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Post edited 11:32 pm – January 25, 2010 by odo

For those of you who like to read medical reviews – Cut & pasted from Medscape:

January 15, 2010 — Excessive intake of fructose, a common sweetener in soft drinks, can induce features of metabolic syndrome and may be a risk factor for chronic kidney disease, according to the findings from two studies.

The results of both studies suggest that these adverse effects are mediated, at least in part, through elevations in uric acid levels.

“Excessive fructose intake causes metabolic syndrome in animals and can be partially prevented by lowering the uric acid level,” Dr. S. E. Perez-Pozo, lead author of the first study, and colleagues note. “We tested the hypothesis that fructose might induce features of metabolic syndrome in adult men and whether that is protected by allopurinol.”

The researchers' study, reported in the December 22nd online issue of the International Journal of Obesity, featured 74 adult men who were randomized to receive 200 g fructose daily for 2 weeks without or without allopurinol. Primary endpoints included changes in ambulatory blood pressure, lipid levels, glucose and insulin, homeostatic model assessment (HOMA) index, body mass index, and criteria for metabolic syndrome.

Fructose intake was associated with an average increase in systolic and diastolic blood pressure of 7 and 5 mm Hg, respectively (p < 0.004 and p < 0.007, respectively), Dr. Perez-Pozo, from Son Llatzer Hospital–Palm of Majorca, Spain, and colleagues report.

Mean fasting triglyceride levels rose by 0.62 mmol/L (p < 0.002), while high-density lipoprotein cholesterol levels fell by 0.06 mmol/L (p < 0.001).

Although plasma glucose levels did not change, a significant increase in fasting insulin and HOMA indices was observed. Depending on the criteria used, the prevalence of metabolic syndrome increased by 25% to 33%.

Allopurinol treatment reduced uric acid levels and prevented the increase in blood pressure. In addition, it reduced levels of low-density lipoprotein cholesterol. Although allopurinol did not reduce HOMA or fasting triglyceride levels, it did help stave off newly diagnosed metabolic syndrome (p = 0.009).

The results “suggest that the primary effect of lowering the uric acid level on the metabolic syndrome induced by fructose is to reduce the blood pressure elevation,” the authors conclude. “It remains possible that the lowering of uric acid level might be beneficial on lipids and insulin resistance if postprandial levels were targeted as opposed to fasting levels,” they add.

In the second study, published in the December 23rd online issue of Kidney International, Dr. Andrew S. Bomback, from Columbia University College of Physicians and Surgeons, New York, and colleagues assessed the impact of sugar-sweetened soda intake on the risk of hyperuricemia and reduced kidney function. They analyzed data from 15,745 patients in the Atherosclerosis Risk in Communities Study who completed dietary questionnaires at baseline and had levels of creatinine and uric acid measured.

On cross-sectional analysis, consumption of more than 1 soda per day increased the odds of hyperuricemia by 31% relative to intake of less than 1 soda per day. Likewise, such intake was associated with 46% increased risk of chronic kidney disease, defined as an estimated glomerular filtration rate of <60 mL/min per 1.73 meters-squared. In subjects with uric acid levels over 9.0 mg/dL, intake of more than 1 soda per day increased the risk of kidney disease by 159%.

By contrast, on longitudinal analysis, high soda intake was not linked with hyperuricemia or chronic kidney disease at either 3 years or 9 years, the findings indicate.

Given that only the cross-sectional analysis showed a significant association between soda intake and hyperuricemia/chronic kidney disease, “our findings add to but in no way close the heated discussion over the potential dangers of sugar-sweetened soda,” the authors conclude.

Int J Obesity. Published online December 22, 2009.

Kidney Int. Published online December 23, 2009.

