Bad Coke Habit

Things don’t go better with Coca Cola. At all.

A growing body of evidence puts the Atlanta-based ‘total beverage company’, and rivals PepsiCo and Keurig Dr Pepper, close to the centre of global declining health. Even the CDC, a conservative body currently under timely revision by Bobby Kennedy’s Make America Healthy Again movement, concedes that sugar-sweetened beverages (SSBs) are the leading source of added sugars in the American diet, and that people who consume these regularly are more likely to develop non-communicable diseases (1).

The situation is broadly similar in Mexico (2), Canada (3), and almost everywhere else around the globe (4). Coke is teaching the world to sing, on their way to the grave, years before their time and consuming unholy amounts of health care as they go.

If anything, PepsiCo and JAB Holdings, who own Keurig/Dr. Pepper, are worse. They pair their drinks with a portfolio of ultra- processed junk foods, selling a dual insult to a sickening planet.

A new study from Tufts University in Boston (5) suggests that approximately one in 10 new cases of Type 2 diabetes and one in 30 new cases of cardiovascular disease are linked to SSBs. The authors calculated that between 1990 and 2020 Coke, Pepsi, Dr Pepper and their fellow poisoners were responsible for approximately 12.5 million years of healthy life lost to disease.

The major soft drink companies are a sub-set of Big Food, but to simplify matters I will refer to them hereinafter as Big Gulp.

Growing awareness of health issues in the developed nations and pending regulatory initiatives (7) have contributed to flat or declining domestic sales. Following in the footsteps of their nicotine-stained cousins, Big Gulp are now pushing their product into emerging markets where populations are still susceptible to aspirational Western brands.

Developing nations including Colombia, Mexico, and South Africa are among the hardest hit. In Colombia, half of new diabetes cases and a quarter of new cardiovascular disease cases have been linked to SSB consumption (6).

In regional terms, Latin America is among the most victimised. Badly infected by Coca-colonisation, economic losses due to increased health care spending and lost productivity in the period 2030-2050 are predicted to soak up 4% of the entire area’s GDP (6). The Middle East is almost equally damaged (7).

And then there is kidney and liver disease (8).

Free sugars are a known risk factor for fatty liver disease, more correctly metabolic dysfunction-associated steatotic liver disease or MASLD (8-10). According to new UK Biobank research which is still in poster form (11), a single can of an SSB is enough to raise the risk of MASLD significantly. And this fits the Tufts data quite well, because ..

.. MASLD increases the risk of Type 2 diabetes (12), cardiovascular disease (13) and renal disease (14). Conversely, diabetes increases the risk of cardiovascular disease (15) and MASLD (16). Together, these conditions form an interactive pathology termed Cardio-Renal-Liver-Metabolic Syndrome (17). This morbid network involves insulin resistance, chronic inflammation, dysbiosis and dyslipidaemia, and is largely driven by diet with a side-helping of inactivity.

From a mechanistic / pharmaconutritional perspective, this makes perfect sense.

Drinking 10% sugar solutions creates glycemic spikes in the blood. These glycemic spikes drive inflammation (18-21), vascular damage (18), dyslipidaemia (21-23) and dysbiosis (23, 24). There is also good evidence that prolonged insulin signalling (too many SSB’s, especially in the context of a high GL diet) leads to insulin resistance (25, 26), which switches on down-stream inflammatory cascades (27). This in turn is likely to increase the risk of a range of clinical inflammatory disorders (28-32).

A sedentary lifestyle makes all the above connections worse (23-36).

This is why Cardio-Renal-Liver-Metabolic Syndrome now affects the majority of US adults, with over 90% showing signs of impaired cardiometabolic health (37). But there is a paradox buried in these weeds.

The Tufts study (5) excluded zero-calorie artificially sweetened drinks from their analysis and ascribed the increase in cardiovascular and diabetic disease to SSBs. The British BioBank study (11), on the other hand, found that switching to artificially sweetened zero-calorie drinks was associated with a higher risk of liver damage.

This was a large study; 123,788 ‘healthy’ subjects were followed for 10.3 years. However, size isn’t everything.

MASLD is an independent risk factor for cardiovascular disease, diabetes and renal disease (12-14). If the Biobankers were right you would expect the intense sweeteners, a very diverse group of molecules, to be linked to increased death from multiple causes in humans. Considering that roughly 1 in 4 Americans consume low-calorie drink products (38), the number of deaths linked to these compounds should be substantial and the connection clear – but they are not, and it is not.

