What’s to Drink?

Staying Hydrated in the Heat

On a hot day, nothing quite hits the spot like a cold drink. But cold (and hot) beverages are not just enjoyable; they’re necessary for good health. Drinking adequate fluids in hot or cold weather keeps your body hydrated and running smoothly. When your body doesn’t have enough fluids, you can feel sluggish and irritable, get headaches, and have trouble controlling your blood glucose levels. You tend to need more fluids in hot weather because more are lost through sweat.

Water is a good choice for staying hydrated because it has no calories, carbohydrate, fat, alcohol, or caffeine. Beverages that contain calories, carbohydrate, fat, or caffeine still provide needed fluids, but when drunk in large quantities, they can make weight control and blood glucose control more difficult.


Alcohol has a diuretic effect, meaning it increases urine output, so beverages containing alcohol can promote dehydration. When you’re thirsty, having a drink containing alcohol is not a good choice; it’s better to drink nonalcoholic beverages first to quench your thirst before drinking any alcoholic drinks for pleasure. However, alcoholic beverages also contain calories, carbohydrate, and, less commonly, fat.

While water is a good choice for health reasons, many people enjoy beverages with a little more flavor, such as fruit juices, soft drinks, tea, or coffee. There’s nothing inherently wrong with any of these beverages – and in fact, fruit juices, teas, and coffees contain beneficial antioxidants – but a high consumption of sweetened beverages has been identified as one of the reasons the United States is having an obesity epidemic. Part of the problem is that people tend to ignore the calories, carbohydrate, and fat in beverages. Studies suggest that calories from beverages don’t make a person feel full or satisfied the way calories from food do.

In an effort to help Americans make better beverage choices, a group of scientists from universities around the country recently formed a panel to review the evidence on beverage consumption and draw up guidelines on what and how much people should drink. They published their Beverage Guidance System in the March 2006 issue of American Journal of Clinical Nutrition.

Overall, the panel recommended limiting calories from beverages to less than 10% of daily calories, or less than 200 calories in a 2,000-calorie-per-day diet. (Currently, the average American gets 21% of his daily calories from beverages. Click here for calorie content and other nutrition information for various carbonated and noncarbonated drinks.) The panel ranked beverages based on their nutritional pros, caloric cons, and other risks and benefits. Here’s how different types of beverages were ranked, along with their recommended daily amounts:

1. Water: 20—50 ounces (or 2 1/2 to 6 1/4 cups) a day

2. Unsweetened tea and coffee: 0—40 ounces, with a limit of 400 milligrams of caffeine (the amount in about 32 ounces, or 4 cups, of coffee)

3. Low-fat or skim milk and low-fat soy beverages: 0—16 ounces

4. Noncalorically sweetened beverages (such as diet soft drinks): 0—32 ounces

5. Caloric beverages with some nutrients: 0—8 ounces of 100% fruit juices; up to one alcoholic drink for women and two alcoholic drinks for men

6. Calorically sweetened beverages (such as nondiet soft drinks): 0—8 ounces


Water straight from the tap is cheap and easy, but not everyone enjoys drinking it. Chilling tap water in the refrigerator before drinking it can make it more palatable, as can adding some ice cubes or a twist of lemon or lime.

Bottled, flavored, or carbonated waters are other options that cost more but offer the same benefits as tap water (except, possibly, fluoridation) and may be preferable to some people. An inexpensive way to flavor water at home is to brew some caffeine-free herbal iced tea.


Plain tea contains no calories or carbohydrate, meaning it is a “free food” in a diabetes meal plan. When sugar, honey, or milk is added, however, a cup of tea can have enough carbohydrate to require its being counted as a carbohydrate-containing food.

Tea is believed to have various health benefits, largely because of the naturally occurring antioxidants called flavonoids in tea. Some studies have suggested that regular tea consumption may reduce the risk of developing Type 2 diabetes, protect against coronary heart disease, and improve bone and dental health. So far, however, the FDA has rejected the petitions of distributors of green tea to print health claims on tea package labels, saying there is insufficient evidence to claim that tea can help prevent heart disease or cancer.

Tea contains caffeine, which, in moderate amounts does not appear to affect blood glucose levels. However, some research suggests that consuming 500 milligrams (mg) of caffeine over a short period has the potential to raise blood glucose levels. Such large doses of caffeine enhance the effects of the hormones epinephrine and glucagon, which stimulate the release of glucose from the liver.

Luckily, it would be difficult to get that much caffeine from drinking tea. A cup of brewed black tea contains about 40 mg of caffeine, a cup of brewed oolong tea contains about 30 mg of caffeine, and a cup of green tea contains about 20 mg of caffeine. White tea, which is rarer and more expensive than the other types, contains about 15 mg of caffeine per brewed cup.

