June 1, 2010 -- Anyone who cares about their weight probably wouldn't sit down and eat six Krispy Kreme donuts on a regular basis. But they might head out to a convenience store, pick up an energy drink and unwittingly down the equivalent amount of sugar.
It's true. One 16-ounce can of Rockstar Energy Drink is all it takes to pack in the same amount of sugar as half a dozen Krispy Kreme Original Glazed donuts.
"People will sometimes drink these things not realizing what they've got," said Dr. Daniel Einhorn, president of the American Association of Clinical Endocrinologists.
Einhorn said the fight against diabetes has a large stake in what people drink. Diabetes currently affects 23.6 million Americans, according to the American Diabetes Association. Another 57 million Americans are pre-diabetic, and may be able to change their risk through exercise, diet and their drink choices.
"It's calories," said Einhorn. "However you get heavier and however you get excess calories, that is how you get to diabetes."
Last week, Men's Health put out a list of the "20 Worst Drinks in America." Since there are so many beverages to choose from -- alcoholic, coffee-based drinks, energy drinks and more -- Men's Health decided to name their idea of "worst" from each category.
Energy drinks aren't the only confusing culprits. Einhorn said the calorie and sugar content of flavored water and even old fashioned juice often surprises people.
Take, for instance number 20 on the list: Snapple Agave Melon Antioxidant Water. It has the equivalent sugar of two Good Humor Chocolate Eclair Bars.
"It goes in the category of stealth bad foods. It sounds good, but it's not the original food," said Einhorn.
Einhorn's recommendation is simple.
"Water, water, water," said Einhorn. "Learn to enjoy water. It can be fizzy water, it can be club soda water, but water."
Water or Nothing?
While experts say sugary beverages have a large impact on unhealthy diets that put people at risk for diabetes, it also may be the easiest change to make.
"I would say 80 percent of the success we have in changing diets is taking away these sugar drinks," said Dr. Joel Zonszein, professor of Clinical Medicine at Albert Einstein College of Medicine in New York City.
Looking at the list, even he was shocked by some of the high sugar counts.
"I'm amazed of these margaritas and Starbucks," said Zonszein, referring to number 7 of the Men's Health List, the Traditional Red Lobster Lobsterita margarita.
In total, the 24-ounce margarita has 890 calories and the same number of carbohydrates as six or seven Almond Joy candy bars.
"People don't realize what they do," said Zonszein, director of the Clinical Diabetes Center at Montefiore Hospital in New York City.
Although, traditionally, people who were concerned about developing diabetes might pay attention to their sugar, Zonszein said it is smarter to look at the calories of food.
When it comes to drinks, those calories are almost always derived from carbohydrates.
"They don't develop diabetes because they eat sugar, but it is the caloric intake and their predisposition," said Zonzein. "It's an easy to drink calories, you don't drink fat. Even milk is very rich in sugar and has high calories."
"A lot of drinks are packed with sugar and energy and someone with diabetes or someone who is just trying to have a healthy diet in general needs to read the label," said Dr. Nanette Steinle, an assistant professor of medicine in the Division of Endocrinology, Diabetes and Nutrition at the University of Maryland in College Park.
"I think they have a sense that there's sugar, but I don't think people have a concept of how high the sugar content might be, or even a reference," said Steinle.
She said just one flavored water could eat up a fourth of the calories for a woman in a day.
Cecilia Sauter, a registered dietician and certified diabetes educator at the University of Michigan, said nature also plays a part in tricking us with liquid calories.
"Our brain, when we drink something, is not just going to check it off as, 'I quenched my hunger,'" said Sauter. "When I drink eight ounces of juice, I am not going to feel satisfied."
Rather, she said, it's better to eat the carbohydrate equivalent of fruit and feel satisfied.
Sauter said the list made by Men's Health might be a little dramatic. For instance, many of the drinks have sugar equivalents to, say, six donuts, but have far fewer calories.
Rockstar Energy Drink might have as much sugar as six donuts, but the calories are equivalent to just one donut.
"I think there is a reality behind it. I think they're playing the shock therapy," she said. "But it is true that a lot of these drinks have a lot more carbohydrates than people believe."
Some of the drinks on top 20 list were in categories that would obviously involve some high calories. A few of them let people consume a whole day's worth of calories in one sitting.
Clocking in at number one was the "worst beverage in America" the Cold Stone PB&C -- a milkshake -- in the 24-ounce size. That drink had 2,010 calories.
Milkshakes Are Bad, So What Else?
Those who treat diabetes say drinks with even a fraction of the calories of the Cold Stone PB&C milkshake, for example, might cause weight gain if people drink them often.
"I don't think you have to even think about a severe situation like that," said Dr. Michael Goran, a professor of preventive medicine and director of the Childhood Obesity Research Center at the University of Southern California.
Goran recommends just 10 to 15 grams of sugar per drink. However, a typical can of soda is 50 grams of sugar, which translates to 17 teaspoons of sugar.
"Imagine going into a Starbucks and ordering a coffee and putting 17 packets of sugar in your coffee," said Goran. "Nobody in their right mind would do that. But they would drink a soda without thinking about it."