Some Hard Truths About Soft Drinks

Dr. Adrian Pujayana

WHENEVER I hear about any study that just came out (or ones that came out in the past), I ask a few basic questions: 1. What was the study’s design — how many participants, how were they influenced or affected and by what? 2. What were the study’s conclusions? 3. Are the conclusions relevant — are they practical or merely statistical?

In September 2019, the Journal of the American Medical Association Internal Medicine published a study that tracked mortality patterns of 451,000-plus people over eight years who consumed two or more soft drinks per day. The result … a positive association of “all-cause death” with the consumption of 2-plus sugar-sweetened and artificially sweetened drinks per day. Meaning … the consumption of two or more soft drinks per day (from sugar or artificial sweeteners) are linked to all sorts of causes of death, especially by diseases like cancer, circulatory disease, diabetes and strokes.

Now let’s ask our three basic questions.

What was the study design?

Over 500,000 people were enrolled, but 451,000 qualified to meet the study criteria. Mean age was 50 years (+/- 9.8 years) mostly women (71 percent women 29 percent men) who consumed two or more soft drinks per day between the years of 1992 and 2000. Subjects were from 10 European countries (Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden and the United Kingdom). Mortality was determined by causes of death from diseases like cancer, strokes, heart disease, hypertension digestive disease and pulmonary disorder. Those who reported any sort of the diseases mentioned were excluded from the study, and those who did not indicate dietary information about their soft drink habit were also excluded. Follow-ups were conducted on the subjects’ health status between 16-19 years later.

What were the

Generally healthy European adults who consumed two or more soft drinks per day were statistically connected to “early death” from the above mentioned diseases. Subjects were disease free at baseline, and nearly 42,000 deaths (about 10 percent) were connected to cancer, heart, pulmonary or digestive diseases.

What is the relevance of the author’s conclusions?

This last question is probably the most debatable part of any study, as people have different individual circumstances than those who were in the study.  The authors correlated a statistically significant mortality rate between those who consumed two or more soft drinks per day, with those who had less than one soft drink per month. These observations were also done on a European cohort, and may arguably be different than those living in the United States.  Finally, the study recognizes that even though soft drinks were statistically significant in mortality, these habits were not causative, but may perhaps be a “surrogate for adverse healthy behaviors.” In other words, those who consumed more than one soft drink per day were also likely to engage in other “unhealthy” behaviors like lacking exercise and physical activity, over-eating, increased stress, smoking, alcoholism and being overweight, among others.

This study adds to the body of knowledge about observations we see on a regular basis, that our health is intimately related to our diet. Consuming sugar-sweetened or artificially sweetened food products have consequences, oftentimes unnoticeable for several decades.  A study like the one above should be taken seriously from a public-health standpoint, but it is still up to the individual reader to make these conclusions personal and relevant. What will your dietary follow-up consist of in 16-19 years?

Dr. Adrian Pujayana has been providing drug-free solutions for health and wellness to adults, athletes and youth since 2000 through his private practice at Family Chiropractic Center of South Pasadena, a place for strength training and nutrition-based health care. For comments or questions, email him at