Healthy Beverage Guidelines

Harvard T.H. Chan School of Public Health > The Nutrition Source > Healthy Beverage
Guidelines

Table of Contents

Introduction

Beverage Guidelines from the Experts

o Water

o Tea and Coffee

o Low-Fat and Skim Milk and Soy Beverages

o Noncalorically Sweetened Beverages

o Caloric Beverages with Some Nutrients

o Calorically Sweetened Beverages

Putting it All Together: A Sample Beverage Plan

References

Introduction

In the beginning there was waterabundant, refreshing, providing everything the body needs to
replenish the fluids it loses. Humans relied on it as their only beverage for millions of years.
Milk came next, with the advent of agriculture and the domestication of animals. Then beer and
wine and coffee and tea, all drunk for taste and pleasure as much as for the fluids they provide.
The newcomerssoft drinks, sports and energy drinks, and the likeoffer hydration but with a
hefty dose of unnecessary calories that the body may have a hard time regulating.

With so many choices, all with different, sometimes unexpected effects on health, its easy to be
confused about the best beverages for health. This prompted a group of nutrition experts from
across the U.S. to form the independent Beverage Guidance Panel. These six researchers,
including Dr. Walter C. Willett of the Harvard School of Public Healths Department of
Nutrition, reviewed the evidence on beverages and health and ranked categories of beverages
into six levels, based on calories delivered, contribution to intake of energy and essential
nutrients, and evidence for positive and negative effects on health. (1) The winner? Water. But
that doesnt mean that water is the only beverage thats good for your health, or that everyone
needs to drink eight glasses of water a day.

Beverage Guidelines from the Experts

The Beverage Guidance Panel distilled its advice into a six-level pitcher, much as food experts
have done with the food pyramid. The group published its recommendations in the March 2006
issue of the American Journal of Clinical Nutrition. Here is a description of each level:

Level 1: Water

Water provides everything the body needspure H2Oto restore fluids lost through
metabolism, breathing, sweating, and the removal of waste. Its the perfect beverage for
quenching thirst and rehydrating your system. When it comes from the tap, it costs a fraction of a
penny per glass. Water should be the beverage you turn to most of the time.

Its impossible to set a single requirement for how much water the hypothetical average
American needs each day. The amount you need depends on how much you eat, what the
weather is, and how active you are. So instead of setting an estimated average requirement for
water, as it has done for other nutrients, the Institute of Medicine has set an adequate intake of
125 ounces (about 15 cups) for men and 91 ounces for women (about 11 cups). (5) Note that this
is not a daily target, but a general guide. In most people, about 80% of this comes from
beverages; the rest comes from food. As for the oft-repeated nutrition advice to drink eight
glasses of water every day, theres little evidence to support it, but this would be one excellent
way to fulfill most of a persons fluid requirement.

Level 2: Tea and Coffee

After water, tea and coffee are the two most commonly consumed beverages on the planet.
Drunk plain, they are calorie-free beverages brimming with antioxidants, flavonoids, and other
biologically active substances that may be good for health. Up to three or four cups of coffee or
tea a day appear to be fine. Green tea, especially the strong variety served in Japan, has received
attention for its potential role in protecting against heart disease, while coffee may help protect
against type 2 diabetes. (2, 3) More research on the health benefits of tea and coffee is needed,
but one thing is for certain: The addition of cream, sugar, whipped cream, and flavorings can turn
coffee or tea from a healthful beverage into a not-so-healthful one. For example, a 16-ounce Mint
Mocha Chip Frappuccino with Chocolate Whipped Cream contains 470 calories. Tucked in this
beverage (which is actually closer to a dessert) are 12 grams of saturated fatnearly a days
worthand 71 grams of sugar, the equivalent of 17 teaspoons of sugar. (4) Keep in mind that for
pregnant women, the jury is still out on whether high coffee or caffeine intakes increase the risk
of miscarriage, but it seems prudent to limit caffeinated beverages to one cup per day. (For more
information about coffee and chronic disease, see Ask the Expert: Coffee and Health.)

Level 3: Low-Fat and Skim Milk and Soy Beverages

For children, milk is a key source of calcium and vitamin D. Fortified soy milk is a good
alternative source of calcium and vitamin D for those who prefer not to drinks cows milk. Both
are also good sources of protein and other essential micronutrients. Low-fat milk, sold as 1% or
1.5% milk, or skim milk, which is virtually fat-free, are the best choices because they contain
much less saturated fat than reduced-fat milk or whole milk, which contain 2% and 4% milk fat,
respectively. Even low-fat milk is high in calories, and high levels of consumption may increase
the risk of prostate and ovarian cancer (see The Nutrition Source article Calcium and Milk:
Whats Best for Your Bones and Health? for more information). So its best for adults to limit
milk (and all dairy products) to a glass or two a day; less is fine, as long as you get enough
calcium from other sources. For growing children, the ideal amount of milk and calcium is less
clear, but not pushing beyond two glasses of milk per day appears to provide sufficient nutrition
without being excessive.

Level 4: Noncalorically Sweetened Beverages

So-called diet sodas and other diet drinks are sweetened with calorie-free artificial sweeteners
such as aspartame (Equal, NutraSweet, others), saccharin (SweetN Low, Necta Sweet,
others), or sucralose (Splenda); a new addition to the market are drinks sweetened with stevia, a
calorie-free sweetener made from the leaves of a South and Central American shrub. These diet
drinks are a better choice than sugar-sweetened soft drinks because they are lower in calories.
But the possibility that they may contribute to weight gain suggests that they arent an innocuous
alternative to water, and should be drunk as the occasional treat rather than as a daily beverage.
For those who find it difficult to give up full-calorie soda, these may be useful in making the
transition to healthier beverages, like a nicotine patch can do for smokers.

