Beyond the sugar: Chemicals in sodas and their link to systemic diseases and oral health

By Sarah Biggs, Jeni Dunn, May Yao

Soda consumption in the United States has been on a steady rise since the 1940s. Along with the increased consumption over time, there has been an increase in illness and disease that has plagued our society. Soft drinks contain many deleterious chemicals that have been linked to systemic diseases such as obesity, type II diabetes, osteoporosis, depression and anxiety, kidney failure, cirrhosis, and cardiovascular disease among others.

According to Leis-Keeling (2010), annual United States production of carbonated soft drinks was 90 eight-ounce servings per person in 1942. Even though the American Medical Association suggested people to limit their intake of sugar from soft drinks, the consumption of soft drinks continued to rise throughout the decades. A recent Gallup Poll revealed that 48% of Americans drank soda daily and the average daily intake was 2.6 glasses (Saad, 2012).

With the tremendous increase in consumption of soft drinks, numerous studies were conducted on the possible relationship between soft drink intake and health problems. There was an increase in the intake of soft drinks that contributed to the sweeping increase of obesity, renal disease, osteoporosis, type-II diabetes, non-alcoholic fatty liver disease, and cancer, among others. In addition to these systemic diseases, soda consumption also brought out issues on risk-taking behaviors in adolescents (Ziegler & Temple, 2015).

This paper reviewed current findings on the outcome of soft drink consumption and revealed how the ingredients in soft drinks impacted both physical and behavioral health of consumers. Current modifications of soft drinks on the market will also be discussed.

Ingredients

Soft drinks typically contain carbonated water, high fructose corn syrup (sugar), caramel color, caffeine, phosphoric acid, citric acid, natural flavors, carbon dioxide, organic diol, and Brominated vegetable oil (BVO), in addition to many others (Leis-Keeling, 2010).

High fructose corn syrup

High fructose corn syrup (HFCS) was widely used in soft drinks because it was less expensive than sucrose. However, fructose was rarely consumed alone and was usually consumed in sugar-sweetened beverages with sucrose (Hu & Malik, 2015). HFCS goes through an enzymatic process to raise the fructose level. It was then combined with cornstarch, which was pure glucose. The most frequently used high fructose corn syrup used in soda was HFCS 55, meaning it was roughly 55% fructose and 45% glucose and the taste was equivalent to table sugar (Leis-Keeling, 2010).

Systemic effects linked to high fructose corn syrup: Glucose could be broken down by any cell in the body. Also, muscle cells and the liver could store glucose to be used at a later time. The liver quickly metabolized fructose and contributed to greater triglyceride synthesis, which increased the fat stored in the liver. This could increase cardiovascular issues and could lead to a greater risk of developing non-alcohol fatty liver disease, which plagued 20-30% of adults in developed countries. This condition could lead to increased death rates from liver cancer, cirrhosis, and even cardiovascular disease (Leis-Keeling, 2010).

There was a large discrepancy on the ample use of HFCS and the systemic effects it had on the body. However, research claimed high fructose diets helped contribute to conditions such as diabetes, high blood pressure, kidney stones, gout, chronic diarrhea, and other functional bowel issues, as well as obesity (Leis-Keeling, 2010).

Obesity linked to high fructose corn syrup: If an individual consumed just one soda a day without reducing other calories in one’s diet it would lead to an increase of 15 pounds per year (Leis-Keeling, 2010). Obesity affiliated deaths were responsible for 3.4 million adult deaths per year, which breaks down to 44% attributed to diabetes, 23% attributed to cardiovascular disease, and 41% attributed to cancer. Research has proven a great link between obesity and esophageal, colorectal, pancreas, breast, kidney and endometrial cancers (Charrez, Qiao, & Hebbard, 2015).

Cardiovascular disease linked to high fructose corn syrup: According to Hu & Malik (2015), there is great evidence that sugar sweetened beverages (SSB), including both fructose and glucose, created a greater risk of developing high blood pressure, inflammation, stroke, and coronary heart disease. A study of 88,000 females followed for 24 years found that the women who drank two or more servings a day were at a 35% greater risk of a heart attack or fatal heart disease when compared to women who were infrequent SSB consumers.

A different study followed 84,085 women and 43,371 men for 20-plus years. They found a 16% greater risk of having a stroke with those who consumed one or more SSB compared to those who do not drink SSB.

