American consumption of all beverages has gone from 13-15% of daily calories in the 1970’s to 21% now. This is proof that our patients either forget or do not realize how many extra calories they drink!

Recently an expert panel developed guidelines to help our patients make responsible beverage choices. The “Healthy Beverage Guidelines” were published in the American Journal of Clinical Nutrition.¹ The experts ranked the beverages in 6 levels, from plain water at Level One to Level Six beverages that should be consumed in limited quantities. These guidelines are based on sugar, fat, caffeine, and caloric content.

The expert panel stressed that a healthy diet does not rely on fluids to provide energy or nutrient needs, and that water – necessary for metabolism and normal physiological function – is the only fluid truly needed by the body. For variety and individual preferences, healthful diets can contain other beverages. Of important note is that liquid calories do not alleviate hunger as effectively as solid food.

The expert panel did not rank artificially-sweetened drinks as high as other drinks because of evidence that sweetness, regardless of its caloric content, may result in habituation to and preference for sweet taste. This evidence needs further study,but to the panel, it seemed prudent to emphasize unsweetened beverages, particularly since artificial sweetness does not add to the nutritional value of the beverage.

The Beverage Guidance System is outlined below.

• Level One: Water
  Recommendation: 20-50 ounces per day
• Level Two: Unsweetened Tea and Coffee
  Caffeine is the limiting factor, with twice as much in coffee as in tea.
  Recommendation: 0-40 ounces of unsweetened tea per day; 0-32 ounces of unsweetened coffee per day.
• Level Three: Low Fat (1.5% or 1%) and Skim (Nonfat) Milk and Soy Beverages
  Recommendation: 0-16 ounces a day
• Level Four: Non-calorically Sweetened Beverages
  Diet sodas and other sugar-free drinks are preferable to sugar-sweetened beverages because they provide no calories. FDA approved non-caloric sweeteners are considered safe
  Recommendations: 0-32 ounces per day
• Level Five: Caloric Beverages with Some Nutrients
  • 100% fruit juice
    Recommendation: 0-8 ounces per day
  • Vegetable juices (tomato and multivegetable juices)
    A healthy alternative; the trade-off is sugar for sodium as many of these drinks are moderately high in sodium.
    Recommendation:0-8 ounces per day
  • Whole milk
    Recommendation: No whole milk
  • Sports drinks
    Recommendation: Consume sparingly except for endurance athletes, 0-16 ounces per day
  • Alcoholic Beverages
    Recommendation: 0-1 drink per day for women and 0-2 drinks per day for men (one drink is 12 ounces beer, 5 ounces wine, or 1.5 ounces distilled spirits)
• Level Six: Calorically Sweetened Beverages without Nutrients
  Carbonated and non-carbonated beverages, usually sweetened with high-fructose corn syrup or sucrose.
  Recommendation: No more than one 8-ounce serving per day

References

1. Popkin BA, Armstrong LE, Bray GM, Caballero B, Frei B, Willett WC. A new proposed guidance system for beverage consumption in the United States. Am J Clin Nutr. 2006;83:529-42.
2. Tufts University Health and Nutrition Letter. June 2006:6-7.