This topic has become such a huge concern for me; I don’t know where to start. Shall we talk about the rising tooth decay in infants, toddlers and our teenage children? Shall we talk about acidic drinks that are dissolving the teeth out of young mouths that have never even had one cavity? How about the sharp rise in diabetes (1,5) in our youth or the relation between acidic (2) and carbonated beverages and the increasing osteoporosis problem in our population, including teenage girls? (4) Shall we discuss chemical addiction and the marketing plans of the beverage companies? (3,6)
Well, I’m a dentist so I am going to do my best in the limited space of this page to stick to the teeth. If you listen to what I have to say about beverages and you respond, you will do an enormous favor for the health of your entire body.
First my foundational bias. The human body developed around a diet of water and whole food. Anything less is subject to suspicion and scrutiny as to its value as a food.
Liquid candy. Any food that we eat that is primarily sugar, contains few or no vitamins, few or no minerals, little or no protein, and little or no complex carbohydrate fiber is candy. If you add water, stir it up and drink it, it is liquid candy. Liquid candy includes carbonated beverages (soda pop), fruit juice (yes, pure 100% fruit juice), sport drinks, sweet teas, sweetened and flavored waters, juicers and numerous home mixed concoctions. They provide a large caloric source without the necessary extra ingredients that our enzymatic systems need to utilize the energy. It is the missing vitamins and minerals that are the essential keys to enzyme systems working in our body. They act as the catalysts and active ingredients of the critical chemical reactions going on in our bodies. These excess calories, without the other nutrients to utilize them, just (1) stress the blood sugar controlling mechanism and have been indicted as one factor in the rising incidence of diabetes in our population and the alarming rise of diabetes in our children, and (2) pile up as excess weight and are highly correlated with the rising obesity statistics in our population, especially our youth, and (3) the excess sugar, specifically fructose, causes a fatty degeneration of the liver.
If you are drinking a beverage other than water, is it liquid candy? And are you monitoring it like you would candy in your diet?
Acidity. These drinks are acidic. That is what gives them their bite and tang. We are seeing a new kind of cavity that didn't show up until about 1990. These cavities are related to acid eroding the enamel tips off of the teeth, leaving them sensitive and susceptible to cavities. Are your teens or pre-teens complaining of occasional sharp pain in their molars when they bite?
Phosphoric acid is added to colas for the bite. Citric, ascorbic, and malic acids are added to the fruity drinks to provide the tang or sourness. The carbonation is from carbonic acid.
Controlled studies have shown that drinking as little as 6 oz. of soda per day creates a measurable excess loss of tooth enamel after just one week. The average teenager drinks about two cans (24 oz.) of soda per day, 7/365. If we eliminate from the statistics those teens who don’t drink soda, the ones who do average 3 ½ cans per day (42 oz.).
Now try frothing, the act of forcing the soda back and forth through your teeth for that effervescent bite of the carbonic acid. Frothing multiplies the damage to teeth by 9 times. A one can per day frother will do as much damage to teeth as someone who drinks 9 cans a day the regular way.
Frothers are easy to spot in the office because they are dissolving the subtle anatomy off the incisors. Seventy-year-old adults who have been vigorous tooth brushers their whole life have worn down that subtle anatomy about the same as a teenager who has been frothing for a year or so.
A colleague of mine in Santa Rosa had a 13-year-old patient who had never had a cavity. He developed an acid snacking habit (sour candies and soda) that destroyed his teeth and at age 14 needed crown rebuilds on nearly all his back teeth.
Juice. Yes, good old 100% fruit juice. Fruit is a spectacular food that provides vitamins, minerals, soluble and insoluble fiber, energy and great taste. Juice, however, has had the fiber squeezed out of it along with most of the vitamins and minerals. It leaves the sugar and an inadequate and incomplete amount of the water-soluble vitamins in the juice; too much sugar for the body’s endocrine system to handle in a few gulps. It takes 6 to 8 oranges to squeeze a glass of juice. When was the last time you ate 6 – 8 oranges? If you eat whole foods, the bulk of the fruit prevents you from getting more sugar than your body can handle. Also the other nutrients in the whole fruit allow you to properly metabolize it, and get more food value than the juice, at 1/6 the calories.
