Do Sugared Drinks Cause Arthritis?

A new analysis of data from the Nurses Study shows that young women who drink sugar-sweetened soft drinks, fruit drinks and fruit juices more than five times a week are three times more likely to develop arthritis than those who drink less than that (Nutrition & Diabetes, published online March 7, 2016). Other studies have shown that sugared drinks are associated with increased risk for rheumatoid arthritis (Am J Clin Nutr, 2014;100:959–967). Most forms of arthritis in young adults are classified as auto-immune diseases, in which a person's immunity is overactive. An overactive immunity is called inflammation. The immune system acts as if it is trying to kill germs, but doctors usually are unable to find any specific germ that is responsible.

Fructose May Be the Culprit Only four sugars (glucose, fructose, galactose and mannose) can be absorbed into your bloodstream. Of these four, only glucose can circulate in your bloodstream. The other three go to the liver where they are changed into glucose before they can circulate in your bloodstream. Virtually all of the sugared drinks on the market today (soft drinks, fruit drinks and fruit juices) contain both fructose and glucose.

The authors of this new study want to blame fructose as a source of inflammation that causes or worsens arthritis. They explain that fructose is poorly absorbed in the intestines and is more likely than the other sugars to bind to proteins to form sugar-protein chemicals called Advanced Glycation End Products (AGEs). These AGEs are absorbed and pass to other tissues in your body to turn on your immunity to cause inflammation (Dig Dis Sci, 2012;57:48–57).

Previous studies have shown that AGEs:

• are found in higher than normal amounts in rheumatoid arthritis patients (Arthritis Res Ther, 2011;13:R205)

• are found in the joint sacs (synovium) of patients with rheumatoid arthritis (Ann Rheum Dis, 2002;61:488–492)

• can be used as a measure of an overactive immunity in people with swollen, painful joints (Arthritis Res Ther, 2005;7:142–144)

• cause the same damage that is seen under the microscope in both the joints of reactive arthritis and intestines in Crohn's disease (Gut, 1987; 28:394–401)

• can damage the joints and intestines, so intestinal symptoms are extremely common in patients with rheumatoid arthritis (J Rheumatol, 2000;27:1373–1378) or lupus erythematosus (World J Gastroenterol, 2010;16:2971–2977).

Drinks containing the sugar fructose are also associated with increased risk for other diseases of inflammation such as chronic bronchitis (Nutr J, 2015 Oct 16;14:107), childhood asthma (Public Health Nutr. 2016 Jan;19(1):123-30), and Crohn's disease and ulcerative colitis (Aliment Pharmacol Ther, July 1, 2009;30(2):165-74).

My Recommendations This recent study makes a convincing argument, but does not prove, that fructose is more harmful to your health than glucose, and is more responsible for the association between sugared drinks and arthritis, weight gain, diabetes and heart attacks. The authors suggest that fructose also increases risk for some cancers, lupus, Crohn's disease, ulcerative colitis, asthma, chronic bronchitis and other inflammatory diseases.

We do not know if fructose is worse than other sugars, but I am convinced that sugared drinks are harmful to your health even though nobody really knows the mechanism. I recommend restricting your intake of all types of drinks that contain any form of sugar or fruit juice, and I also recommend restricting artificial sweeteners. Quench your thirst with water unless you are in the midst of prolonged, vigorous exercise that demands a quick source of sugar to replenish your muscles. Avoid drinks with sugar except during vigorous exercise Sodas with sugar may age cells Coca Cola pays to convince you that sugared drinks are safe

Checked 4/2/17

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