Even if it doesn’t raise blood glucose levels, caffeine can increase heart rate, a symptom that may be mistaken as a sign of low blood glucose. If you experience what feels like symptoms of low blood glucose after drinking tea or other caffeinated beverages, check your blood glucose level with your meter to see what effect if any caffeine has on it.


Like plain tea, black coffee contains no calories or carbohydrate and is a free food in a diabetes meal plan. However, many people add milk or soy milk to their coffee, in which case their coffee drink would count toward both their coffee and milk totals in the Beverage Guidance System. One-quarter cup of skim milk adds about 23 calories and 4 grams of carbohydrate, 1/4 cup of low-fat (1%) milk adds about 26 calories and 3 grams of carbohydrate, and 1/4 cup of unsweetened soy milk adds about 23 calories and 1 gram of carbohydrate.

One cup (8 ounces) of brewed coffee generally contains between 85 and 135 mg of caffeine. A serving of espresso, which is 1—2 ounces, contains about 100 mg of caffeine. Drinks that contain several “shots” of espresso, therefore, can contain quite a bit of caffeine.

Powdered dessert coffees sold at grocery stores come in many flavors in both regular and sugar-free varieties. Varieties sweetened with sugar provide 11—20 grams of carbohydrate (1 carbohydrate choice) per serving. Sugar-free varieties contain about 5 grams of carbohydrate per serving, making a single serving of this coffee a free food.

When you prepare coffee at home, it’s easy to figure out how many calories and grams of carbohydrate and fat you’re consuming. When you purchase coffee drinks in a coffee shop such as Starbucks or Dunkin’ Donuts, it can be more difficult, since the nutrition information may not be posted next to the menu, and some menu terms may be unfamiliar. However, many restaurant chains now post nutrition information on their Web sites, so you can plan your purchases in advance by looking online.

As you peruse your options, keep in mind that the American Diabetes Association (ADA) recommends that people with diabetes keep their saturated fat intake to less than 7% of total calories. For most women, that works out to 12—14 grams of saturated fat per day (based on 1,600—1,800 calories per day), and for most men, it works out to 14—16 grams per day (based on 1,800—2,000 calories per day). Selecting coffee drinks with no more than 2 grams of saturated fat per serving will help you stay within recommended limits.

The ADA also suggests limiting cholesterol intake from food or beverages to no more than 300 milligrams per day. If your low-density lipoprotein (LDL, or “bad” cholesterol) is above 100 mg/dl, the recommendation is to limit your cholesterol intake to 200 milligrams a day. Many coffee drinks provide no cholesterol or only very small amounts. But drinks with whole milk, chocolate, or whipped cream added can contain quite a bit.

Even sodium can be a concern with some coffee drinks, with many containing 250—300 mg of sodium. If you are on a sodium-restricted diet, it pays to check the nutrition information before ordering.

When it comes to price, brewing your coffee at home has clear advantages. The average customer of a coffee shop spends about $50—$60 per month on coffee orders. Brewing a similar amount of coffee at home would total only $10—$20 per month, depending on brand and type of coffee brewed.

Milk and soy milk

Milk, fortified soy milk, and yogurt drinks can be important sources of protein, calcium, and other nutrients in the diet. Milk has the advantage over soy milk of being fortified with vitamin D, and its calcium may be more easily absorbed, as well. Until age two, children who drink cow’s milk should drink whole milk. After that, low-fat or fat-free milk is recommended. People who have trouble digesting lactose (milk sugar) may be able to tolerate low-lactose milk and yogurt and yogurt drinks, which are lower in lactose.

Noncaloric soft drinks

Most diet soft drinks contain 0—1 gram of carbohydrate per 12-ounce serving and are considered free foods in a diabetes meal plan. However, a few diet drinks may have as much as 5 grams of carbohydrate per serving. In that case, if more than one serving is consumed, the carbohydrate content must be counted.

While these drinks appear to be safe, the authors of the Beverage Guidance System recommend limiting their intake to no more than 32 ounces because of the possibility that the intense sweetness of many of these drinks conditions people to prefer very sweet tastes. Hypothetically, this could lead to overeating and weight gain; some animal studies have supported this hypothesis.

