As soon as one walks into any supermarket, we are confronted with a huge variety of highly attractive and sometimes even unaffordable drinks. These range from non-alcoholic beverages such as carbonated sodas, sports drinks, energy drinks, artificially-sweetened sodas, fruit juices, and bottled water – all of which are not only mostly unnecessary but can be potentially harmful. Packed milk too can be equally if not more hazardous, and most packaged fruit juices come with sugar or some unwanted chemicals and additives. One thing is certain, by the time you have done your groceries, you are likely to find the healthy veggies only once, but are sure to bump into the drinks again and again right until you finally make the payments. This is by design and not by default and usually quite sufficient to make you throw caution to the winds and actually purchase some of them. But the question remains – which of them is safe or at least less hazardous. We will never have any definitive answers to that question regardless of where we are on this planet.
Let’s start with water. Ever since I was born in Karachi, except for a year that I was in Lahore in 1965-66, we were in the habit of boiling drinking water without fail. This was usually done by one of my parents as they could not afford to entrust our health to domestic help. Some cousins of mine, used to buy and drink plain soda water around the year, obviating the necessity of boiling water. A bottle hardly cost 20 paisas so you could get five bottles in a rupee. Today an imported soda can will cost 500 rupees. However, if I visit Lahore now, even as the guest of the Governor of Punjab, I would not dare to take tap water even over there.
Meanwhile, during the eighties or early nineties, water started coming in bottles commonly known as ‘mineral water’. Till now I have never cared to know which minerals it contains to add to my quality of life. All I know is that in the process of mushrooming of such brands, most have been tested and found to be unfit for human consumption, while the remaining – mostly 3-4 brands of multinational companies – were found to be safe. But given the prevalence of corruption in our society, can we even be sure of those ones? Nevertheless, a faster lifestyle makes bottled water of a reliable brand, one of the few rational choices of modern life.
One thing is certain, by the time you have done your groceries, you are likely to find the healthy veggies only once, but are sure to bump into the drinks again and again right until you finally make the payments.
Scientific literature is usually sprinkled with a number of qualifiers. For instance the authors will say the findings were based on “limited evidence”, or could be influenced by “chance”, “bias” or other “confounders”, and at the end most researchers are asking for more studies; mainly because they are genuinely unsure and sometimes to create a justification for seeking research grants. Either way, they are saying they are not sure about what they are saying. For instance, take the case of aspartame, globally used to artificially sweeten most diet sodas and chewing gums, recently implicated by the World Health Organization in a type of liver cancer. In addition to the usual qualifiers, we are also told that aspartame is actually safe if consumed within the recommended daily limit. Yet they advise not taking it. Even otherwise, countries which taxed sugar sweetened beverages (SSBs), taxed artificially sweetened beverages as well, conscious of the toxic effects of both sorts of drinks.
The issue is not so simplistic either. SSBs are a major source of added sugars in the diet, whose habitual intake is associated with weight gain and therefore a higher risk of not just diabetes but cardiovascular diseases and some cancers as well, besides being seriously implicated in dental caries and erosion. To further complicate problems, SSBs are consumed widely on a global scale by the vast majority of the population, with a high intake of sugar.
In a country like Pakistan where diabetes is estimated to occur in one in six persons (17%) with the third highest prevalence in the world after India and China, it is important to know that it is mostly obesity, hereditary influences or pancreatic disorders, which cause diabetes, not per se what we eat or drink. For a person of normal weight, it is safe to eat or drink anything. But extreme caution is required here – remember it is ten times easier to go from normal weight to overweight and from overweight to obesity than the return journey. So it is better not to be overweight in the first place, tempt the devil and fall into the vicious cycle of obesity and diabetes. Once you are a prediabetic, you may feel more hungry and eat more leading to actual diabetes, which adversely affects almost every part of the body and can make life a living hell. So please avoid fatty or sugary foods and eat less than required while drinking more fluids – which brings us back to what to drink.
Yet everything is not bad! There is some good news for tea or coffee drinkers emanating in the recent scientific literature, of course with the pre-added qualifiers. Both tea and coffee are said to possess the ability to promote health and to prevent, mitigate and even treat numerous disorders such as diabetes, cardiovascular diseases and cancers due to their caffeine content, in addition to some other compounds by fat storage, reduction of appetite, less food consumption and absorption. Tea and coffee are also credited with antioxidant and neuroprotective properties and improved fertility (not that we need it). Tea is also said to protect against stone formation. Caffeine, of course, has a diuretic effect and increases the urinary excretion of calcium, which needs to be compensated. Green and herbal teas taken sensibly have lower oxalate content and carry a lower risk for stone formation. Moderation is, however, of essence to the use of all caffeinated drinks to avoid restlessness, insomnia or certain cardiac disorders. The addition of milk may neutralize some of their positive aspects. Also as is generally known, more caution is necessary in pregnant or postmenopausal women, to guard against most chronic diseases. Here I must make mention of a surge of products with synthetic caffeine additives, such as energy bars and drinks that are becoming increasingly popular and may have serious toxic effects identified in the future. As regards alcoholic drinks, these were effectively banned in Pakistan ever since July 1977, hence the vast majority of our population is not exposed to their detrimental effects.
Lastly, in our country context, I cannot overemphasize the need to purify drinking water at the household level to reduce bouts of diarrhea that lead to a lot of preventable mortality in infants and children under-5. This can be all the more problematic in humanitarian disasters such as droughts or flooding. But the overarching question remains – what should we drink?
The writer is a senior public health and policy specialist and can be reached at [email protected]