The BioBank folk found an association between consumption of sweeteners and MASLD, but no causative link, and their suggested mechanisms of action seem implausible. The authors mention insulin responses (but these are larger with sugar); dysbiosis (but this is already extremely prevalent (39-41); and increased sweet cravings (but sugar consumption in the UK is in long-term decline (42).

Their last and rather undigested theory is that sugary drinks may replace healthier options, resulting in people missing out on essential nutrients. This can lead to malnutrition, weight gain, and inflammation.’ Well, duh. Look around you. This is the very definition of the post-transitional landscape …

I think it is more likely that consumers of zero-calorie beverages were choosing them because they were already overweight, or had glycemic control issues (see also 30, 31, 43). I admit that I can’t prove this, which illustrates a more general point; association may not be causation, especially if there is no plausible mechanistic link. Consider, for example, the diet soda / dementia link.

A 2017 paper (44) found that drinking diet soda (but not SSBs) was associated with an increased risk of stroke and dementia. More recently, the Northern Manhattan Study (NOMAS) discovered a four-fold increase in the risk of developing dementia, among dementia-free individuals, in those who may have consumed more than one diet soda per day for a decade (43); but here again, the SSBs came out as innocent.

Convinced now that sweeteners are the root of all evil? You shouldn’t be. In the NOMAS trawl, the increased risk showed in whites and blacks but not Hispanics. That’s a major red flag, and the NOMAS findings were further weakened when excluding diabetes and obesity removed the association altogether.

My message to non-scientists would be, don’t let your hatred of intense sweeteners cloud your judgement. The mechanistic evidence that sugar spiking is bad for you is extensive, while that for the artificial sweeteners is diffuse at best. NO MÁS conexiones sin mecanismo!

In the meantime, should we continue to allow SSBs to flood our markets? The social costs, after all, are huge (6, 7). The more Pepsi and coke thrive, the more we die.

Various regulatory bodies monitor different aspects of food safety. In the United States these are the FDA, the USDA’s Food Safety and Inspection Service, and the CDC. None of them did anything until, last year, Bobby Kennedy and the MAHA movement forced their hands. Waivers have now been approved for 18 states to prevent SNAP card benefits from being used to purchase SSBs and other junk foods (45).

I wish MAHA well but sadly, I doubt this will work.

SNAP cards will be used to make healthier purchases that will subequently be bartered for the ultraprocessed foods that so many are addicted to. Big Food and Big Gulp will lobby politicians, who prioritise cash over constituents, to restore SNAP privileges. Liberals will howl about the loss of freedom to maintain a junk food habit, and being coerced to lead healthier lives. (And I do see their point, up to a point.)

But the food market is being changed anyway, by the GLP1 agonists.

The side effects of Mounjaro, Wegovy et al include a sharp decline in junk food consumption. There has been a fall of 10% in snack categories and fast foods with a shift to proteins, yoghurt, fruit and veg (46, 47). And it will likely continue; by 2034, one in five US adults are predicted to be using a GLP-1 agonist (46, 47).

Big Food and Gulp worry about lost revenue, changing production lines and new reasons for mergers and acquisitions (48). The companies behind them, however, aren’t concerned.

Coca-Cola and JAB are their own thing, but lurking behind Pepsi are the usual suspects: Black Rock, Vanguard, and State Street, the same people who effectively own healthcare and the pharmaceutical industry (49). What they lose on the swings, they will gain on the roundabouts. After all, they own the playground.

They have unlimited funds, and they have time. They know that the majority of GLP-1 users stop their medication within the first 12 months, mostly because of cost and side effects (50). Once these consumers stop there is accelerated weight gain, and all their cardiovascular risk markers rebound (51-53). Followed by another cycle of Wegovy, weight loss and regain, another step towards sarcopenia (54), debility, further drug dependence and an early death.

The sick interdependency of food and pharma is very clear in this instance. Big GLP-1 is the spawn of Big Gulp.

This mouth-watering market will be expanded by the next generation, who Big Gulp targets relentlessly (ie 55-57). Thanks to this aggressive targeting 30% of US adolescents now have prediabetes or type 2 diabetes (58) and a reduced health expectancy which no drugs will be able to prevent.

To escape this singularly vicious circle will require extensive re-imagining and re-structuring of the food and health landscapes. I have dedicated the last half-century of my life towards these twin goals, and will continue the struggle for whatever time I have left.

References

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