Gout linked to high fructose corn syrup: Increased blood levels of uric acid, or hyperuricemia, caused from high fructose sweetened drinks, raised the likelihood of one developing the painful joint disease known as gout. One study followed more than 46,000 men, with no history of gout, over the course of several years. The results showed a strong relationship between a high risk of developing gout and drinking sweetened soda and fructose. Furthermore, a different study concluded that fructose was linked to an increased development of kidney stones (Leis-Keeling, 2010).

Diabetes linked to high fructose corn syrup: A 26% increased risk of developing diabetes was found in a study of 310,819 individuals who consumed one to two servings of SSB daily when compared to individuals who rarely (non or less than one serving a month) consumed SSB (Hu & Malik, 2015). In an eight-year study of 91,249 women it was found that those who drank one or more sodas a day were two times more likely to develop diabetes than those females who drank less than one soda a month (Leis-Keeling, 2010, p.15). Hence, the way fructose was metabolized by creating excess triglycerides, unfortunately, lead to cirrhosis and insulin resistance, which in turn lead to diabetes and heart disease (Hu & Malik, 2015).

Systemic Effects of Diabetes

Increased fructose consumption was linked to negative health complications of diabetes such as increased glycation leading to aging and kidney, vascular and ocular conditions (Leis-Keeling, 2010). Diabetes could contribute to other complications in the body, for example, a weakened immune system, which made it difficult for the body to fight infection. It could also lead to skin infections such as boils, tuberculosis, urinary tract infections, and acanthosis nigricans, hyper-pigmented skin and velvety-textured plaques, which could appear in the folds of skin on the body such as the neck and hand area (Ibsen & Phelan, 2014)

Oral Manifestations of Diabetes

As reported by Ibsen & Phelan (2014), oral manifestations that were usually seen in poorly controlled diabetes include increased candidiasis, mucormycosis, which was a fungus that affected the palate and sinuses, parotid gland enlargement, burning mouth or tongue, dehydration which could lead to xerostomia that could have helped contribute to the formation of dental caries and partial dysgeusia.

Patients with diabetes had an aggregated response to plaque. Overgrowth of gingiva could have occurred, along with sudden abscesses, extravagant bone loss, tooth mobility and early tooth loss. Periodontal disease was also more likely in individuals that had diabetes. Infections irritated the diabetes and it created a dangerous cycle where the likelihood of infection was increased.

Cirrhosis linked to high fructose corn syrup: Non-alcohol fatty liver disease, also known as cirrhosis, was caused by increased amounts of triglycerides that scarred and damaged the liver. The scarred liver interfered with normal functions of the liver, such as purifying blood processes, and imperative nutrient making, for example, a vitamin D deficiency, known as oesteomalacia. Many oral manifestations could be caused by cirrhosis, for instance, bleeding conditions, yellowing of the skin, halitosis, cheilitis, smooth tongue, dry mouth, bruxism and crusted dermatitis (Ibsen & Plelan, 2014, Cirrhosis, 2016; Cruz-Pamplona, Margaix-Munoz, & Sarrion-Perez, 2011).

Aspartame

Aspartame is the number one sweetener used in diet sodas. It is about 180 times sweeter than sugar, but without the calories. When consumed, aspartame was broken down into “phenylalanine, aspartic acid, methanol which further produces formaldehyde, formic acid and diketopiperazine.” Some people did not have the ability to metabolize phenylalanine and should have refrained from ingesting aspartame because it possibly could have caused seizures and mental retardation (Leis-Keeling, 2010, p.20)

Systemic effects of aspartame: Likely side effects from aspartame ingestion could have been confusion, loss of memory, facial pain, restless legs, tremors, seizures, weight changes, parasthesia, depression, irritation, aggression, anxiousness, loss of hearing, ringing in the ears, slurred speech, dry eyes, itching, intense premenstrual syndrome, and changes in menstruation (Leis-Keeling, 2010).

In 1985, Dr. Adrian Gross, a toxicologist for the FDA, informed Congress that “without a shadow of a doubt, aspartame can cause brain tumors and brain cancer.” Before long, a new FDA commissioner was appointed, who in fact approved the use of aspartame for the public. The acceptable daily intake of aspartame was 50mg/kg. This meant a 120 pound woman could have consumed roughly 15 cans of diet soda a day before being in danger of consuming the acceptable daily intake of aspartame. This type of excessive diet drink consumption would rarely happen.

However, there are 6,000 other foods and drinks that could also contain aspartame. It could take about 300 days for aspartame to metabolize in the body when the pH is 4.3. For individuals that consumed aspartame continuously, the sweetener would continue to accumulate in the body with the body never having the ability to rid itself of the artificial sweetener (Leis-Keeling, 2010).

