Put down that sugary soda. It could be deadly, particularly if you have type 2 diabetes.
A nearly two-decade-long study linked high intake of sugar-sweetened beverages -- soda, lemonade and fruit punch -- with premature death in people with type 2 diabetes. The link was found for both heart-related reasons and all causes.
But other beverages -- specifically coffee, tea, low-fat milk and plain water -- helped lower the odds of early death.
These findings point to the potential role of healthy drinks for folks with type 2 diabetes, the study concluded.
"Beverages can be a source of sugar, but also could be an important source of other dietary constituents, so it is natural to hypothesize that the different beverages may really have different effects on health among diabetes patients,"said study co-author Dr. Qi Sun, an associate professor of nutrition and epidemiology at Harvard T.H. Chan School of Public Health. He noted that there was little existing evidence about the impact of beverages on type 2 diabetes-related death.
Data from the study came from more than 9,200 women and more than 3,500 men who were part of other major research projects. All had diagnosed with type 2 diabetes during the 18.5-year study period.
Every two to four years, they reported how often they consumed sugar-sweetened or artificially sweetened beverages, as well as juice, coffee, tea, water and low-fat milk.
Each additional daily serving of a sugar-sweetened beverage was associated with an 8% uptick in death from all causes for people with type 2 diabetes. Replacing that drink with one of the healthy options lowered risk of early death by 18%.
The study does not prove that unhealthy drinking habits cause early death, only that there is an association between the two.
In 2021, an estimated 537 million adults worldwide had type 2 diabetes. That number is projected to reach 783 million by 2045, the researchers wrote.
Some healthy drinking habits reaped big benefits, the study found.
For example, replacing one serving of soda or lemonade with a cup of coffee was linked with an 18% lower risk of premature death from all causes and a 20% lower risk of death from heart disease. For tea, that benefit was 16% and 24%, respectively.
Plain water paid dividends, too -- lowering risk of early death by 16% for all causes and 20% for heart-related causes.
Replacing a sugar-sweetened beverage with low-fat dairy milk showed a 12% and 19% lower risk.
"I think the keyword, if there's only one keyword here, is quality,"Sun said. "One factor to measure quality is the association of health effects of beverages."
His advice: Drink healthy versions of beverages and reduce or avoid unhealthy choices.
Beverages with artificial sweeteners were found to be less problematic than their sugary counterparts. But they weren't as good as healthier choices, the study found. Replacing a sugar-sweetened drink with an artificially sweetened one was linked to an 8% lower risk of early death and a 15% lower risk of death from heart-related causes
Fruit juices, with high natural sugar content but also nutrients, fell somewhere in between.
"Fruit juice is still better than the sugar-sweetened beverages,"Sun said.
Dr. Nita Gandhi Forouhi, of the University of Cambridge in England, is the author of an accompanying editorial. She wrote that the findings point in one direction: Drinking fewer sugar-sweetened drinks and more of the healthier alternatives is best for folks with type 2 diabetes.
Forouhi noted that the analysis did not differentiate between different types of tea or the impact of adding sugar to coffee.
Yet, the choice of beverage clearly matters.
These drinks contribute to energy intake and to diet quality, which can affect obesity and longer-term health, Forouhi said.
"Diabetes is a pretty serious issue and it does indeed cut down people's life expectancy and, at the very least, their quality of life," she said. "Even if they live long, they have a life often that is complicated with heart disease and all sorts of other problems, kidney disease and sensation problems and so on, so if there is something seemingly so simple as just swap your drinks and that can really have quite a meaningful impact, I think that's a pretty powerful message."
Connie Diekman, a food and nutrition consultant and former president of the Academy of Nutrition and Dietetics, noted that sugar-sweetened beverages have lots of calories but little, if any, nutritional value. They don't satisfy hunger, and it's possible to consume a large quantity within minutes. A healthy lifestyle can be about finding balance, she said.
"As a registered dietitian, what I always say to people is, 'OK, so if you want the hundred calories in this food that gives you nothing else, what other food are you willing to not consume?'" Diekman said.
She suggested that people diagnosed with type 2 diabetes meet with a registered dietitian to help determine what they should eat and review their overall health, eating habits and lifestyle.
Everyone, not just people with type 2 diabetes, should look at how much of these drinks they consume, Diekman suggested.
"Take about three days, look at your food intake. How much sugar-sweetened beverage is in there? Is it one a day, two a day, three a day? And how can you begin to reduce that?"Diekman said. "Do it slowly, so that it's comfortable and maintainable."
The study and editorial were published April 19 in The BMJ.
More information
The U.S. Centers for Disease Control and Prevention has more on sugar-sweetened beverages.
SOURCES: Qi Sun, MD, ScD, associate professor, nutrition and epidemiology, Harvard T.H. Chan School of Public Health, Cambridge, Mass.; Nita Gandhi Forouhi, MRCP, PhD, program leader and investigator, MRC Epidemiology Unit, and director, organizational affairs, School of Clinical Medicine, University of Cambridge, U.K.; Connie Diekman, MEd, RD, LD, food and nutrition consultant and former president, Academy of Nutrition and Dietetics; The BMJ, April 19, 2023
