References:
1.International Osteoporosis Foundation. Prevention:
http://www.iofbonehealth.org/patients-public/about-osteoporosis/pr
evention.html
2.National Institutes of Health. Consensus Development Conference
Statement, Optimal Calcium Intake, 1994:
http://consensus.nih.gov/1994/1994OptimalCalcium097html.htm
3.American Medical Association, Council on Scientific Affairs. Intake of
dietary calcium to reduce the incidence of osteoporosis. Archives of
Family Medicine, 6:495-499,1997.
4.Institute of Medicine, National Academy of Sciences. Dietary
Reference Intakes for calcium, phosphorus, magnesium, vitamin D,
and fluoride. 1997.
http://books.nap.edu/openbook.php?record_id=5776&page=R1
5.National Institutes of Health. Consensus Development Conference
Statement, Osteoporosis Prevention, Diagnosis, and Therapy, 2000:
http://consensus.nih.gov/2000/2000Osteoporosis111html.htm
6.U.S. Surgeon General. Bone Health and Osteoporosis: A Report of the
Surgeon General. 2004.
http://www.surgeongeneral.gov/library/bonehealth/content.html
7.Dawson-Hughes B and the International Osteoporosis Foundation.
Bone Appétit: The role of food and nutrition in building and maintaining
strong bones. 2006.
http://www.iofbonehealth.org/publications/bone-appetit.html
8.International Osteoporosis Foundation. Symptoms/Risk Factors:
http://www.iofbonehealth.org/patients-public/about-osteoporosis/sy
mptoms-risk-factors.html
12.Moore C, et al. Vitamin D intake in the United States. Journal
American Dietetic Association 104(6):980-983, 2004.
13.Holick MF. Vitamin D: a D-lightful health perspective.
Reviews, 66 (Suppl. 2): S182-194, 2008.
Nutrition
14.Prentice A. Vitamin D deficiency: a global perspective. Nutrition
Reviews, 66 (Suppl. 2): S153-164, 2008.
You asked about
beverages and
BONE HEALTH
15.Bügel S. Vitamin K and bone health in adult humans. Vitam Horm.
2008;78:393-416.
16.Tsugawa N, et al. Vitamin K status of healthy Japanese women:
age-related vitamin K requirement for gamma-carboxylation of
osteocalcin. Am J Clin Nutr. 2006 Feb;83(2):380-6.
17.Feskanich D, Weber P, Willett WC, Rockett H, Booth SL, Colditz GA.
Vitamin K intake and hip fractures in women: a prospective study. Am
J Clin Nutr. 1999;69:74-79.
18.Booth SL, Tucker KL, Chen H, et al. Dietary vitamin K intakes are
associated with hip fracture but not with bone mineral density in elderly
men and women. Am J Clin Nutr. 2000;71:1201-1208.
19.Booth SL, Broe KE, Gagnon DR, et al. Vitamin K intake and bone
mineral density in women and men. Am J Clin Nutr. 2003;77:512-516.
20.Booth SL, Broe KE, Peterson JW, et al. Associations between vitamin
K biochemical measures and bone mineral density in men and
women. J Clin Endocrinol Metab. 2004;89:4904-4909.
21.van Summeren MJ, et al. Vitamin K status is associated with
childhood bone mineral content. Br J Nutr. 2008 Oct;100(4):852-8.
9.British Nutrition Foundation. Nutrient Requirements:
http://www.nutrition.org.uk/attachments/053_Micronutrient%20DRVs.
pdf
10.Tsanzi E, et al. Effect of consuming different caloric sweeteners on
bone health and possible mechanisms. Nutrition Reviews,
66(6):301-308, 2008.
http://www.ncbi.nlm.nih.gov/pubmed/18522618
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Coca-Cola Singapore
11.Fitzpatrick L and Heaney RP. Editorial, Got Soda? Journal of Bone and
Mineral Research, 18(9):1570-1572, 2003.
http://www.jbmronline.org/doi/full/10.1359/jbmr.2003.18.9.1570
www.coca-cola.com.sg
www.beverageinstitute.org
FAQ:
BONE HEALTH
Drinking sparkling beverages that contain caffeine and/or phosphoric
acid does not weaken your bones or cause osteoporosis. Good
nutrition, adequate calcium, vitamin D, and vitamin K, as well as
physical activity that includes regular weight-bearing exercise, play key
roles in determining bone health.
Key Facts:
• For more than fifteen years, a series of scientific and
patient-advocacy organizations have carried out investigations to
determine whether the phosphorus and caffeine in sparkling
beverages has any impact on bone health. Each has concluded that
there is no evidence of any negative effect in healthy individuals, as
long as their calcium intake is sufficient.
- In 1994, the U.S. National Institutes of Health (NIH) assembled
experts in osteoporosis and bone health at a conference on
Optimal Calcium Intake. The report from that meeting
concluded that “phosphate has not been found to affect
calcium absorption or excretion significantly.”2 The American
Medical Association reviewed the NIH experts’ statement and
similarly concluded that the effect of phosphate on calcium
absorption was “physiologically trivial.”3
- The Institute of Medicine of the National Academy of Sciences
(IOM/NAS) reviewed the scientific data about phosphorus in
1997 and found that it did not appear to negatively affect
calcium absorption.4
- In 2000, the NIH Consensus Development Conference on
osteoporosis reaffirmed that dietary phosphorus and caffeine
is not an important factor in osteoporosis for people eating a
balanced diet.5
- In 2004, the U.S. Surgeon General’s Report on Bone Health
and Osteoporosis reviewed the scientific data acknowledging
the concerns raised about caffeine, phosphorus and
carbonated beverages and concluded that “as long as
adequate levels of calcium intake are maintained, both
carbonated and caffeinated beverages can be consumed in
moderation.”6
- In 2006, the International Osteoporosis Foundation published
a review of nutrition and bone health that noted the concerns
over “carbonated soft drinks, notably cola drinks” and bone
health. It concluded that there is no convincing evidence that
“carbonated drinks” adversely affect bone health.7
Q: Does drinking caffeinated or sparkling beverages weaken my bones
or cause osteoporosis?