Kidney function decline linked to aspartame: A study of over 3,000 women concluded consuming two servings or more of artificially sweetened soft drinks a day was significantly linked to more rapid renal function decline in older women and doubled the risk of kidney function decline (Lin & Curhan, 2010).

Type II diabetes linked to aspartame: A 14-year study of over 66,000 women found increased amounts of regular and diet soft drinks was linked with a greater increase of acquiring type II diabetes. It was found that there was an even greater risk with diet soft drinks. The artificial sweetener, aspartame, produced an influx of glycemia, having raised the insulin levels more so than sucrose, which lead to an increased risk of diabetes (Clavel-Chapelon & Fagherazzi, 2013).

Non-Hodgkin lymphoma, multiple myeloma, and leukemia linked to aspartame: A study that compared increased diet soda consumption of one or more servings a day to no diet soda intake found a link to a greater risk of non-Hodgkin lymphoma (NHL) and multiple myeloma. Not only did aspartame in diet sodas contribute to NHL and multiple myeloma, it was also found that a greater risk of leukemia existed in those who consumed higher amounts of diet soda compared to those who consumed smaller amounts (Aune, 2012).

Non-Hodgkin lymphoma can manifest in the mouth as necrotic, ulcerated or nonulcerated tumors. Multiple myeloma, a cancer of plasma cells that caused abnormal areas in the bones, was normally painful. Affected weakened bones could have easily fractured due to the damage caused by the over growth of neoplastic plasma cells. The lower jaw was commonly more affected than the maxilla (Ibsen & Phelan, 2014).

Leukemia, a cancer of the blood that produced an abundance of irregular white blood cells have caused fatigue, anemia, thrombocytopenia, fever, swollen lymph nodes, loss in weight, swollen spleen and liver. Oral manifestations included gingival hyperplasia, ulcerative necrotizing gingivitis, gums that bled easily, pale lips and gums, toothaches caused by leukemia cells in the pulp, and irregular periodontal disease (Ibsen & Phelan, 2014).

Caffeine

Caffeine, a stimulant, is one of the major ingredients in sodas. In the United States, consumption of sodas with caffeine had been on an increase for years. Due to the gastric upset that was caused by coffee, many people began drinking caffeine-containing soft drinks in place of coffee, in order to get the same benefits that the caffeine in coffee gave, but without the adverse gastrointestinal effects.

The amount of caffeine in sodas was much less than that in coffee in terms of amount per serving, but people were drinking more ounces of sodas than they did coffee, typically 12 ounces versus six to eight ounces (Kuhn, Swartzwelder, Wilson, Wilson, & Foster, 2014). The amount of caffeine in a 12-ounce soda ranged from 20-50 mg per serving, as compared to 75-150 mg per eight-ounce cup of coffee (Kuhn et al., 2014).

Caffeine metabolized through the body: Caffeine, most often always taken by mouth, moved through the body and was metabolized in a certain way. First, it entered the oral cavity and was then slowly absorbed into the blood through the linings of the stomach. Most was absorbed in the next phase through the gastrointestinal tract. Once it reached the small intestines, most all of the caffeine consumed had been absorbed through the body.

Distributed evenly throughout the body, once the caffeine was fully absorbed, it took 30 to 60 minutes before the full effects were experienced throughout the body. The amount of food in a person’s system and how much soda was consumed influenced the time it took for the effects to take place. The direct effects that caffeine have had on a particular system in the body intensified or diminished the indirect effects on a system (Kuhn et al., 2014).

After absorption, caffeine was metabolized through the liver, excreted by the kidneys, and disposed of fairly slowly. When consumed in the morning, it took roughly three hours for caffeine to decrease by half of its original concentration. Therefore, the affects of drinking a soda containing caffeine could remain in one’s system well into the afternoon. Consuming a second soda in the afternoon would be adding to the remaining amount of caffeine in the body. Individuals who consumed soda throughout the day would likely feel jittery from the compounded effects of caffeine by the day’s end (Kuhn et al., 2014).

