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Soda danger: sugar, acid, carbonation

July 17, 2017
Leigh Erin Connealy, M.D.

You know those exciting new “artisanal” alternatives to Big Sugar’s sodas?  Wow! Naturally flavored, zero-calorie, “vitamin waters” like watermelon-tarragon. Natural sweeteners instead of high-fructose corn syrup (HFC).  At least they’re healthier than soda, right?  No, not even the best of the newcomers.

Thank you, foodies everywhere

Believe me, I’m loving the growing movement of foodie entrepreneurs cooking up healthy alternatives to the deadly, hyper-sugared, HFC-soaked staples of the Standard American Diet (SAD). So don’t get me wrong when I sound a note of caution about the new generation of flavored waters and sodas.

It’s a major victory that high-fructose corn syrup (HFC) is no longer dominant as a sweetener. In fact, my caution here isn’t even about sugar content, as it always was in the past.

While we still need to avoid added sugars wherever they show up, our vigilance should be directed elsewhere when it comes to “healthy, “artisanal,” “craft” replacements for sugary drinks and sodas.

They still present all kinds of soda danger.

Acids—teeth on fire

What makes these beverages taste so good is what makes them caution-worthy. Their flavor essences, mostly citric and other fruit acids, can soften and even dissolve tooth enamel. Combine that with the carbonic acid, created through the carbonation process, and you’ve got a recipe for tooth decay and…

  • Reduced tooth structural strength
  • Increased risk of fracture
  • Hypersensitivity to heat and cold
  • Increased risk of cavities

Back to high-school chemistry

Remember learning about pH, the measure of how acidic or alkaline something is? In the beverages world, the pH tells us how likely a drink is to erode teeth. The lower the pH, the more acidic, and the more potentially harmful.

Here’s are some pH reference points:

  • Neutral pH = pH 7.0
  • Our blood = pH 7.4
  • Typical tap water = pH 6–8
  • Beverage with pH under pH 4 = too acidic, threatens dental health

When you artificially carbonate plain water, you’re adding carbonic acid, which lowers the water’s pH to about pH 5—it’s still acidic, but it’s not in the under-pH 4 danger zone. So I’ll call this unflavored bubbly water by itself nothing to worry about, except in excess.  Happy burping!

The taste of trouble

However, when carbonic acid for carbonation, and citric or other fruit acid based flavors are both added to plain water, here comes trouble, in the form of a one-two acid punch:

  1. The combination increases the water’s acidity to the point when it can begin to soften and strip enamel from teeth.
  2. The increased acidity in your body (called acidosis) forces your body to take alkalizing calcium and other minerals from your teeth and bones, and even other parts of your body, to restore a healthier acid/alkaline balance

The risks here are:

  • Enamel-stripped teeth can’t “re-enamel” themselves
  • Bones can rebuild themselves—but only once acidosis is reversed and enough calcium is available
  • When one part of the body “borrows” calcium from another part, healthy routine in the other part is disrupted

So the cascade of events leads to vulnerable, enamel-stripped teeth, held in place by bones craving calcium—that isn’t there, or that gets leached from elsewhere in the body.

So the bones can’t rebuild themselves, and can eventually deteriorate to the point of collapse. You probably know this as osteoporosis.

Goodbye teeth and bones.

Carbonated vs uncarbonated?

Various studies have found:

  • Un-carbonated, mega-selling grape, lemon, and strawberry Dasani waters = pH 3
  • Carbonated RC Cola and Coca-Cola = pH 2.32 and 2.37, essentially a dead heat, and uncomfortably close to the pH = 2.25 of pure lemon juice

A mouth full of pure lemon juice?  Let that sink in. You can hear your enamel screaming.

Bacteria pile on

Sorry to further take the fun out of the moment, but you need to know that pathogenic oral bacteria thrive in an environment that’s sugary and acidic.

Most of the additives in flavored waters are both. So the bacteria will continue messing with the pH of your mouth for however long they’re in there getting fed.

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In fact, “bad” oral bacteria are the most destructive source of acid in the mouth. When they feed on sugar, guess what they produce?

More acid.

So as long as they can feed on the sugars they need, the pH of your mouth is acid—plus more acid.

You folks who sip flavored water throughout the day, please take note.

I recommend you don’t sip.  Using a straw protects your teeth somewhat. But if you MUST indulge, finish your drink in fifteen minutes or so.

More advice?

Don’t drink it all the time

An occasional sparkling kiwi-mango water is a lovely treat now and then. But make it a treat, not a habit.

Drink it with a meal or snack

Eating gets your acid-neutralizing salivary glands going.

Make your own

There are lots of ways you can enjoy fresh, fruity goodness without all the sugar and acids. And talk about simple—how about just adding small pieces of fresh fruit to your favorite still or bubbly water?

Even better, drink tea (especially high antioxidant green tea and herbal teas like chamomile, valerian, turmeric, mint, or ginger.

Invest in a carbonating device (like Soda Stream) to make your own plain bubbly water.  Do not use Soda Stream syrups for flavor, though—way too sugary.  Instead, add your own fresh fruits or fruit juice or make combinations like watermelon-tarragon.  Get inventive!

Just remember that any carbonated, flavored soda contains acids that can really damage your pearly whites.

If you must have carbonation, look for a drink with electrolytes or alkalizing agents that can de-fang and neutralize some of the acidity. I recommend Germany’s Gerolsteiner brand.  But generally, stay away from too much carbonation.

Don’t swish, swallow

Savoring the flavor by swishing it all around your mouth is fun. Until you realize it’s like giving your teeth and gums an acid shower.  The less contact between teeth and carbonation/flavoring, the better.

Don’t panic

This is not to say that you should never enjoy one of the new flavored waters.  As with most health risks, the real enemies are too little knowledge—which I hope I’ve corrected here—and too much consumption.

So don’t deny yourself refreshing flavored water now and again—hey, it’s summer.  But do try the make-your-own route—and get the same tasty results with reduced risk of harming your teeth.

And if you still want to buy at the market, go ahead.

Just don’t overdo it.  Know what you’re getting into—and what’s getting into you.

Take good care.


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  • Iris C Morales

    How about no sodium no sugar seltzer water. Is that OK? Or is it a no, no?

  • ken

    I’m glad that this information is out in the open these days. I used to drink a lot of diet soda when I was younger and had no idea how destructive it is, especially to one’s teeth. I’ve had 4 tooth fractures over the last 15 years and fortunately can afford implants. Soda also takes off your enamel if you drink enough of it. Water is truly best! (for health and dental reasons)

  • Robert T. “Bo” Myers

    Drink water and beer!!! One will hydrate you the other will dehydrate you, but you will be happy and are drinking “liquid bread!”

    Thanks, Dr. C….Your newsletter is GREAT!!


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