Scientists have compiled a rating of drinks for patients with diabetes

The debate about which drinks are the most harmful does not subside. Candidates are sweetened sodas, fruit juices, milk, coffee… A new study by scientists published in the medical journal BMJ has presented a curious ranking of the health risks of popular drinks in descending order based on studies conducted among people with type 2 diabetes. They tried to understand which of the drinks regularly present in the diet had the greatest impact on complications and mortality, and came to surprising conclusions.

The spread of type 2 diabetes mellitus (DM) in the world has long been recognized as a non-communicable pandemic, and the army of patients continues to grow at an alarming rate. In 2021, there were about 537 million adults with diabetes and this number is projected to increase to 783 million by 2045. In Russia, according to expert estimates, at least 10 million people have type 2 diabetes, and about 5 million more are at the stage of prediabetes (the disease has not yet come, but everything is leading to this).

No one doubts the reasons: the lifestyle of modern people, which is based on malnutrition and physical inactivity, leads to an increase in obesity, which someday develops into type 2 diabetes. Adults with type 2 diabetes, however, are at increased risk for cardiovascular disease (CVD), kidney disease, other health problems, and premature death.

Diet for such patients is the basis of safe life. Suffice it to say that the same prediabetes is a reversible condition if a person finds the strength to eat right and lead an active lifestyle. In patients already diagnosed, diet plays a critical role in managing blood sugar levels. And not only the food that makes up the diet is important, but also the drinks.

It is the role of beverages in the diet of such patients and their impact on disease outcomes and mortality in adults with diabetes that the authors of a new paper in The BMJ decided to evaluate. The study was conducted among 15,486 US health workers diagnosed with type 2 diabetes mellitus for an average of 40 (!) years. All cases of lethal outcomes and the frequency of cardiovascular diseases and mortality from them were studied. Every 2-4 years, volunteers filled out questionnaires on the topic of what they drink most often. The categories considered were: drinks with added sugar (caffeinated cola, decaffeinated cola, fruit punch, soft drinks, soft drinks); drinks with sweeteners (all of the above, but with sugar substitutes); fruit juices; tea; coffee (with and without caffeine); milk (skimmed, 1%, 2%, whole); water. Based on the analysis of the data, each category of drinks was assigned risk ratios for mortality from all. Drinks with added sugar and whole milk received the highest coefficient (1.2 each). Fruit juices moved into second place (0.98), followed by drinks with sweeteners (0.96). This is followed by skimmed milk (0.88), tea (0.79), water (0.77) and finally coffee (0.74). Similar results were obtained for the risk of cardiovascular disease. Curiously, if, after diagnosis, the patient refused drinks with added sugar and switched to drinks with sweeteners, or refused both; if they stopped drinking whole milk and fruit juices and started drinking tea, water, and coffee instead, the risks were reduced. Strongest of all – for … coffee!

The scientists’ conclusion: Higher consumption of sugar-sweetened beverages is associated with a higher risk of all-cause mortality and cardiovascular disease in people with type 2 diabetes. In contrast, consumption of coffee, low-fat milk, and plain water is associated with lower CVD morbidity and mortality in this population. Increased coffee consumption after diagnosis is separately associated with reduced mortality.

Previous research has already shown that higher consumption of sweetened beverages is associated with an increased risk of weight gain, type 2 diabetes, and all-cause mortality and cardiovascular disease. And consumption of coffee, tea, and plain water is associated with a lower risk of CVD, type 2 diabetes, cancer, and mortality in the general population. With milk, things are not so clear: consumption of whole and full-fat milk is associated with an increased risk of all-cause mortality, CVD and cancer. In contrast, low-fat milk reduces the risk of type 2 diabetes and stroke.

Some researchers suggest that the high fructose content of sweetened beverages may be a key contributor to adverse health effects (weight gain, insulin resistance, and inflammation). In contrast, coffee and tea contain beneficial bioactive compounds such as chlorogenic acids, melanoidin, and catechins, which have antioxidant and anti-inflammatory properties and may help reduce oxidative stress and inflammation. The authors of the work come to the conclusion that it is necessary to develop separate recommendations for the use of drinks in patients with type 2 diabetes.

And although this study concerns only this group of patients, it is not difficult to guess that they may be relevant for everyone. Especially encouraging is the news about coffee, which, according to this work, turned out to be more useful than even water, about which scientists have never had any disputes at all. According to Olga Grigoryan, a well-known nutritionist and leading researcher at the Russian Academy of Medical Sciences, the body needs coffee: “It is a good adaptogen for the body. We need products with substances that increase performance. In addition, we, doctors, today are promoting the receipt by Russians of stimulants of natural origin – no pills, no injections, no cola, which has a shaking effect on the nervous system and quickly causes the development of fatigue. There is modern data from researchers about the benefits of coffee. Cardiologists have stopped forbidding coffee to people with hypertension and allow them to drink 3-4 cups a day of a natural drink that improves blood oxygen saturation and normalizes blood circulation in the body.”