Effects of caffeine on the brain: According to Kuhn et al. (2014), adenosine receptors, found in the brain as well as throughout the body, in blood vessels, fat cells, the heart, kidneys, and smooth muscle were neurotransmitters blocked by the impact of caffeine. Adenosine, when bound to adenosine receptors, reduced activity of the brain, having a sedative effect. The action of caffeine was to block these neurotransmitters, enabling them to produce a sedative effect. Caffeine intake at moderate doses of about 200 mg, which would be equivalent to about four or five 12-ounce sodas, has been shown to arouse the brain. Caffeine actually lowers blood flow to the brain, which seems contradictory considering how powerful its stimulatory affects could be. Caffeine would always produce a decreased blood flow to the brain, no matter how little or infrequent the consumption. It produced the same affect in heavy and light caffeine users.

Systemic effects of caffeine: Caffeine has also been known to affect other parts of the body, such as the kidneys. Caffeine acted upon the adenosine receptors in the kidneys, which produced diuretic effects, causing an increased urine production. Lower birth rates have also been reported in some studies in relation to women having consumed caffeine during pregnancy, as well as a significant reduction in becoming pregnant.

Caffeine has also been known to exacerbate normal stress responses, as it increased adrenaline in the body during stressful situations. Caffeine and stress produced a synergistic effect as they produced an increase in bodily stress more so than caffeine or stress did alone. In moderate amounts, and in healthy individuals, caffeine is generally not harmful to the body, although in most people it has produced the unwanted side effects of jitteriness, nervousness, and gastric upset (Kuhn et al., 2014).

In 2015, a study was published that followed nine- and 10-year old girls for 10 years, which compared the impact of consumption in caffeinated soft drinks versus decaffeinated soft drinks. It was found that girls who consumed caffeinated soft drinks were at a higher risk for starting their first menstrual cycle early, whereas those girls who drank decaffeinated soft drinks were not at the same risk. According to this report, evidence has shown that early menarche was correlated with many different types of chronic diseases, including hormone-related cancers, type II diabetes, cardiovascular disease, and nonalcoholic fatty liver disease (Mueller et al., 2015).

Oral manifestations of caffeine: While it is clearly evident that caffeine had effects throughout the body, these systemic effects, in turn, have had effects on the oral cavity. As previously mentioned, caffeine has been linked to early menstruation, which produced oral manifestations.

Menstruation has been associated to an increased risk of recurrent aphthous ulcers. There were painful oral ulcers, also known as canker sores or aphthous stomatitis, that occurred more frequently in women than men (Ibsen & Phelan, 2014). The hormonal affects of menstruation have also been known to manifest themselves orally through recurrent herpes simplex infection, also known as cold sores or fever blisters. These clinical manifestations are triggered by stimuli, such as menstruation, that have initiated these viral immunologic changes (Ibsen & Phelan, 2014). Menstruation may have also caused an amplified response to local irritants, as well as gingival tissue that bled easily (Wilkins, 2013).

As mentioned above, caffeine increased bodily stress, which had numerous implications that affected the oral cavity, such as aphthous ulcers, bruxism, geographic tongue, and lichen planus, to name a few (Ibsen & Phelan, 2014).

Dependence and withdrawal symptoms of caffeine: Even for those individuals who had a mild tolerance to caffeine, an aroused effect could be reached when the dose was increased that included alertness and mild euphoria. For those who have made caffeine a part of their daily routine, dependence was likely to develop (Kuhn et al., 2014). According to, Luebbe & Bell, physical dependence on caffeine could be seen in adults who have consumed as little as 100 mg in a day (2009). Withdrawal symptoms, which included headaches and fatigue, began anywhere from 12-24 hours after caffeine cessation, and were the strongest during the first couple of days (Kuhn et al., 2014).

A study was done that showed the relationship on the effects of caffeine in children compared to adolescents. This psychoactive drug had a direct impact linking depression and anxiety with these two groups, although the impact was more intense for children than adolescents. Hence, they consumed caffeine in less time than adolescents and also weighed less, causing more profound psychological and stimulating effects. These factors increased their risk for caffeine dependence. They were also at an increased risk for depression because of the psychological, stimulating and withdrawal effects, which in turn could affect their personal adjustment, academic performance and health (Luebbe & Bell, 2009).

Caramel color

Research has shown that caramel coloring, an ingredient in many soft drinks, had two carcinogenic elements. According to this report, “researchers at the National Toxicology Program…have found “clear evidence” that both 2-methylimidazole (2-MI) and 4-methylimidazole (4-MI) are animal carcinogens and likely to pose a risk to humans.” The caramel coloring was made through a process of exposing sugars to ammonia, sulfites, and certain industrial chemicals. While the United States still uses artificial coloring in many of their food and beverage products, such as sodas, European countries have replaced these with natural plant-based dyes. Not only did the U.S. use these potentially harmful artificial ingredients in consumer products, research has shown that 4-MI has been used in five brands of soda in amounts up to 12 times more than the permissible amount (Maheshwari, 2014).

