Q & A: Diet Colas—Concerns for Patients with Eating Disorders?
Reprinted from Eating Disorders Review
January/February 2007 Volume 18, Number 1
©2007 Gürze Books
Q: Many of my eating disorder patients seem to be drinking large amounts of diet colas. Does this pose any problems? (L.M., Charlotte, WV)
A: The answer is clearly "yes." Recent research has shed even greater light on the problems that diet colas may cause for women with eating disorders. First, many patients drink diet colas not only for their stimulant value but because they offer gastric volume without any calories, which is not necessarily a good idea for women with eating disorders.
Second, a large study (the Framingham Osteoporosis Study) showed that drinking diet cola daily put older women at greater risk for osteopenia of the hip compared to women who drank less than one serving per month. Bone mineral densities were about 4%-5% lower at several hip sites in cola drinkers (regular or diet) than non-cola drinkers. For women with eating disorders, who already have an increased risk of osteopenia and osteoporosis due to poor nutrition, depression, stress and, in many instances, cigarette smoking, each of which independently adds to the risk of bone loss, injecting yet an additional risk factor for depleting skeletal calcium is unwise. Of note, no significant relationships were found among non-cola carbonated beverages and reduced bone mineral density. Also, these relationships were not seen in the men in this study (Am J Clin Nutrition 2006;84:936).
Finally, drinking diet or regular cola increases the risk of dental enamel erosion and dental decay. In the context of an eating disorder, sugar-containing sodas are worse, but since the pH of diet cola is 3.39, reasonably acidic, that in itself contributes to the risk of erosion. Here is even more bad news: light-colored sodas, canned iced teas, and energy sports drinks appear to be even worse for dental health than colas! (Gen Dent 2005; 53:28). Add this to the burden already imposed by frequent vomiting among patients with eating disorders and you markedly increase the likelihood of severe dental problems.
The best advice? Drink water.