Cola is one of the most popular drinks in the world.
However, concern exists about its potentially negative health effects.
This article reviews cola and its contents and examines recent scientific research on its health effects.
For the avoidance of doubt, this article will focus on regular sugar-sweetened cola rather than sugar-free beverages.
Table of contents
What Is Cola?
Cola is a soft drink that combines carbonated water, sugar, and several other ingredients. It is one of the most popular drinks in the world.
In this regard, market research shows that Americans drink an average of 399 Coke servings per year, 63% of which is Coca-Cola Classic (1).
Furthermore, this statistic only considers cola drinks made by Coca-Cola and ignores all the other popular Cola products.
Coca-Cola and Pepsi are the two market leaders in the cola (and wider soft drink) markets (2).
Typical Ingredients
While the exact ingredients in a cola product may vary among brands, they all contain similar ingredients.
The most famous cola product, Coca-Cola, has the following ingredients profile in the United States (3, 4):
- Carbonated water
- High-fructose corn syrup*
- Caramel
- Phosphoric acid
- Caffeine
- Natural flavors
* In many countries, such as the United Kingdom, sugar is used instead of high-fructose corn syrup (5).
Carbonated water and sugar provide the fizziness and the mouthfeel of the drink.
Caramel is a coloring, while phosphoric acid, caffeine, and natural flavors are all used for flavoring.
How Is It Made?
Perhaps surprisingly, cola companies like Coca-Cola typically only produce a “flavoring syrup” that they distribute to worldwide bottlers.
The production process in the bottling plants involves the following steps (6):
- Filtered water is disinfected to remove any impurities
- Sugar and the cola flavoring are added to the water
- This drink mixture is then carbonated by a blender machine that adds carbon dioxide
- The machinery then dispenses the mixture into bottles and cans of varying specific quantities
- These bottles and cans then move through a labeling and checking process, after which they are ready for distribution.
Nutrition Facts + Caffeine Content
As previously mentioned, the ingredients profile of cola products may slightly change depending on brand and country.
Here are the nutritional values for the United States version of Coca-Cola per 12 fl oz (360 ml) serving (4):
| Nutrient | Amount | % Daily Value |
|---|---|---|
| Calories | 140 kcal | |
| Carbohydrates | 38.9 g | 14.1% DV |
| Fiber | 0 g | |
| Sugars | 38.9 g | 77.9% DV |
| Fat | 0 g | |
| Saturated fat | 0 g | |
| Protein | 0 g | |
| Caffeine content | 34 mg |
However, as stated, the nutritional content of cola can depend on the brand and country of sale.
Since the main two nutritional aspects of cola we need to know are the calorie and sugar content, let’s look at how different brands (in various regions) compare.
For more about the caffeine content of different varieties of cola, soda, and more, see the following guide:
The Caffeine Content of 300+ Popular Drinks
How Many Calories and Grams of Sugar Does Cola Contain?
The following table shows the calorie and sugar content of cola by brand, product size, and region of sale (4, 5, 6, 7, 8):
| Cola Product | Calories | Sugar |
|---|---|---|
| Coca-Cola (US) – 355 ml | 140 kcal | 38.9 g |
| Coca-Cola (US) – 100 ml | 39 kcal | 10.8 g |
| Pepsi cola (US) – 355 ml | 150 kcal | 41.0 g |
| Pepsi Cola (US) – 100 ml | 42 kcal | 11.4 g |
| Coca-Cola (UK) – 330 ml | 139 kcal | 35.0 g |
| Coca-Cola (UK) – 100 ml | 42 kcal | 10.6 g |
| Pepsi cola (UK) – 330 ml | 135 kcal | 36.0 g |
| Pepsi cola (UK) – 100 ml | 41 kcal | 11.0 g |
| Coca-Cola (Mexico) – 100 ml | 30 kcal | 7.5 g |
| Coca-Cola (Canada) – 100 ml | 40 kcal | 11.0 g |
| Coca-Cola (Canada) – 355 ml | 140 kcal | 39.0 g |
As we can see, cola products’ sugar and calorie content vary slightly by region.
However, they all contain between 10.5 and 11.5 grams of sugar per 100 ml.
Potential Downsides of Drinking Cola
Here are some potential downsides of drinking cola products.
Liquid Calories Are Easy To Over-Consume
Sugar-sweetened beverages (SSBs) like cola are high in liquid calories, do not elicit a strong satiety response, and can be easily consumed (9).
Based on data collected between 2011 and 2014 for the National Health and Nutrition Examination Survey, the average US adult consumes at least one SSB daily. Breaking this data down further (10):
- On average, men consumed 179 calories from SSBs per day.
- Women consumed 113 calories from SSBs per day.
- Young adults had the highest mean intake of calories from SSBs per day.
While a moderate intake of sugar-sweetened beverages can fit into a healthy dietary pattern, they offer little nutritional value. Also, studies show that substituting sugar-free, non-caloric soft drinks for SSBs improves weight and general health outcomes (11, 12).
High In Added Sugars
Regular cola is a significant source of added sugars.
The daily value for added sugars in the United States, as set by the Food and Drug Administration (FDA), is 50 grams daily. Despite this, one serving of cola contains 39 grams of added sugar (4, 13).
Other countries have even stricter upper recommendations for added sugars. For example, Public Health England recommends no more than 30 grams per day (14).
Added sugars can be a significant contributor to energy intake.