A different study conducted by Krishna, Goel, Krishna (2014) on caramel coloring and its potentially harmful affects in humans, used three computer-based software programs to predict possible genotoxicity and tumorigenicity, possible cancer and tumor causing agents. According to the study, all three software programs predicted genotoxicity in 2-MI and 4-MI, but of the three, only one software program showed a link to tumorigenicity.

Studies have found that soft drinks may have increased insulin resistance and inflammation due to the advanced glycation end products in caramel coloring (Leis-Keeling, 2010).

Oral manifestations of caramel coloring: Cancer treatments had an array of complications that affected the oral cavity, including, but not limited to, oral mucositis/stomatitis; xerostomia; bacterial, viral, or fungal infections; spontaneous bleeding; neurotoxcity; radiation caries; taste loss; trismus; osteoradionecrosis; and periodontal infection (Wilkins, 2013).

Phosphoric Acid

Phosphoric acid (H3PO4) was a corrosive acid. As a colorless and odorless agent, it was found in most acidic soft drinks (Keeling, 2010). Depending on replacement of different numbers of hydrogen atoms, it could form three classes of salts that were named primary phosphates, dibasic phosphates, and tribasic phosphates. Primary phosphate could control acidity of solution, dibasic phosphate could rust-proof metals, while tribasic was more used in soaps and detergents. Calcium dihydrogen phosphate was an important fertilizer ingredient. It also played a role in the natural preservation of soft drinks.

Osteoporosis linked to phosphoric acid: Osteoporosis is a harmful health condition. With this disease, bones become very weak and brittle. It is prevalent in older people, especially among the female population. There are many studies that linked soft drink consumption and bone density.

According to Tucker et al. (2006), phosphoric acid in cola beverages had a negative affect on bones by binding calcium in the stomach and keeping it from being absorbed into the body. They examined the bone mineral density readings of more than 2,500 adult men and women and surveyed their soda- drinking patterns. They found women who drank more than three 12 ounce servings of cola a day had 2.3 to 5.1 percent lower bone mineral density (BMD) in the hip compared to women who consumed less than one serving each day (Tuker et al., 2006).

Similar results were reported by Williams (2007), who conducted a clinical experiment using an animal model to study the relationship between BMD and soda beverage consumption, found that in the soda test group, rats had a statistically significant decrease in the amount of BMD compared to the control rats. In the other clinical experiment conducted by Williams (2007), 1,413 women and 115 men were used as study subjects to measure BMD in relation to the frequency of soft drink consumption. The mean BMD of those with daily soda intake was 3.7% lower at the femoral neck and 5.4% lower at Ward’s area than those who consumed less than one serving of soda per month.

In Krall’s (2001) research, the author found that the number of teeth with progression of alveolar bone loss over a seven-year period was extravagantly higher in people whose calcium intake was below 1,000 mg. According to Jeffcoat & Chestnut, evidence showed increased risk factors between osteoporosis and oral bone loss under low calcium conditions that resulted in tooth and ridge resorption in the mouth (1993).

These previous studies demonstrated consumption of soft drinks with phosphoric acid that lead to the development of hypocalcemia, lower bone mineral density, and directly influenced periodontal disease and tooth loss.

Kidney disease linked to phosphoric acid: Chronic kidney disease affects more than 20 million adults in the U.S and had become a significant public health burden. There are many risk factors contributing to this disease.

According to Saldana, in addition to well-documented risk factors such as diabetes, hypertension, kidney stones and family history, phosphoric acid was a big risk factor for kidney disease. In their study, consumption of two or more soda beverages daily was associated with an increased risk of chronic kidney diseases, while there was no increase in non-soda drink carbonated beverages. The difference between soda and non-soda carbonated beverages was that soda beverages were generally acidified using phosphoric acid, while non-soda beverages used citric acid. So, it was the long-term consumption of soda that lead to a high level of phosphoric acid, which had an effect on kidney disease.