Fruit juices and fruit drinks

Fruit juices and fruit drinks pack a lot of calories and carbohydrate into a relatively small serving. Virtually all of the calories in these beverages come from sugar, whether natural or added. However, not all fruit juices are created equal: Unsweetened grapefruit juice has 22 grams of carbohydrate per 8-ounce serving (1 1/2 carbohydrate choices), orange juice has 25—27 grams (2 carbohydrate choices), apple juice has 28—29 grams (2 carbohydrate choices), cranberry juice cocktail has 35 grams (2 1/2 carbohydrate choices), Cran-Apple has 35—39 grams (2 1/2 carbohydrate choices), grape juice has 38—42 grams (2 1/2—3 carbohydrate choices), and prune juice has 43—45 grams (3 carbohydrate choices). “Light” versions of some of these drinks have less carbohydrate per serving.

Most bottled juices and juice drinks list the serving size as 8 ounces (1 cup) on the Nutrition Facts panel of the label, even if the bottle or can contains 12 or 16 ounces. In those cases, if you consume the whole can or bottle, you will need to multiply the number of calories and grams of carbohydrate by 1.5 (for a 12-ounce container) or 2 (for a 16-ounce container).

A cup of juice is plenty for some people but may not seem like much to others, especially if they’re thirsty. If a cup of juice leaves you wanting more, consider mixing the juice with seltzer or club soda to stretch the serving, or purchase lower-sugar or sugar-free juice drinks to help you control the amount of calories and carbohydrates in your diet.

Most fruit juices and juice drinks contain very little sodium, but tomato and vegetable juices can have quite a lot. The regular varieties of these drinks generally have between 440 and 990 milligrams of sodium per 8-ounce serving. Low-sodium versions have 140 milligrams of sodium per serving, and no-salt-added juices may have as little as 25 milligrams per serving. The latest recommendations regarding sodium intake from the Institute of Medicine of the National Academies of Science, the body that sets the recommended dietary allowances for both macro- and micronutrients, are that healthy Americans should consume no more than 2,300 milligrams of sodium per day. A high sodium intake can raise blood pressure in some people. African-Americans appear to be particularly susceptible to its effects. High blood pressure, if left untreated, increases the risk of heart, eye, and kidney disease. If you are watching your sodium intake to keep your blood pressure normal, selecting the low-sodium versions of these drinks will assist in keeping your sodium intake in target range.

Soft drinks

Regular soft drinks may taste good, but most provide no nutrients other than sugar, and they provide plenty of that. A 12-ounce serving may provide anywhere from 90 to 200 calories and 23—52 grams of carbohydrate. On some meal plans, a single soft drink would supply the total goal amount of carbohydrate for a whole meal. Some carbonated soft drinks also contain caffeine, and some contain sodium.

Regular soft drinks can be useful to have on hand for treating hypoglycemia (but only drink an amount containing 15 grams of carbohydrate at a time) or for sipping when you have the flu and can’t tolerate any other foods. Otherwise, because they’re so high in carbohydrate and calories, it’s a good idea to reserve regular soft drinks for an occasional treat.

Sports and energy drinks

Sports drinks, such as Gatorade, that contain low amounts of sugar, sodium, and potassium can be helpful during or after workouts that last an hour or more. The carbohydrate in the drink helps replace fuel stores, called glycogen, in the muscles (glycogen is a storage form of glucose), and the sodium and potassium replace electrolytes (or salts) lost in sweat. For shorter workouts, sports drinks may not hurt but probably aren’t necessary. Water is usually sufficient to replace fluid lost through sweat.

Energy drinks are similar to sports drinks, but they tend to contain more sugar (unless they’re artificially sweetened), caffeine, and sometimes amino acids. They are typically marketed to young people as tools for increased mental capacity or physical performance. While sugar is an energy source, and caffeine can increase mental alertness and possibly athletic performance in the short term, energy drinks are no substitute for a following a good diet, getting a good night’s sleep, and doing regular training for either mental or physical performance. In addition, there’s no evidence that there’s any need to consume individual amino acids if a person consumes an adequate amount of protein in his diet. Energy drinks may also contain more sugar and caffeine than you wish to consume at any one time.

The serving size for sports and energy drinks is about 8—8 1/2 ounces. The carbohydrate content of these drinks ranges from 11 to 37 grams (1—2 1/2 carbohydrate choices). Many brands also have low-sugar or sugar-free versions of the drink, with 0—3 grams of carbohydrate per serving.

Swimming in choices

Each year, the beverage industry adds hundreds of new choices to tempt people to drink more of their products. While it’s fun to try new products and sample new tastes, keep an eye on the Nutrition Facts panel on the beverages you buy. Controlling the amount of calories, fat, cholesterol, sodium, and carbohydrate in beverages will not only help you control your diabetes, but it can also prevent heart disease and weight gain.