Though "calorie- free," sodas are not free

Keep suggesting at least moderation through patient education

Over the past 16 years, the amount of sugar in American diets has increased by 28%, with about a third of it coming from soft drinks. Carbonated soft drinks have become a dietary staple for millions of people. To decrease sugar intake, some individuals are turning to diet soft drinks containing artificial sweeteners and synthetic chemicals. Artificial sweeteners are most appealing because they have virtually no calories and deliver zero fat.

The FDA has approved five artificial sweeteners:

• Aspartame (NutraSweet, Equal): 180 times sweeter than sugar
• Neotame (NutraSweet): Between 7,000 and 13,000 times sweeter than sugar
• Saccharin (Sweet'N Low): 300 times sweeter than sugar
• Sucralose (Splenda): 600 times sweeter than sugar
• Acesulfame potassium (Stevia): a plant-derived noncaloric sweetener

Both aspartame and saccharin are toxic and cause many health problems and chronic diseases. Although not proven, aspartame is suspected to cause cancer and has been linked to Alzheimer's disease. Those individuals with the PKU gene (phenylketonuria) cannot process phenylalanine, an amino acid found in aspartame, so it is best to avoid these beverages.

Many people drink diet soda to help maintain or lose weight, but the opposite is actually true. As noted in the first paragraph regarding the FDA approved artificial sweeteners, they are hundreds to thousands of times sweeter than regular sugar. When drinking diet soft drinks, your body experiences a sweet taste and expects calories; but when nourishment is not met you become hungrier, and your body starts craving more sugar and starchy carbohydrates to satiate your hunger. The long-term result is weight gain. Aspartame will turn body cells into a fat-storing machine, especially in hips and thighs. Now isn't that just special!

HEALTH CONCERNS

According to a recent case report presented at the American Association of Clinical Endocrinologists during their 22nd Annual Scientific and Clinical Congress, sugar substitutes may adversely affect endocrine health. "An overabundance of sugar-substituted beverages could pose a serious health risk if you are a thyroid patient. While the issue is being studied more in-depth, thyroid patients should manage their intake of sugar substitutes while consulting their endocrinologist," says Dr. Sachmechi, MD, FACE, FACP, of New Hyde Park, New York. Dr. Sachmechi's statement is a result of his treating a patient diagnosed with Hashimoto's thyroiditis. The symptom resolved completely with the elimination of artificial sweeteners, including Sweet'N Low, Equal, Splenda, and diet sodas.

In 2005, Harvard researchers participating in the national Nurses' Health Study found evidence that long-term diet soda consumption can decrease kidney function over time.

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Consider reading:

• Celebrate National Nutrition Month: nutrition facts, label programs
• The absence of periodontal inflammation
• Preventing dental erosion in the pregnant patient

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A 2007 study by researchers at Boston University School of Medicine indicated that drinking more than one soda a day, even a diet soda, increased the risk of developing metabolic syndrome. Metabolic syndrome is a term used to describe several different major contributing factors that affect your risk for stroke, heart disease, or diabetes. These contributing factors can include high blood pressure, low HDL levels, thickening of the waistline, and high blood sugar. Metabolic syndrome results when three or more health risk factors are present.

Diet or otherwise, all sodas are acidic and play a role in eroding tooth enamel. Diet soda is very acidic, with a pH of 3.2. Consider using a straw to keep the liquid away from the teeth. The evidence is strong that cutting back on sugary drinks or eliminating them altogether is ideal. For children, the long-term effects of consuming artificially sweetened beverages are unknown, so it is best for kids to avoid them altogether. Ultimately, as boring as it is, water is the best choice for staying hydrated and maintaining weight. RDH

Susan Clark, RDH, OM, is a registered dental hygienist, orofacial myologist, key opinion leader, public speaker, and self-published author of "Exploring Dental Hygiene, Finding the Hidden Rewards." She is in her second term as president of the San Diego County Dental Hygienists' Society, California delegate to the House of Delegates, and an alternate delegate to the ADHA House of Delegates. She is a 2013 Sunstar/RDH Award of Distinction recipient. Susan offers a variety of presentations for dental hygiene schools and components. Visit her website at sgclark.net or contact her directly at [email protected].

References:

Bellisle F, Drewnowski A. Intense sweeteners, energy intake and the control of body weight. European Journal of Clinical Nutrition. 2007;61:691-700.

Cause and Effect: Case Report Shows an Association between Sugar Substitutes and Common Thyroid Disorder [Press release]; AACE 22nd Annual Scientific and Clinical Congress in Phoenix. http://media.aace.com/press-release/cause-and-effect-case-report-shows-association-between-sugar-substitutes-and-common-th. Updated May 2013. Accessed May 2013.

Komaroff A. Are artificial sweeteners a healthy substitute for sugar? Harvard Health Blog. http://www.health.harvard.edu/blog/are-artificial-sweeteners-a-healthy-substitute-for-sugar-201112304047. Updated December 30, 2011. Accessed April 2013.

New analysis suggests ‘diet soda paradox' – less sugar, more weight [Press release]; UT Health Science Center San Antonio. http://www.uthscsa.edu/hscnews/singleformat2.asp?newID=1539. Updated June 2005. Accessed April 2013.

Wein H. The Role of Diet in Metabolic Syndrome. NIH Research Matters. http://www.nih.gov/researchmatters/february2008/02252008junkfood.htm. Updated February 2008. Accessed April 2013.

Besides artificial sweeteners, diet soft drinks can contain carbonated water, caffeine, phosphoric acid, citric acid, potassium benzoate, potassium citrate, and food additives such as caramel color. Here are some other underlying health concerns.

• Carbonated water is the beverage's primary ingredient, acting as a preservative and giving it fizz.
• Citric acid protects the taste and along with potassium benzoate, potassium citrate acts as a preservative.
• Caffeine is a diuretic, which facilitates dehydration, making you more, not less, thirsty. The caffeine also is a central nervous system stimulant. Caffeine found in diet soda is artificial, whereas in coffee and tea, the caffeine is natural. One 12-ounce can of diet soda can contain anywhere from 50 to 80 mg of caffeine.
• Phosphoric acid is an acidifying agent to give colas their tangy flavor. The combination of artificial sweeteners and phosphoric acid can pose serious health risks over time. Drinking more than occasional diet sodas may also increase your risk for tooth or bone disorders, such as osteoporosis. This is not due to the carbonation, but to the high levels of phosphoric acid. Ingesting high levels of this acid, more than your kidneys are able to process, may force your body to leach calcium from your bones or teeth to neutralize it. Phosphoric acid also neutralizes the hydrochloric acid in your stomach, which we need to digest food and use its nutrients, particularly calcium, causing further mineral loss from your body.
• Food additives enhance appearance. Coloring, such as caramel, yellow 5, red 40, and blue 1 are used to make cola drinks appear brown, citrus drinks appear yellow, and fruity drinks appear red or orange.