In trial studies, the results also showed among people with kidney stones, people who kept drinking beverages containing phosphoric acid had higher recurrence of kidney stones than those who consumed beverages with citric acid. It was the phosphoric acid in soft drinks that changed urine composition, which leaded to kidney stone formation. (Saldana et al., 2007)

Oral manifestations of phosphoric acid: Phosphoric and citric acid present in soft drinks lowered the pH of these drinks. Those acidic ingredients weakened the tooth enamel with long exposure time, removing the protective layer (enamel) and exposing the soft dentin. These circumstances lead to tooth decay and hypersensitivity. Young children and adolescents were the most affected population due to their consumption at peak periods (Tahmassebi, Duggal, Malik-Kotru, Curzon, 2006).

Other concerns with phosphoric acid: In Kalantar-Zadeh et al.’s (2010) report, phosphoric acid in soft drinks would bring phosphor burden that may worsen hyperparathyroidism, promote vascular calcification and cardiovascular events, and increase mortality. Inorganic phosphor in soft drinks was more bioavailable than organic phosphor, so the intestines more easily and readily absorbed it. Protein and phosphor intake were closely correlated. For overall human health, food had the least amount of inorganic phosphor, low phosphor-to-protein ratios with adequate protein content as suggested by Kalantar-Zadeh et al (2010). Soft drinks absolutely were not qualified for the nutrient requirement and high dietary phosphorus (P) burden leaded to many system diseases (Kalantar-Zadeh et al., 2010).

Brominated Vegetable Oil (BVO)

As a popular food additive, brominated vegetable oil had reportedly been used in three of the top 10 selling soft drinks in U.S. It has been used as a solubility transmitter and clouding agent since 1931 in the U.S.

By adding bromine to the double bonds of unsaturated fatty acids in vegetable oil, BVO could prevent insoluble citrus oils separating from the water phase. Combining BVO with the lipophilic ingredients, the density could be adjusted to that of a soft drink.

Because BVO degraded enzymatically in the same way as normal vegetable oils, more and more research brought out concerns on BVO. Their previous study had reported cardiac lesion presented in rats fed at high doses of BVO, but not in the control group that was fed unbrominated lipids. Myocardial cellular degeneration, edema and necrosis were also observed when BVO was fed. A person who consumed two to four BVO-containing soft drinks suffered headache, fatigue, ataxia, and memory loss that progressed over 30 days. These were symptoms of severe bromine (Bendig, Maier &Vetter, 2012).

In another study, which was made by Jih, Khanna, & Smoach (2003), when a patient consumed eight L of a BVO-containing soft drink daily, his or her serum bromine level was about twice the normal level. All of these studies had shown that consumption of high amounts of BVO-containing soft drinks increased the serum bromine level and could lead to halogen acne like bromoderma. Due to direct exposure to organ bromine compounds via BVO, BVO was not allowed for use in any drink in Europe. While in North America, BVO was still a substantial source for the human dietary intake of organ bromine compounds through soft drinks (Bendig, Maier & Walter 2012 ).

Other concerns with soft drink consumption

Consumption of soft drinks also had other concerns related to health issues. “Telomeres are the DNA-protein caps at the end of chromosomes that promote chromosomal stability and protect the genomic DNA from damage.” Current studies showed the sugar-sweetened sodas significantly shortened immune cell telomere length, which was a biological risk factor for aging (Leung et al., 2014, p. 2425).

Ziegler and Temple used the data from 2011 youth risk behavior surveillance system to compare the odds of engaging in a series of risk taking behaviors among students who consumed soda daily, occasionally, or never. The result showed that in addition to reducing sleep quality, soda consumption had a positive relationship with increased risk –taking behavior (2011).

Conclusion

Our paper discusses several chemicals that have been found in soft drinks, which include high fructose corn syrup, aspartame, caffeine, caramel coloring, phosphoric acid, and brominated vegetable oil. These ingredients have been attributed to our societies continuous health decline and weight gain. They actually contributed to multiple systemic diseases and the oral complications thereof.

Annually, 3.4 million adults die each year from obesity-associated diseases such as, diabetes, heart disease, and cancer. Many other diseases are affiliated with these chemicals, included but were not limited to high blood pressure, gout, kidney function decline, cirrhosis, depression and anxiety, and osteoporosis. These conditions affect the body, which in turn affected the oral cavity by causing manifesations such as xerostomia, aphthous ulcers, chelitis, halitosis, bruxism, lichen planus, necrotizing ulcerative gingivitis, bone loss, tooth loss and periodontal disease.

Hopefully in the future, more companies will begin to follow suit with others who have made positive changes to the formulation of sodas, which will make them less toxic to our health.

Sarah Biggs, Jeni Dunn, and May Yao are students in the dental hygiene program at Collin College in McKinney, Texas.

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