Featured StoryEditor's Pick
Latest Articles
What Sugary Drinks Actually Do Over the Long Term — and Why Energy Drinks Are a Separate Problem
The case against sugar-sweetened soft drinks is unusually well-supported by long-term research — type 2 diabetes, cardiovascular disease, weight gain, dental decay, and elevated all-cause mortality all appear in the data, in dose-dependent ways. Energy drinks layer additional cardiovascular concerns on top of the same sugar problem. Here's what the evidence actually shows, with the specific magnitudes, and how to think about it without either fearmongering or downplaying.
A Rare Case Where the Evidence Is Both Strong and Worrying
In nutrition science, most claims are messier than they look. Correlations are inconsistent, randomized trials are hard to run, and single nutrients rarely behave as advertised. But there are a few areas where the evidence has converged with enough force, across enough study designs, that the conclusion is no longer seriously contested in the research community. The health effects of sugar-sweetened beverages — soft drinks, sodas, sweetened iced teas, fruit-flavored drinks — are one of them.
The shorter version is that habitual consumption of sugary drinks is consistently associated, across dozens of large prospective studies, with higher risk of type 2 diabetes, cardiovascular disease, weight gain, dental decay, and earlier death. The associations are dose-dependent — more consumption, more risk. Energy drinks add a separate cluster of cardiovascular concerns on top of the sugar problem, particularly in adolescents and young adults.
This is worth understanding clearly because the average consumption levels in most developed countries are well above what the evidence suggests is reasonable, and the marketing around these products often obscures rather than clarifies the actual picture.
What the Long-Term Evidence Actually Shows
The headline finding comes from large meta-analyses of prospective cohort studies — research designs that track tens of thousands of people for years to decades and observe what actually happens.
A 2023 meta-analysis published in Frontiers in Nutrition pooled data from 72 prospective studies covering millions of participant-years of observation [1]. People with the highest sugar-sweetened beverage intake had roughly a 27% higher risk of developing type 2 diabetes compared to those with the lowest intake (relative risk 1.27), a measurable increase in hypertension and cardiovascular disease, and elevated all-cause mortality [1]. The associations were dose-responsive — every additional serving per day increased the risk further, with no clear "safe" threshold above zero [1].
A 2021 dose-response meta-analysis in Nutrients drew similar conclusions from a different set of 34 studies, with consistent findings: a clear, graded relationship between sugar-sweetened beverage consumption and risk of type 2 diabetes, cardiovascular disease, and death from any cause [2]. The mechanisms behind these effects are well characterized in experimental research: sugary drinks deliver large doses of rapidly absorbed sugar with essentially no satiety effect, drive metabolic disturbance and weight gain, accelerate chronic low-grade inflammation, and disrupt healthy lipid metabolism.
A specific subgroup worth noting: a 2024 meta-analysis focused on people who already had type 2 diabetes found that ongoing sugary drink consumption was associated with higher mortality (hazard ratio 1.20) — meaning the harm doesn't end once someone has been diagnosed; it continues to compound.
The Dental Story Is Often Underweighted
The cardiovascular and metabolic findings get most of the attention, but the most direct and well-documented harm from sugary drinks is to teeth. The World Health Organization's guideline on free sugars — which covers added sugars and sugars in honey, syrups, and fruit juices — recommends that free sugars provide less than 10% of total energy intake for both adults and children, and ideally less than 5% [3]. The primary basis for that recommendation is dental caries (tooth decay), which the WHO describes as the most prevalent noncommunicable chronic disease worldwide, affecting up to 80% of the global population [3].
To put 5% of energy in concrete terms: for an adult consuming roughly 2,000 calories a day, that's about 25 grams of added sugar — less than the amount in a single 350 ml (12 oz) can of regular soda. The WHO specifically recommends that children under two years of age consume no sugar-sweetened beverages at all.
This is worth pausing on. Most adults in most developed countries consume substantially more than 25 grams of added sugar a day, often two or three times that, and sugary drinks are typically the largest single source. The threshold isn't hypothetical — it's the level at which the dental caries evidence becomes notably worse.
Energy Drinks: A Different Problem on Top of the Sugar Problem
Energy drinks deserve a separate discussion because they aren't just sugary drinks with stimulants added — they appear to produce distinct cardiovascular effects that aren't fully explained by their sugar or caffeine content alone.
A 2025 PRISMA review published in the journal Beverages synthesized 33 original studies on energy drinks and cardiovascular health in young people [4]. Across studies, habitual energy drink intake was associated with acute blood pressure increases, arrhythmias (irregular heart rhythms), endothelial dysfunction, and metabolic disturbances — sometimes appearing within 24 hours of a single can [4]. The risks were amplified by the high caffeine doses common in these products (often 200-300 mg per can, compared with roughly 95 mg in a standard cup of coffee) and by combinations with alcohol or intense exercise [4].
The 2025 EDKAR study published in European Journal of Epidemiology specifically examined chronic high energy drink consumption in adolescents and found measurable cardiovascular differences between heavy consumers and controls, even at ages when underlying heart disease would normally be vanishingly rare [5].
Several specific concerns are worth knowing about:
**The sugar load is often higher than soda.** A single energy drink can contain 50 grams of sugar or more — twice the WHO's recommended daily limit for an adult, and more than a typical soda of the same volume.