Scientific Research on the Health Effects of Cola
Over recent years, there has been much research on the health impacts of sugar-sweetened beverages like cola.
Most research on sugar-sweetened drinks is negative, and most findings are observational (rather than human trials).
It is important to note that an association between particular foods or drinks and adverse health outcomes doesn’t necessarily mean the food/drink causes those outcomes. However, there is likely some effect when there are consistent findings from observational research across diverse populations.
Here is a summary of some recent research findings.
Sugar-Sweetened Beverages and Weight Gain
- A 2022 systematic review and meta-analysis of cohort studies and randomized controlled trials (RCTs) demonstrated that SSB intake promotes a higher body mass index (BMI) and body weight in adults and children. This extensive review covered 61 cohorts and 24 RCTs and found a consistent, linear dose-response association between SSB intake and weight gain (15).
- In a 2023 systematic review and meta-analysis of 60 observational studies, researchers examined the link between overweight/obesity and various foods and beverages. Based on 26 studies, the review found that high (versus low) intake of SSBs increased the odds of overweight/obesity by 20% (16).
- A 2022 systematic review and meta-analysis examined the link between SSBs and obesity and cardiometabolic disease risk. This review examined 27 observational studies that featured more than 1.5 million participants. Results showed that higher SSB intake raised the relative risks for type 2 diabetes by 20% and obesity by 17% (17).
Metabolic Syndrome
Metabolic syndrome is a cluster of conditions associated with increased diabetes and heart disease risk. These include larger waist circumference, high blood pressure, high triglyceride levels, low high-density lipoprotein (HDL) levels, and high blood glucose (18).
A 2023 systematic review and meta-analysis examined the association between SSB consumption and metabolic syndrome risk.
The meta-analysis reviewed 14 observational studies (9 cross-sectional and 5 cohort studies).
Based on the nine cross-sectional studies, participants with the highest intake of SSBs compared to the lowest had a 35% higher risk of metabolic syndrome. Based on the cohort studies, the highest consumers of SSBs had an 18% increased risk of metabolic syndrome (19).
Dental Health
A 2021 systematic review and meta-analysis investigated the effects of SSB consumption on dental health.
Based on 38 cross-sectional studies, moderate intake (compared to low intake) of SSBs increased the risk of dental caries and tooth erosion by 57% and 43%, respectively. Additionally, a high compared to moderate SSB intake further increased the risk of caries by 53% and erosion by 209% (20).
Hypertension
A 2020 systematic review and meta-analysis found that high SSB intake increased the risk of hypertension in children and adolescents. Across 14 studies, high SSB intake was associated with a small (1.67 mmHg) increase in systolic blood pressure. Also, participants with a high SSB intake (compared to low) were 36% more likely to develop hypertension (21).
Bone Health
A 2021 systematic review and meta-analysis of 26 observational studies examined the association between SSBs and bone health. Among the study’s findings, one important finding was a moderate inverse association between SSB consumption and bone mineral density in individuals under 50 (22).
All-Cause Mortality
A 2021 systematic review and dose-response meta-analysis examined thirteen cohort studies involving 1,539,127 participants. The dose-response meta-analysis found that each 250 ml per day increase in SSB intake was associated with a 4% higher risk of all-cause mortality and 8% higher cardiovascular disease mortality (23).
Effects of Sugar-Sweetened Beverages Versus Zero Calorie Beverages
A 2022 systematic review and meta-analysis of randomized controlled trials compared the effects of SSB intake, like cola, with zero-calorie beverages, like diet cola.
The results demonstrated that substituting low or no-calorie beverages for SSBs was associated with lower BMI, body weight, body fat percentage, and systolic blood pressure. Furthermore, there was no evidence of harm from these beverages; compared to SSBs, they had a similar direction of benefit to water (24).
Can Sugar-Sweetened Cola Have Any Benefits?
There are no real nutritional benefits of cola.
However, as a source of sugar and calories, cola can provide energy.
In some situations where an individual urgently needs to gain weight, cola may have potential benefits if the individual enjoys and is willing to drink it. However, this is not a unique benefit, and any caloric foods or drinks can be helpful in this context.
It is also important to note that anyone needing to gain weight for medical reasons should do so in full collaboration with their healthcare team.
Sugar-sweetened cola has relatively little nutritional value outside of its energy content.
There are also far healthier foods and drinks that provide energy.
How Often Should You Drink Cola?
As previously mentioned and as evidenced by data, diet cola is a better choice than sugar-sweetened cola (24).
However, even regular cola can still fit into a healthy dietary pattern for those who wish to drink it occasionally. In this regard, no individual food or drink will make or break a diet, and the healthfulness of any diet depends on the overall diet composition.
That said, sugar-sweetened cola offers little nutritional value and is high in calories and sugar.
It is a case of the less consumed, the better.
Healthier Alternatives To Cola
There are numerous drink options for those looking for healthier cola alternatives. These include:
- Diet cola: the best like-for-like replacement
- Water
- Zero-calorie soft drinks: these may include fruit-flavored beverages and sugar-free energy drinks
- Juice and smoothies: these can sometimes be high in sugar, but unlike cola, fruit juice also provides vitamins and minerals
- Tea: there are numerous ‘true tea’ and herbal tea options
- Coffee
Final Thoughts
Cola has a pleasant taste, and it is understandable why it enjoys popularity worldwide.
However, sugar-sweetened cola is high in sugar and calories and offers little nutritional value.
As shown in this article, there are clear reasons to limit our intake of sugar-sweetened cola.