A: No, drinking caffeinated or sparkling beverages does not weaken
your bones or cause osteoporosis. Risk factors for osteoporosis
listed by the International Osteoporosis Foundation include age,
female gender, family history, menopause, poor nutrition,
insufficient calcium and vitamin D intakes, insufficient exercise, low
body mass index (being too thin), smoking and excessive alcohol
consumption.8
Q: Has scientific research shown that sparkling beverages can hurt my
bones?
A: No. For more than fifteen years, a series of scientific and
patient-advocacy organizations have studied whether the
phosphorus and/or caffeine in sparkling beverages has any impact
on bone health and concluded that there is no negative effect in
healthy individuals as long as their calcium intake is sufficient.
Q: What is phosphorus?
A: Phosphorus is a mineral found widely in nature and plays an
important role in how our bodies get energy. It is a major component
of bones and teeth. Phosphoric acid, which contains phosphorus, is
used as a preservative in a variety of foods and beverages and is
used to add a tangy taste to some colas. You can find phosphorus
in milk, cheese, meat, bread, bran, breakfast cereals, eggs, nuts,
fish,100 percent juice, juice drinks, soy-based beverages, soft drinks,
low-calorie soft drinks and sports drinks.
Q: What is the daily recommended intake for phosphorus?
A: The World Health Organization and the Food and Agriculture
Organization of the United Nations have not established a
recommended daily intake amount for phosphorus, but some
countries have. For example, the United Kingdom has set their
Reference Nutrient Intake for phosphorus at 550 mg/day for adults,
not including women who are pregnant or lactating.9 The United
States Institute of Medicine has set a Recommended Dietary
Allowance for phosphorus at 700 mg per day for all adults over age
18, including pregnant and lactating women.4
Q: How much phosphorus is in sparkling beverages?
A: Sparkling beverages add only very small amounts of phosphorus to
the diet through phosphoric acid, an ingredient that helps give cola
drinks their tangy taste. A glass (240 mL [8 fl. oz.]) of Coca-Cola
provides 41 mg of phosphorus. By comparison, the same amount of
milk has about 200 mg of phosphorus, one cup of cooked chicken
(140 grams) has about 230 mg of phosphorus, and one cup of
cooked white rice (150 grams) has about 90 mg of phosphorus.
Q: What Coca-Cola Company beverages help support bone health?
A: Our Minute Maid brand was the first orange juice in the U.S. to offer
calcium fortification, and has been doing so since 1987. In 2002, we
pioneered the addition of vitamin D to orange juice in the U.S. to
assist with calcium absorption. Today, brands such as Odwalla,
Jugos del Valle, Andina Nutri Huesos and Simply support bone
health with nutrients such as calcium and vitamin D in other
countries including Colombia, Philippines, Angola, Chile, Cape
Verde, Ghana, Korea, South Africa and Canada.
Q: Is vitamin D deficiency really a problem?
A: Increased awareness of the importance of vitamin D has led to
concern about the prevalence of vitamin D deficiency worldwide and
scientific experts are advocating for increasing the recommended
intake levels.
A principal scientist with The Coca-Cola Company analyzed dietary
intake data from U.S. dietary intake surveys and found that less than
10 percent of U.S. adults between ages 51 and 70 met their daily
vitamin D requirements through the food they ate alone.12 That
number fell to two percent for people over 70 years of age. The study
also found that the lowest dietary intakes of vitamin D were reported
by female teenagers and female adults.
More recently, a noted vitamin D researcher has described vitamin D
deficiency as a “pandemic,” stating that it is “one of the most
common undiagnosed medical conditions in the world.”13
Another researcher has documented that vitamin D deficiency
extreme enough to lead to rickets and osteomalacia “is high in many
parts of the world” 14.
Q: I’ve read vitamin K is also important for supporting strong, healthy
bones. Is this true?
A: Yes. Studies have suggested that having adequate vitamin K in the
body is associated with better bone status in both adults and
children 15-21. Our bodies need Vitamin K for proper mineralization
of bone, a process of binding calcium to bone matrix to build strong
and rigid bones. Like calcium and vitamin D, vitamin K is also an
important bone nutrient that helps keep your bones strong.
Q: What effect do caloric sweeteners (sugars) have on bone health?
A: In June 2008, a published review looked at the effect of caloric
sweeteners, such as table sugar (sucrose) and high fructose corn
syrup (HFCS), on bone health. The authors concluded that there is
not enough scientific literature available to make any conclusions
about any effect of caloric sweeteners on bone health.10 A 2003
publication said that sugars increase urinary calcium excretion, but
the body adjusts so there is no net loss of calcium.11 But, it’s
important to ensure you are eating a healthy diet, with adequate
calcium, vitamin D, and vitamin K, and that you are engaged in
physical activity that includes regular weight-bearing exercises.
Q: Is it true that too much caffeine keeps your body from absorbing
calcium and leads to weak bones and osteoporosis?
A: No. For more than fifteen years, a series of scientific and patient
advocacy organizations have studied whether the caffeine in
sparkling beverages had any impact on bone health and concluded
that there is no negative effect in healthy individuals as long as their
calcium intake is sufficient.
Q: What other lifestyle factors, in addition to nutrition and physical
activity, play a key role in determining bone health?
A: According to the International Osteoporosis Foundation, not
smoking and the avoidance of excessive alcohol consumption are
also important lifestyle measures you can take to protect your
bones.1