-risk (accessed May 13, 2015).
- BBC Health, “Sugar warning for ‘healthy’ soft drinks,” BBC News, April 17, 2012, http://www.bbc.com/news/health-17731052, (accessed May 13, 2015).
- Pete Bee, “Don’t count calories, it’ll just make you fatter! Which foods really make us fat?,” Daily Mail Australia, September 11, 2012, http://www.dailymail.co.uk/health/article-2201280/Calories-Dont-count-calories-itll-just-make-FATTER-Which-foods-really-make-fat.html, (accessed May 13, 2015).
- Cynthia Sass, “Why calorie counts are wrong: 6 diet myths, busted,” Health.com, February 7, 2013, http://news.health.com/2013/02/07/why-calorie-counts-are-wrong-6-diet-myths-busted/, (accessed May 12, 2015).
- Jonathan Bailor, The calorie myth: How to eat more, exercise less, lose weight, and life better (New York: HarperCollins, 2013), p.30.
- Alexander Heyne, “Myth: eat fewer calories if you want to lose weight,” Modern Health Monk, http://modernhealthmonk.com/low-calorie-myth/, (accessed May 12, 2015).
- Bee, Don’t count calories.
- Laura Whitney, “Good calories & bad calories: what are you supposed to eat?” SF Gate, http://healthyeating.sfgate.com/good-calories-bad-calories-supposed-eat-8301.html, (accessed May 12, 2015).
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