Not drinking sugary drinks — even switching to sugar-free ones doesn’t help

Cost: There’s no cost involved, nor does it take any extra time. Switching to plain water or sugar-free tea can even save money. The real challenge is breaking the habit of drinking sweet beverages, including sugar-free ones.
In plain terms: People who drink more than two sugary drinks per day have about a 20% higher chance of dying during the same period compared to those who rarely drink them. Those who consume one to two per day still face a roughly 10% higher risk. Switching to sugar-free versions brings no benefit: individuals drinking two or more sugar-free drinks daily actually have a 25% higher risk of death.
Benefit: Two large U.S. studies followed large groups of people without any subgroup categorization; together they included around 118,000 participants and documented 36,000 deaths. Those drinking two or more sugary drinks daily had a 21% higher risk of death compared to those consuming less than one per month (HR 1.21). For those drinking one to two per day, the risk rose by about 14% (HR 1.14). The European EPIC study followed 450,000 people across 10 countries under similar conditions; again no subgroups were defined. Compared to those drinking less than one sugary drink per month, daily consumers of two or more sugary drinks faced an 8% higher risk (HR 1.08, 95% CI 1.01–1.16). Those drinking two or more sugar-free drinks daily had a 26% higher risk (HR 1.26, 95% CI 1.16–1.35). When all types of soft drinks were considered together, the risk increase was about 17% (HR 1.17, 95% CI 1.11–1.22).
Evidence grade: A
Sources:Malik VS 等 (2019). Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.118.037401；Mullee A, Romaguera D, Pearson-Stuttard J, et al. (2019). Association Between Soft Drink Consumption and Mortality in 10 European Countries. JAMA Internal Medicine, 179(11), 1479-1490. https://doi.org/10.1001/jamainternmed.2019.2478
Notes: There is ongoing debate regarding sugar-free drinks. The association between sugar-free drinks and health outcomes appears even stronger than that of sugary drinks, which likely reflects reverse causality: individuals who are already overweight or have diabetes tend to switch to sugar-free versions. Therefore, we cannot claim sugar-free drinks are more harmful based on this alone. Nevertheless, this evidence clearly shows that the idea “switching to sugar-free drinks solves the problem” lacks any factual support. The safest choice remains plain water or sugar-free tea. Additionally, these studies rely solely on observational tracking rather than controlled trials; people who consume more sugary drinks often lead less healthy lifestyles overall, which may contribute to the observed higher risk figures.