Limit sugar-sweetened drinks
Drink mostly water and unsweetened drinks
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Overview of evidence
There is strong evidence that regular consumption of sugar sweetened drinks is a cause of weight gain, as well as increasing the risk overweight and obesity.
The main mechanisms for this is via an increased risk of excess energy intake relative to expenditure. Greater body weight* is a cause of many cancers.
Goal
- Do not consume sugar sweetened drinks
Evidence
There is convincing evidence that consumption of sugar sweetened drinks is a cause of weight gain and overweight and obesity in both children and adults, especially when consumed frequently or in large portions. Sugar sweetened drinks do this by promoting excess energy intake relative to energy expenditure.
It’s best to drink water or unsweetened drinks, such as tea or coffee without added sugar. Fruit juices should not be consumed in large quantities, as even with no added sugar they are likely to promote weight gain in a similar way to sugar sweetened drinks.
There is no strong evidence in humans to suggest that artificially sweetened drinks with minimal energy content, such as diet sodas, are a cause of cancer. At the same time, the evidence that they help prevent weight gain and overweight and obesity is not consistent.
The available evidence is insufficient to make a recommendation regarding artificially-sweetened drinks and we, therefore, recommend water or other unsweetened alternatives.
Additional information
In addition to sugary drinks the Panel assessed the evidence on other types of drinks and found strong evidence that:
- Arsenic in drinking water INCREASES the risk of lung, bladder and skin cancers
- A recommendation for arsenic in drinking water has not been made, as people cannot control whether or not their local water supply is contaminated. However, contamination of water supplies with arsenic is a public health issue, particularly in Bangladesh, China and West Bengal. Authorities should ensure that safe water supplies are available when such contamination occurs.
- Maté, as drunk scalding hot in the traditional style in South America, INCREASES the risk of oesophageal squamous cell carcinoma
- A recommendation on maté has not been made as it is consumed only in specific parts of the world, but the Panel advises that maté should not be consumed scalding hot in the traditional style.
- Coffee DECREASES the risk of liver and endometrial cancers
- A recommendation has not been made about coffee as there are many unanswered questions, for example around coffee type and preparation method
- Milk DECREASES the risk of colorectal cancer
- A recommendation has not been made about milk (and dairy) as there is suggestive evidence that dairy products may INCREASE the risk of prostate cancer
Mechanisms
The mechanisms underpinning links between cancer and sugar sweetened drinks are indirect in that they are linked to the multiple mechanisms involved in the development of overweight and obesity.
Mechanistic evidence about the other types of drinks discussed here, that may increase/decrease cancer risk, is briefly detailed below:
- Arsenic in drinking water: exposure to arsenic and its metabolites may induce production of reactive oxygen species, which induces DNA damage and modulates the expression of genes involved in cell growth, survival and cancer risk.
- Maté: the carcinogenic effects of mate are due to consumption at very hot temperatures (over 65°C), which can cause chronic mucosal injury and promote tumorigenesis.
- Coffee: coffee drinking provides exposure to a range of biologically active compounds, many of which have been demonstrated to target pathways associated with carcinogenesis in a variety of tissues. Coffee is also a source of natural diterpenes, such as cafestol and kahweol, which have been shown to induce apoptosis (cell death) and have anti-oxidative and anti-inflammatory effects.
- Milk (dairy): milk and other dairy products contain high levels of calcium, and the casein and lactose in milk may increase calcium bioavailability.
Implications for other diseases
There is strong evidence that regular consumption of sugar sweetened drinks increases the risk of weight gain and overweight and obesity. Greater body weight is a common risk factor for many diseases and disorders, including CVD and type 2 diabetes.
Public health / policy implications
The consumption of sugar sweetened drinks has rapidly increased in many parts of the world, especially in low- and middle-income countries, contributing to rising rates of overweight and obesity. A whole-of-government, whole-of-society approach is necessary to create environments for people and communities that are conducive to limiting consumption of sugar sweetened drinks and are consistent with our Cancer Prevention Recommendations.
A comprehensive package of policies is needed to limit the availability, affordability, and acceptability of sugar sweetened drinks. This includes marketing restrictions and taxes on sugar sweetened drinks, and securing access to clean water (particularly relevant in school settings).
Sugar sweetened drinks are often sold in single-use plastic bottles that may not be recycled. Policies are needed that influence the food environment, the food system, and behaviour change communication across the life course.
Policies that encourage reduced consumption can also help contribute to a sustainable ecological environment. Policymakers are encouraged to frame specific goals and actions according to their national context.
More relevant information
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Notes
* ‘The term ‘body weight’ is used as a simpler term for adiposity; it includes, for example, body mass index, waist circumference, waist-to-hip ratio’