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A report in the International Journal of Clinical Practice is warning of the perils of quaffing too much cola - a habit which can, by lowering blood potassium levels, result in symptoms from mild muscular weakness to paralysis.

The doctors behind the fizzy doom-mongering cite the extreme case of the Oz ostrich farmer who, having drunk 4-10 litres of cola a day for three years, required emergency treatment for lung paralysis following "sudden onset of muscle weakness after returning home from an evening of kangaroo-shooting".

The paper's author, Dr Moses Elisaf of the University of Ioannina in Greece, explained that hypokalaemia could be caused by too much of three common cola ingredients - caffeine, fructose and glucose.

He said: "The individual role of each of these ingredients in the pathophysiology of cola-induced hypokalaemia has not been determined and may vary in different patients.

"However in most of the cases we looked at for our review, caffeine intoxication was thought to play the most important role. This has been borne out by case studies that focus on other products that contain high levels of caffeine but no glucose or fructose."

In an commentary on the paper, Dr Clifford Packer of Ohio's Louis Stokes Cleveland VA Medical Centre, noted that some people might think 10-litre-a-day Aussies might be considered "so rare that it is not a public health issue".

However, he notes that from 1999 to 2002, "several million US teenagers were consuming two or more litres per day" and that "aggressive mass marketing, super-sizing of soft drinks, and the effects of caffeine tolerance and dependence, there is very little doubt that tens of millions of people in industrialised countries drink at least 2–3 litres of cola per day".

Apart from the risks associated with depleted blood potassium levels, "sugar-sweetened soft drinks have been shown to cause obesity, type 2 diabetes, dental decay and metabolic syndrome".

Packer's list continues: "They appear also to increase the risk for osteoporosis, gout, gastroesophageal reflux disease, hypovitaminosis C, albuminuria and chronic kidney disease (CKD).

"Case reports have linked soft drinks with secondary hyperparathyroidism, oesophageal perforation, haematuria, swallow syncope, pseudoporphyria, tongue erosions, hyponatraemia and gastritis."

And the good news? Packer notes: "The only therapeutic use of soft drinks is described in a few case reports of the successful use of Coca-Cola to dissolve phytobezoars."

For the record, phytobezoars are "concretions of poorly digested fruit and vegetable fibres that are found in the alimentary tract", and those of you with a penchant for unusual alimentary tract concretions can find one such case right here. ®

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