Level 5: Caloric Beverages with Some Nutrients

This category includes fruit juice, vegetable juice, whole milk, sports drinks, vitamin-enhanced
waters, and alcoholic beverages. Each has its pluses and minuses. One-hundred-percent fruit
juice has most of the nutrients of the fruit itself, but it usually delivers more energy. The Dietary
Guidelines for Americans recommends no more than one serving (4 ounces) of 100% fruit juice
as part of the daily fruit intake. Fruit smoothies are usually very high in calories, and so arent
recommended as daily beverages. Vegetable juice is a lower calorie alternative to fruit juice, but
may contain a lot of sodium. Whole milk is a good source of calcium and vitamin D, but has
nearly twice the calories as skim milk. Whole milk is also a significant source of saturated fat,
with 4.5 grams per glass. Sports drinks have fewer calories than soft drinks, and offer small
amounts of sodium, chloride, and potassium. They arent needed by casual athletes or daily
walkers. The only people who really need them are endurance athletes who exercise for more
than an hour at a stretch and who sweat a lot. Vitamin-enhanced waters, meanwhile, are not
necessary for anyone who takes a daily multivitamin, and adding vitamins to a sugary drink does
not make it a healthy choice. Alcohol may have benefits for some but may be hazardous for
others, and entire books have been written on the subject (see The Nutrition Source article
Alcohol: Balancing Risks and Benefits for more information).

Level 6: Calorically Sweetened Beverages

The Beverage Guidance Panel gave its least recommended designation to beverages that are
sweetened with sugar, high-fructose corn syrup, or other high-calorie sweeteners and that have
few other nutrients. These include carbonated and noncarbonated soft drinks, fruit drinks,
lemonade, and other ades. They get the thumbs down as a daily beverage because they provide
so many calories and virtually no other nutrients. Routinely drinking these beverages can lead to
weight gain and increase the risk of type 2 diabetes. Fruit smoothies, many flavored coffee and
tea drinks, and some so-called energy drinks also fall into this category. (For a handy guide to the
calories and sugar in popular beverages, see How Sweet Is It? on The Nutrition Source.)

Putting It All Together: A Sample Beverage Plan

Your body would be perfectly content if you drank nothing but water. You would get all the fluid
you need, and you would get all of your nutrients from food. But with so many choices available,
most people drink a variety of beverages. To give some perspective to choosing beverages, the
Beverage Guidance Panel poured its recommendations into a pitcher (see our version above).
The exact number of ounces isnt whats importantthese are given for a typical person taking
in 2,200 calories a day. What matters are the proportions. Heres one way the Panel suggests
getting less than 10 percent of daily calories from beverages:

At least half of your daily fluid should come from water. For a person who needs 12 cups
of fluid a day, that would mean six cups of water. More is fineup to 100% of your daily
beverage needs.

About one-third (or about three to four cups) can come from unsweetened coffee or tea. If
you flavor your coffee or tea with a lot of sugar, cream, or whole milk, then drinking less
would help manage weight. If you take a pass on coffee or tea, choose water instead.

Low-fat milk can make up another 20 percent, or about two 8-ounce glasses. Less is fine,
just make sure you get your calcium from another source.
 A small glass (4 ounces) of 100% fruit juice, and no more than 1 to 2 alcoholic drinks for
men or no more than 1 for women.

Ideally, zero diet drinks made with artificial sweeteners, but up to 1 to 2 glasses (8 to
16 ounces) a day (this is adapted from the Beverage Guidance Panels original
recommendation of up to 32 ounces per day).

Ideally, zero drinks sweetened with sugar or high-fructose corn syrup, but up to a
maximum of 8 ounces.

*Suggested beverage consumption pattern for a person who requires 2,200 calories per day,
providing 10 percent of calories from beverages. The values 50, 28, 16, and 4 fluid ounces are
shown for illustrative purposes only; the total should sum to 98 fluid ounces, as shown at the top
of the figure. The range listed at each level refers to the Beverage Guidance Panels suggested
consumption range for each beverage. Caffeine is a limiting factor for coffee and tea
consumption; up to 400 mg per day, or approximately 32 fluid ounces of coffee per day (can
replace water). Noncalorically sweetened beverages can substitute for tea and coffee with the
same limitations regarding caffeine, up to 16 fluid ounces per day (this is adapted from the
Beverage Guidance Panels original recommendation of up to 32 fluid ounces per day). Adapted
with permission from Am. J. Clin. Nutr. (2006; 83:529-542), American Society for Nutrition.

References

1. Popkin BM, Armstrong LE, Bray GM, Caballero B, Frei B, Willett WC. A new proposed
guidance system for beverage consumption in the United States. American Journal of Clinical
Nutrition. 2006; 83:529-542.

2. Kuriyama S, Shimazu T, Ohmori K, Kikuchi N, Nakaya N, Nishino Y, Tsubono Y, Tsuji I.

Green tea consumption and mortality due to cardiovascular disease, cancer, and all causes in
Japan: the Ohsaki study. Journal of the American Medical Association. 2006; 296:1255-1265.

3. Van Dam RM, Willett WC, Manson JE, Hu FB. Coffee, caffeine, and risk of type 2 diabetes: a
prospective cohort study in younger and middle-aged U.S. women. Diabetes Care. 2006; 29:398-
403.

4. Starbucks beverage details: Mint Mocha Chip Frappuccino blended coffee with Chocolate
Whipped Cream. Accessed on March 28, 2009.

5. Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and
Sulfate. Washington, D.C.: National Academy Press, 2004. Accessed on March 28, 2009.