Juice now sits on the top of the list as a probable causative agent for the medical chronic disease pandemic facing our children; namely diabetes, obesity, high blood pressure, and osteoporosis, among others; what is refered to as metabolic syndrome. The journals of the American Medical Association and the American Academy of Pediatrics have in recent years recommended that juice be avoided in an infant’s diet. They also recommend that if it is introduced to an older toddler that it be limited to 4 oz. daily (a small glass) and consumed with a meal.
Also relevant to teeth, the organic acids in juice are far more bio-available (and dangerous) and their dissolving power for tooth enamel is actually significantly more damaging than the soda beverages. In the old days dentists occasionally saw the damaging effect of sucking lemons. Now we are seeing it on a broad scale in our sipping youth. A glass of apple juice has about 9 times more titrateable acid than the same size glass of cola!
Sipping. Infants and toddlers who sip most of the day with bottles they carry, bottles at night and sippy cups of sweet beverages destroy their teeth in months. I have rebuilt too many under 3 year old mouths under general anesthesia in the operating room of a hospital. Besides the acid already mentioned, repetitive dosing with sugar for the bacteria in the mouth results in a shift in the balance that favors the cavity causing bacteria. Once established (in the first 3 years of life) an overbalance of cavity causing bacteria will be an issue for live. Infants and toddlers need water!
Addicted to sport drinks? Is that possible? We’ve all known for ages that colas contain caffeine. A cup of coffee has 60 - 120 mg. of caffeine per cup and a 12 oz. can of cola soda has about 120 mg. Two cups of coffee daily provides adequate caffeine to addict a full grown adult. But sport drinks?
Sports Drinks - Not What You Might Hope They Are. Have you checked out the ingredients of your "sports drink?" Basically you will find: 1) water, 2) sugar of some kind, 3) organic acids (or citrus juices) for the tangy taste, and 4) some electrolytes.
The water is obvious and great. We need to rehydrate during and after sweaty exercise. No problem.
Sugar of some kind? The amount of calories we burn during exercise is not as much as you might think. A jogger running for a full hour only uses about 400 Calories. (Just 1 scone at your favorite coffee shop will replace that!) A marathon runner will run for 3 hard hours before he depletes his easily available glucose energy storage in his muscles. Sports event players don't need sugar of any kind in their water. To the contrary, adults and kids alike are consuming hundreds of excess (un-necessary) calories, empty calories (containing no nutrients to help adequately metabolize the calories), with these drinks.
The sipping nature that many people employ drinking these sports drinks is also boosting the sugar loving, cavity causing germs in our mouths. The bacteria that cause cavities will thrive at high metabolic rates for 40 minutes following a simple sugar exposure. Assuming 3 meals and 2 snacks, the teeth are under acid attack 4 hours. The other 20 hours each day the teeth are recovering calcium from the saliva.
People who sip sports drinks from backpacks or before, during and after sports events and celebrations have their teeth under attack a majority of the day with inadequate recovery times to maintain healthy enamel. Screw cap lids make it possible to sip these beverages all day and for those children who do, the teeth have no opportunity to recover the calcium lost during the constant acid attack of the bacteria. Their cavity rates begin to soar.
The human condition has evolved over several millennia with water to hydrate us. In the last couple decades sports drinks have not made us healthier or improved our sports performance. However, they have:
1) Done huge damage to our teeth and oral health.
2) Contributed heavily to an overweight and obese population, especially our kids, that pediatricians and other physicians and health care workers are working desperately to change.
3) Been a significant contributor to the growing problem of Type II diabetes in our children.
A third and highly “hyped” ingredient is electrolytes. Electrolyte replacement with these sports drinks is not necessary. The real bottom line is that our daily diet gives us adequate electrolytes each day so unless you are an extreme athlete doing strenuous endurance exercise several hours each day, you don’t need to be concerned about electrolytes. Sports physiologists have confirmed this.
The last primary ingredient in sports drinks is organic acids (citric acid, ascorbic acid, malic acid, etc.) discussed earlier in this article.
Energy / Sports Drinks - Are We Addicting Our Kids to Them?
We all want more energy and more alertness on the playing field, whether it is sports, debate, cards, or just joking around. It is not surprising the distinction between sports drinks and energy drinks is blurring. The concerns for our youth with growing bodies and developing physiologic systems are multiple. The sugars in these drinks are addicting enough and challenging to the insulin endocrine system. The energy drinks, however, are fundamentally different due to many additives in them.