**Caffeine doses commonly exceed pediatric safety thresholds.** The American Academy of Pediatrics has explicitly recommended that energy drinks should not be consumed by children and adolescents, in part because a single serving frequently exceeds the daily caffeine intake considered safe at those ages.
**Other ingredients (taurine, guarana, L-carnitine, B vitamins in mega-doses) have synergistic effects with caffeine** that aren't well characterized for chronic consumption, particularly in young people.
**Acute presentations are increasing.** Emergency departments have reported rising numbers of pediatric and adolescent visits with cardiovascular symptoms — palpitations, chest pain, arrhythmias — linked to energy drink consumption. These are uncommon outcomes, but they happen in healthy young people who would not otherwise be expected to have such events.
The combination of caffeine and large sugar doses also produces the well-documented "crash" effect — a brief surge in alertness followed by a steeper drop in energy and mood that often prompts further consumption, setting up a cycle that's particularly problematic during academic stress or shift work.
What About Diet Sodas and Artificially Sweetened Drinks?
This is where the evidence gets more complicated, and where many people switch to in the belief they've solved the problem.
The same 2023 Frontiers meta-analysis that found a 27% higher type 2 diabetes risk for sugary drinks also found a 32% higher risk for artificially sweetened beverages (relative risk 1.32). This is not as straightforward as it sounds — some of that association may reflect "reverse causation" (people switch to diet drinks because they're already at higher metabolic risk) rather than the artificial sweeteners themselves causing harm. The evidence is genuinely less clear than for sugar-sweetened beverages.
But the practical takeaway is honest: switching from regular to diet versions is not a settled solution. The clearest evidence-supported strategy is reducing consumption of both, and replacing sweetened beverages with water, plain or sparkling, unsweetened tea, or coffee in moderation, rather than swapping one sweetened beverage category for another.
What the Evidence Does Not Show
In the interest of editorial honesty, a few claims that float around the topic but that the evidence does not strongly support:
**"Sugar causes cancer."** Some specific cancers are associated with obesity, which is associated with sugary drinks, but the direct sugar-causes-cancer claim circulating in wellness media oversimplifies a complex picture. The evidence supports reducing sugary drink consumption for metabolic and cardiovascular reasons; the cancer pathway is largely indirect.
**"One soda a week will give you diabetes."** The dose-response is real but operates at the population level over years. Occasional consumption is not equivalent to habitual daily consumption. The evidence is about patterns, not single events.
**"Natural sugars are fine; only added sugars matter."** The WHO definition of free sugars explicitly includes the sugars in honey, syrups, and fruit juices, precisely because metabolically they behave similarly to added sugars when concentrated in liquid form. Whole fruit, with its fiber matrix, is different.
A Reasonable Way to Think About It
The honest framing is that the evidence against habitual sugar-sweetened beverage consumption is among the more robust findings in nutrition science — multiple meta-analyses, dose-response relationships, plausible mechanisms, and converging findings across populations. Energy drinks compound the problem with additional cardiovascular concerns that are particularly relevant for young people.
For most people, the practical implications are not complicated. Reduce regular consumption of sugary soft drinks and energy drinks. Treat them as occasional rather than habitual. Don't assume diet versions solve the problem. For children and adolescents, the evidence is strong enough to support straightforward limits — the AHA recommends no more than 25 grams of added sugar per day for children, and energy drinks are not appropriate for that age group at all.
The bigger picture is that sugary and energy drinks are one of the few categories where the relevant research is unusually clear and the recommended response is unusually simple — drink less, drink water or unsweetened alternatives instead, and don't let marketing convince you that switching products within the same category is meaningful change.
If you have specific concerns about your blood sugar, cardiovascular risk, weight, or your child's beverage consumption, those conversations are best had with a qualified healthcare provider who can give you advice appropriate to your individual situation. Beverages are one input among many that contribute to long-term health.
Further Reading
Consumption of sugar sweetened beverages, artificially sweetened beverages and fruit juices and risk of type 2 diabetes, hypertension, cardiovascular disease, and mortality: A meta-analysis (Frontiers in Nutrition, 2023) — the 72-study meta-analysis showing 27% higher T2D risk for SSBs and 32% for ASBs
ncbi.nlm.nih.gov
Sugar- and Artificially Sweetened Beverages Consumption Linked to Type 2 Diabetes, Cardiovascular Diseases, and All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies (Nutrients, 2021) — establishes the dose-response relationship
ncbi.nlm.nih.gov
WHO Guideline: Sugars Intake for Adults and Children — the canonical international recommendation (<10% of energy, ideally <5%) and the basis for the 25g/day reference
ncbi.nlm.nih.gov
Energy Drinks and Cardiovascular Health: A Critical Review of Recent Evidence (Beverages, 2025) — PRISMA review of 33 studies on energy drinks and cardiovascular outcomes in young people
mdpi.com
Chronic high consumption of energy drinks and cardiovascular risk in adolescents — results of the EDKAR-study (European Journal of Epidemiology, 2025) — specific evidence on adolescent cardiovascular effects from chronic energy drink consumption
pmc.ncbi.nlm.nih.gov
📢 Advertisement — In-Article Ad