I’m Thirsty. What Should I Drink?

Let’s look at a few choices.

Diet soda? There have always been questions about the possible negative effects of diet soda and sugar substitutes. A paper, “Artificial sweeteners induce glucose intolerance by altering the gut microbiota,” published last month in Nature made quite an impact by suggesting that non-caloric artificial sweeteners actually may cause diabetes.

Regular soda? I won’t even bother with a link. We all know how sweet soda is.

How about fruit juice? I’m afraid not. While whole fruits are good for you, fruit juice presents a high glycemic load to the intestines much more rapidly than whole fruits. This causes big changes in blood sugar and insulin levels and increases the risk of diabetes.

There’s always coffee, which has been linked with many salutary effects such as lowering the risks of diabetes, heart disease, Alzheimer’s, Parkinson’s, stroke, and even cancer. Caffeine keeps me awake at night, so regular coffee is out. Decaffeinated coffee might be OK for some people, but I don’t like the taste of either coffee anyway.

Tea? No thanks. Tea is not associated with any illnesses unless you drink gallons of it, and it contains less caffeine than coffee. I don’t like tea, plus I never know what to do with the bag. Even if you love coffee or tea, how many cups can you or should you drink every day?

Milk? There’s a lot of fat in whole milk, so that’s not good, but low-fat milk is not as filling. To compensate, adults and children tend to eat high glycemic index carbohydrates when drinking low-fat milk. And Harvard researchers have questioned the need for humans to drink milk at all, especially low-fat milk.

Bottled water? According to Scientific American, certain chemicals, particularly bisphenol S (BPS), can leach into the contents of plastic bottles and potentially cause “metabolic disorders such as diabetes and obesity, asthma, birth defects or even cancer.”

OK, there’s always tap water, which is fine except for the presence of all sorts of drugs (painkillers, blood thinners, hormones, chemotherapy agents, cocaine, amphetamines) that have been excreted into rivers and lakes and are not filtered by treatment plants.

Due to the amount of estrogen in the water, some fish have been developing eggs in their testes. That’s bad. Although the concentrations of all these drugs are low, it is not clear what the lifetime risk of this low-level exposure is.

In 2009, the New York Times published a lengthy article on the failure of the Federal government to sufficiently regulate the chemicals in tap water. The Safe Drinking Water Act is nearly 40 years old and mentions only 91 of the 60,000 chemicals used in the U.S. As far as I can tell, the list still has not been updated.

Alcohol? Alcohol yields only about 100 calories per 1.5 ounce serving of hard liquor, 12 ounces of light beer, or 5 ounces of wine. Sounds fine, but I don’t think anyone should drink it for breakfast, lunch, and dinner. Too much alcohol causes cirrhosis. And there’s this, “Just five alcoholic drinks a week could reduce sperm quality.”

The final answer? Club soda—from a glass bottle.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 10,400 followers on Twitter.