Ask the Expert: Lawrence Appel on the Risks of Sugar-Sweetened Beverages

The Johns Hopkins Medicine Healthy Beverage Initiative aims to help faculty, staff, patients and visitors make healthier drink choices in their everyday lives. Part of the initiative is to increase the availability of healthy beverages to help offset that of sugar-sweetened beverages, which have shown to elevate problems such as obesity and diabetes, among others.

LawrenceAppelLawrence Appel, director of the Welch Center for Prevention, Epidemiology and Clinical Research, is one of five subject matter experts from the school of medicine and Bloomberg School of Public Health who contributed to the healthy beverage strategy. In today’s Ask the Expert, Appel explains the risks in drinking sugar-sweetened beverages and ways to reduce consumption.

Be sure to visit the Johns Hopkins Healthy Beverages page for more information on this initiative.

What is a sugar-sweetened beverage?

Sugar-sweetened beverages are drinks sweetened with sugar, high-fructose corn syrup or other caloric sweeteners. In addition to nondiet soft drinks, sugar-sweetened beverages include flavored juice drinks (like apple juice), sports drinks, sweetened tea, coffee drinks, energy drinks and electrolyte replacement drinks.


What different types of sugar are added to beverages? Are some better for you than others?

The most common form of sugar in sugar-sweetened beverages is high-fructose corn syrup. The term is a bit misleading, because high-fructose corn syrup is only about half fructose. It is similar in composition to routine table sugar. There is some debate about whether high-fructose corn syrup is worse than other forms of sugar. I tend to focus on total calories, which is probably the major culprit, rather than the form of the sugar.


Why is it important for us to limit the number of sugar-sweetened drinks we consume?

Sugar-sweetened beverages contain large numbers of calories, especially given the current size of beverage containers—often 18 ounces or more. Humans also have a problem regulating calorie intake from beverages. Our bodies don’t sense the excess calories, and we continue to consume these beverages even though we don’t need more calories.


Does drinking sugar-sweetened beverages really have an impact on our health?

Evidence on the harmful effects of sugar-sweetened beverages continues to get stronger. The primary concern is excess weight gain, particularly in children and young adults. It has been estimated that in young adults, approximately 20 percent of calories come from sugars. Obesity is a major risk factor for type 2 diabetes. In addition, there is emerging evidence that sugar-sweetened beverages increase the risk of heart disease.


Why are diet beverages classified in the green, or “healthy,” category as part of the Healthy Beverage Initiative?

The focus of the Healthy Beverage Initiative is to reduce excess calorie intake. Hence, diet beverages, which have few calories, are placed in the “green” category.


If someone doesn’t want to totally give up sugar-sweetened beverages, are there tips you can offer to cut the calories in sugary drinks?

There are several strategies. First, buy the smallest size of the sugar-sweetened beverage that is available. Don’t be lured by value—“Only 10 cents more to supersize it!” Value now comes at the expense of excess weight later in life. Second, never finish the sugar-sweetened beverage all at once. Stretch out consumption over more than one drinking occasion. Third, avoid purchasing sugar-sweetened beverages when you’re thirsty—you need the water, not the calories, that come with the beverage. Fourth, add ice cubes to the drink so it looks like you’re getting more. Pay attention to what triggers you to want a sugar-sweetened beverage. Before drinking one, make sure you really want it. And if you must have a sugar-sweetened beverage, be sure to savor it as special and not routine.


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{ 6 comments… read them below or add one }


Mike October 16, 2014 at 12:51 pm

My daughter has Crones and has noticed that sugar substitutes can cause issues for her.

My preference would be to offer, organic sugared (non hfsc) soft drinks, with and without caffeine, but reduce the size of the offered bottles or cups.

Here's a 9/17/14 link to article on "Artificial sweeteners may leave their users glucose intolerant"


Lawrence Appel October 14, 2014 at 2:42 pm

I appreciate the interest in the Healthy Beverage Initiative and the comments expressed by several members of the Hopkins community. Most comments dealt with the health effects of artificial sweeteners relative to sugar. Several expressed a preference for water, which also happens to be my preferred beverage too. There has been a lot of research on artificial sweeteners. A summary of the evidence by the American Heart Association (Gardner, 2012) concluded that "when used judiciously, non-nutritive sweeteners could facilitate reductions in added sugars intake, thereby resulting in decreased total energy and weight loss/weight control, and promoting beneficial effects on related metabolic parameters." The expert team who helped prepare the Healthy Beverage Initiative will continue to monitor the evidence and update the guidelines.


bmigeon October 8, 2014 at 1:08 pm

Low calorie does not mean non dangerous. What about the downside of artificially sweetened drinks? Why not just drink more water?


Betty Gilman October 8, 2014 at 12:54 pm

I can understand the down sizing of sugar sweetened beverage containers to promote less consumption. But why did Hopkins down size the milk containers? I drink skim milk which is in the GREEN categoroy. However it is now only available in 8 oz cartons. Does Hopkins really want us to drink less milk? I really miss the 16 oz bottles - they were cheaper, too.


Luanne Willhide October 8, 2014 at 10:43 am

Dr. Appel,

Good morning and thank you for your article regarding Risks of Sugar Sweetened Beverages. We believe that this is a great way to tackle obesity and diabetes.

We do feel, however, that the use of artificial sweeteners are more damaging than sugar. There have been several studies indicating that ingesting artificial sweeteners may also cause obesity, diabetes and other metabolic disorders. We have been doing research and have found the attached article to be most interesting. Have there been studies at JHH on artificial sweeteners? If so, we would be interested in the results.

Thank you for your time and your interest in this very important initiative.

Luanne Willhide
Anna Scheinberg


Robyn October 8, 2014 at 10:43 am

I'm loving the availabiliy of Caffeine Free Diet Coke but with that said.......I'm concerned with this initiative as it is promoting aspartame and other artificial sweetners.

As the daughter of a diabetic I have drank diet beverages since they arrived in the form of "Tab" and DietRite. They contained saccharin which was later deemed as a carcinogenic up until 2010 when the FDA removed the warning lable from products containing saccharin. Now aspartame is being attacked. While I don't agree with what some proclaim as the side effects of aspartame I do know that it is as addictive as is caffeine and I've tried numerous times to stop using products with artificial sweetners.

This is just my thought


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