Cycling Wed Healthy Living inflammation Nutrition

Cycling Wed: Does drinking soda cause heart attacks?

A recent trial suggesting that men who drink sugary beverages increase their heart attack risk by 20% was covered extensively in the mainstream media. There’s a lot of liquid sugar consumed around here.

"Sugar-Sweetened Beverage": Hoosiers call it...Pop

I have two rules about drinking this stuff…

My criteria for indulging:

  • greater than three hours on the bike,
  • or after any race.

If it is over 90 degrees, I might partake in two servings. Come on folks, life is short; it seems a tad too risk averse not to treat the self once in a while. And oh how sweet those first few gulps taste after a summer criterium.

Why so stingy about a seemingly harmless beverage?

Let me tell you why I feel this way about pop. Despite what overweight people might think about thin people, this fact is true: the large majority of humans struggle to maintain a normal weight. It’s hard to be thin, and it gets harder as aging slows our metabolism. As a bike-racer with only modest gifts and limited time to train, I try to give myself every advantage possible. Basic physics dictate that lighter riders accelerate faster and overcome gravity with fewer watts.

In the quest to be as light as possible there exists a lot of low-hanging fruit. One of the easiest ways to control weight is to not drink calories. Milk, pop, beer, fruit juice and those mocha-like concoctions are all examples of insulin-spiking, fat storing, belt tightener’s. With all that good food out there to eat, it seems silly to drink calories.

That’s nutrition 101.

But now, a recent Harvard study raises the possibility that regularly drinking pop may do more than just make us jiggly and slower on the bike. Perhaps, drinking liquid sugar creates enough inflammation to raise the risk of heart attack?

The study: Sweetened Beverage Consumption, Incident Coronary Heart Disease and Biomarkers of Risk in Men

Harvard researchers studied nearly 43,000 white health professionals over 22 years. There were 3683 cardiac events during the study. The main finding: those who drank pop daily had a 20% higher risk of having a heart attack. This increased risk persisted after controlling for obvious confounders like weight, smoking and diabetes. Secondary finding: Contrary to  prior studies, consuming diet drinks did not increase the risk of heart events in this study. Inflammatory markers: Looking to explain reasons for the strong association between drinking pop and heart attack, the research team looked at levels of inflammatory markers. Not surprisingly, regular pop-drinkers had higher levels of inflammation, like C-reactive protein (CRP) and Tumor Necrosis Factor (TNF).

My take on the study:

Its three main strengths:

  • First and foremost, the findings make sense. Science peeps say they are plausible. That regularly drinking caramel-colored, caffeinated boluses of sugar might increase the risk of heart disease does not seem like a stretch. It’s not as if heart disease just poofs up from nothing.
  • Second, the results (in men) are consistent with the findings of the Nurses Health Study, a similarly sized study that found female pop-drinkers also sustained a higher risk of heart disease.
  • Third, the findings of increased inflammatory markers in pop drinkers definitely caught my attention.

And its weaknesses:

As pointed out in an accompanying editorial, written in dense academic MPH-speak, Dr.Mark Huffman (Northwestern University) explains that association does not equal causation. It turns out there are nine criteria to assess whether we can say drinking pop causes heart attack. His editorial is highly detailed, and beyond the scope of this post, but suffice it to say, this study isn’t strong enough to go that far. The two biggest knocks against the study include the self-reporting of dietary habits and the huge possibility of confounding factors—was it the pop or something else about the pop-drinkers? These weakness are common to all such dietary association trials.

My takeaway:

I’m no nutritionist or life coach, but it seems obvious that drinking less liquid carbohydrates improves health, and perhaps even reduce the risk of heart attack.

But then there are just rewards for those monster workouts.


References: An excellent journalistic review of this study is available for free on

10 replies on “Cycling Wed: Does drinking soda cause heart attacks?”

Hi John. Thanks for highlighting our attention to this interesting study. Huffman’s editorial is not easy reading – but his point that an association does NOT equal causation is the bottom line – and NO WAY that this de Koning et al study (as large as it is) can in any way be taken as “proof” that drinking sugar-sweetened beverages is “the cause” of heart attacks.

Your “Nutrition-101” is on target – in my book, anyone careless enough to consume hundreds of calories by drinking SSB (when they could just as easily drink diet sodas with zero calories) – is by my definition simply NOT a health-conscious individuals (which is more than enough of an effect to offset the slight 20% increase risk of having an MI).

It is clearly true that drinking SSB is “bad” – and it IS plausible that doing so may increase inflammation, and that this could be a mechanism leading to increased MI risk in certain susceptible subjects – but this study is NOT proof of a cause-and-effect relationship – and it should NOT be taken as such (just like the large observational studies on the “benefits” of estrogen in years past failed when they were finally held to the scrutiny of a scientifically performed study).

Bottom Line: As is frequently stressed in your excellent column – lifestyle, common sense changes are the KEY toward improving one’s health. Avoidance of SSB is among the first steps in striving toward a healthy lifestyle. Thanks again for your column – Ken Grauer, MD

My PCP once told me the story of a patient who came to him all worried, as he had suddenly lost 20 pounds over the course of a few months, He stated he had not changed his eating habits at all, so he was worried about some horrible disease process. After a battery of tests showed everything to be normal, my PCP asked “Are you sure you haven’t been eating differently or dramatically increased your exercise”?

“No”, said the patient. “the only small thing I’ve done is quit buying soda from the machine at work all day in order to save money”. – Bingo . . . . . .

A rheumatologist told me that one of the number one things on the hit parade to avoid for prevention of gout attacks is high fructose corn syrup, and many patients managed to decrease flares or prevent them altogether by avoiding soft drinks. Systemic inflammation, anyone?

I love a good Coke, but limit it to once in a while when nothing else will do. Aspartame and I don’t get along, so diet drinks are not for me. The exception is the newer ones sweetened with Nutrasweet or Stevia.

For me, a big unsweetened ice tea with a touch of lemon and honey or Stevia is as refreshing as anything.

As John always says – moderation and common sense.

Sorry Verted, Nutrasweet is Aspartame. I haven’t seen any sodas made with Stevia but I hope they come to my market soon. I do enjoy the one’s made with Splenda.

Oops Lisa – you are so right. I meant Splenda. Pardon my fuzzy brain (darn these afib drugs)

Stevia sweetened ones are available at our local health foods store. The brand name is Zevia. They have a number of different flavors.

I remember reading a quote from some pro bike racer who said that Coca Cola “can bring you back from the dead.” I thought “yes… I know the feeling.” It is amazing stuff. But as a carbonated drink addict, I try to stick to lemon flavored seltzer or diet ginger ale.

Vincent, I love a good ginger ale with tons of ginger bite. I haven’t found a great diet one for my taste, and most of the commercial ones don’t have enough (or real) ginger for me. There are some smaller brands that do. Unfortunately they are sweetened, so I limit them, but I think I would prefer one to a cola unless the caffeine is a prime need. Last one I had was on Christmas. Don’t know where you live, but I can give you a couple of regional southeast brands to look for that are unreal.

I’ve also gone so far as take a diet (Stevia or Nutrasweet) ginger ale, and then mixed some ground ginger and boiling water (to dissolve the powder), let it cool and add it to the soft drink – that’s how much I like ginger. I also mix in lots of ginger when I cook stir fry chicken and vegetables.

Sorry to get off topic 🙂

H-m-m-m… Sweetened “Pop”. Not Sweetened “Soda”. Must only affect people around the Louisville Pittsburgh area. 🙂

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