The most obvious concern is caffeine. Energy drinks typically contain 10 mg (to 16 mg) per ounce. This totals 240mg (to 390 mg) for a 24 oz. drink. Note: The amount of caffeine necessary to create measurable physiologic changes in a full size adult is about 50mg. Also note: Cardiac arrest (heart failure) has been anecdotally associated with drinking large energy drinks. Although the direct causal relationships have not been proven (obviously difficult research to do if someone’s life is at risk), the implications are obvious. For some young children with sensitive myocardium (heart muscle) the potential threat is clear and catastrophic.
Are we addicting our children's physiologic developing systems to caffeine? The amount of caffeine for full size adults to develop an addiction is about 100 mg per day. In a recent study of 228 families with young children, 75% of the children consumed caffeine. For those children who consumed caffeine, the average daily consumption for 5 to 7 year olds was 52 mg and for 8 to 12 year olds it was 109 mg. Yikes. An additional note about caffeine for youth. Caffeine consumption in youth age 5 to 12 has been correlated with decreased average sleep. Sleep studies have linked inadequate sleep with ADHD type behavior.
Guarana, an additional ingredient in energy drinks contains both caffeine and guaranine, a stimulant that acts very much like caffeine in our bodies. The amount of guaranine (or Guarana) is not listed in these drinks. Guaranine has documented cardiac side affects like caffeine and the medical literature recommends patients under cardiac care consult their physician before taking any Guarana supplements. I have not seen a potency comparison between caffeine and guaranine, but the cardiac affect of the two is additive. Should we be allowing our growing athletes to consume these addictive substances?
Taurine, another ingredient, an amino acid, is more difficult to pinpoint. The literature contains a broad list (with some warnings) of the possible effects and mechanisms of this stimulant. Though we know it stimulates changes in physiologic function within cells, the specific results are ambiguous in the research literature. It is added to these beverages because of its stimulant value. It is concerning to me when I realize children with developing physiologic systems are consuming supplemental amounts of Taurine. All of these ingredients (Caffeine, Guarana, Taurine) came to us from ancient cultures in which the shaman discovered the mood altering capabilities of these herbals. They are not recommended for youth and growing bodies.
Super sizing. Our youth now have screw top bottles that allow them to reseal and sip over several hours. Remember the old days when we opened the 7oz. bottle and if I didn’t drink it in 20 minutes it was either misplaced or thrown away for lack of fizz? No longer! Plus, the bottles are 20 oz. now for 200% more of everything I’ve mentioned in this article!
Sweet teas. It is a smoke screen. If you read the ingredients, they are no different, no healthier, than all the other drinks I’ve mentioned. The sugar load is the same, just read the label. The acids are there too, though they may be slightly different acids. They can’t get enough ginseng or ginko-baloba into one of those drinks to make up for the liver damage the sugar will cause or the tooth cavities (sugar) and enamel loss (acid) they will cause.
Vitamin Water! How dare they call it water! Read the ingredients. It is sugar water with about ½ the amount of sugar present in the drinks already mentioned. It is just a weaker sugared beverage with some water-soluble vitamins. It still has the liver damaging fructose. Still has organic acids. The water-soluble vitamins are minimal. If you want vitamins, take a good multi-vitamin/mineral; it is cheaper and with a better balance of vitamins. Then drink some good clear cold water.
So what do we do? I buy and eat organic food where possible (it saves the planet and has less chemical contaminants). A large portion of my diet is raw. I love herbs. I eat whole food. I drink water. The number of drinks other than water that my kids or I drink can be counted on the fingers of one hand each month. We were meant to drink mother’s milk the first couple years of life, and water after that.
- US Dept. of Health and Human Services. The Surgeon General’s call to action to prevent and decrease overweight and obesity. Rockville, Md: Office of the Surgeon General, 2001.
- Joint Report of the ADA Council on Access, Prevention and Interprofessional Relations and Council on Scientific Affairs to the House of Delegates: Response to Resolution 73H-2000. ADA, October 2001.
- Majewski R. Dental caries in adolescents associated with caffeinated carbonated beverages. Pediatr Dent. 2001;23:3.
- Wyshak G. Teenaged girls, carbonated beverage consumption, and bone fractures. Arch Pediatr Adolesc Med. 2000;154:610-613.
- Ludwig DS, Peterson KE, Gormaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 2001;357:505-508.
- Marion Nestle, Food Politics, Exploiting our Kids, Corrupting Schools.