Clinical Context

Study Highlights

• The objective of the study by Bomback and colleges was to examine whether drinking soda is associated with hyperuricemia and/or reduced renal function in a large biracial cohort.
• Chronic kidney disease was defined as estimated glomerular filtration rate less than 60 mL/minute/1.73 m².
• The study cohort consisted of 15,745 patients in the Atherosclerosis Risk in Communities Study who completed a dietary questionnaire at baseline and who had measurements of serum creatinine and uric acid.
• At 3- and 9-year follow-up, the investigators calculated multivariate odds ratios from logistic regressions for binary outcome of hyperuricemia and chronic kidney disease.
• Prevalence rate of chronic kidney disease was 3% and incidence rate 8% in this cohort.
• There was no association between increased soda consumption and either microalbuminuria or macroalbuminuria.
• In cross-sectional analyses, drinking more than 1 soda per day was associated with increased odds of prevalent hyperuricemia and chronic kidney disease vs participants who drank less.
• In stratified analysis, the association between soda and kidney function became more pronounced as uric acid levels increased.
• Among participants who drank more than 1 soda per day and had serum uric acid levels higher than 9.0 mg/dL, odds ratio for chronic kidney disease significantly increased to 2.59.
• However, longitudinal analyses showed that drinking more than 1 soda per day was not associated with incident hyperuricemia or chronic kidney disease.
• The lack of association between soda drinking and incident chronic kidney disease was not affected by preexistent hyperuricemia or by development of hyperuricemia.
• Post hoc power analyses showed a greater than 80% power to detect a 6.5% higher incidence of hyperuricemia and a 3% higher incidence of chronic kidney disease in participants who drank more than 1 soda per day vs those who drank less than 1 soda per day.
• On the basis of these findings, the investigators concluded that high consumption of sugar-sweetened soda was associated with prevalent but not incident hyperuricemia and chronic kidney disease, adding to but not closing the ongoing debate regarding the potential dangers of sugar-sweetened soda.
• Limitations of this study include its reliance on dietary recall, observational design, unmeasured confounding, possible survival bias, and lack of detailed information on participants' medications and on heavy metal exposure.

Clinical Implications

• In the Atherosclerosis Risk in Communities Study, cross-sectional analyses showed that drinking more than 1 soda per day was associated with increased odds of prevalent hyperuricemia and chronic kidney disease vs participants who drank less. The association between soda intake and renal function became more pronounced as uric acid levels increased.
• Longitudinal analyses showed that drinking more than 1 soda per day was not associated with incident hyperuricemia or chronic kidney disease. The lack of association between soda drinking and incident chronic kidney disease was not affected by preexistent hyperuricemia or by development of hyperuricemia

I used to drink a lot of soda (4+ cans per day) and this last year I gave it up entirely which is when my Gout appeared. I wonder if the two are directly related. I've really tried to get rid of all HFCS from my diet but with all the products it is in these days it's tough to get rid of it entirely. You pretty much have to go almost entirely all unprepared foods you do yourself.

This has puzzled me too, as I recently started a high fruit & veg regime where my SUA fell pretty well.

Like with honey , used in health remedies versus refined sugar which has all micronutrients removed , a natural diet of raw fruit  etc. will have many co-factors which the body uses to process the essentials. For instance, pectin- in apples and pears, is reported to help with vascular health by scavenging the results of inflammations that would lead to plaque build up.

Processed & sugary food is the modern killer via  long, slow process that is catching the headlines more and more via childhood obesity figures alone.

Post edited 12:55 pm – February 9, 2010 by trev

Interesting link- What on earth are we drinking when we go out to enjoy ourselves?

Over 1.2%  alcohol, for sure!

This from a search on alkalising factors [smartbodyz.com]

“Bananas, oranges, potatoes and melons are must-staples of athletes' general diet due to their high potassium content.  Yes, they contain sugar, however, it's in a complex carbohydrate form (less inflammatory) that is a longer lasting fuel for the exercising muscle.  They alkalize once consumed, however, baking soda water is a stronger and more direct alkalizing agent and may mean the difference between 1st and 2nd in an athletic event.”

I'm cautious about Soda supplements- but am happy to take wine in Spritzer' format by mixing with double soda water. a good compromise..

Cheers!

I think most problems with Vit C [if substantiated] are due to levels higher than normal ingestion through fruit.

The amount in fruit is small compared to supplements. I never megadose with any vitamin to be on the safe side- it can make the body lazy anyway and are often chemical analogues rather than as nature would provide.

Post edited 4:20 pm – April 29, 2010 by zip2play

nokka said:

I don't drink many carbonated soft drinks, but when I do they are of the 'diet' varirty. So, Diet Coke and the like. Am I right in believing these kinds of drinks are not an issue as they don't include the sweetener ?

Me too…nothing but Diet Soda, a can a day. FAVES are PepsiONE and CokeZERO but I mix  it up with Diet Crush, Mug Root beer, Birch beer, etc.

I haven't had a REAL soda in 20 years except for the occasional gin and tonic in the very occasional bar. For some reason until this year ALL Diet Tonic was sweetened with saccharine which I despise like poison…I can taste one sip for the rest of the day. But they smartened up and now most have switched over to ASPARTMANE+ACESULFAME as sweetners…and it tastes good. (Acesulfame is what makes my PepsiONE so good…but some people HATE it…go figger,)

Nokka, I agree that the diet sodas are sucrose, fructose, and glucose free so not an issue.

I really cannot fathom why ANYBODY would drink that sticky syrupy sugar-filled high calorie stuff called “REAL” soda.