The JAMA analysis pooled data from 1.5 million adults followed for an average of nearly 18 years. Participants who drank more sugar-sweetened beverages showed a higher risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma — the two main liver cancer subtypes. Diet drinks did not show the same association. The study is observational, which means it cannot prove that sugary drinks caused the cancers, and the authors noted other lifestyle patterns could contribute.
For stone patients, the finding lands on familiar ground: sugary drinks are the clearest dietary risk in the stone literature too, and the mechanisms overlap. Soda and sweet tea displace water and milk, add calories without calcium, and contribute to the metabolic conditions that overlap with stone risk.
On the oxalate table, almost every beverage sits at or near zero — so the differences between drinks are not oxalate. They are sugar, calcium, protein, and what the drink replaces. The table below shows the measured values and the real differences.
| Food | Oxalate (mg) | Serving | Rating |
|---|---|---|---|
| Water | 0 | 8 fl oz | Safe |
| Milk, cow's | 0 | 1 cup | Safe |
| Sparkling water, unsweetened | 0 | 12 fl oz | Safe |
| Lemon-lime soda | 0 | 12 fl oz | Safe |
| Sweet tea (sugar-sweetened) | 14 | 8 fl oz | Safe |
| Orange juice | 2 | 8 fl oz | Safe |
The practical response to both the liver finding and the stone literature is the same: rebuild the beverage default around water and milk. Water at zero oxalate, zero sugar, and zero open questions; milk at zero oxalate with calcium that binds oxalate in the gut. Soda and sweet tea become occasional treats rather than daily staples. Fruit juice, which keeps some nutrients but concentrates sugar, is a small glass occasionally, not a bottle a day.
For patients who genuinely enjoy soda, the measured approach is structure: water as the base, milk at meals for calcium, and one sweet drink as a treat with a defined portion.
The beverage change that matters most is not the occasional soda but the daily default. A household that keeps water at the table, milk in the fridge door, and sparkling water as the 'treat' option has quietly replaced the sugar default without a single argument. The habit works at the individual level the same way: a water bottle on the desk, a glass with every meal, and the sweet drink becomes an exception that must be consciously chosen rather than an autopilot refill.
For patients who find plain water dull, the measured versions add variety without adding sugar or oxalate: lemon or lime slices, cucumber, unsweetened herbal tea, or a splash of unsweetened sparkling water. Each of these sits at zero oxalate. The point of the ladder is not to ban the sweet drink — it is to make water the path of least resistance,
There is also a restaurant and social dimension to the water-first default. Out to dinner, the beverage decision happens before the meal: water ordered first, sweet drinks as the exception rather than the default. At parties, a sparkling water in hand from the start solves the 'what will I drink' question before the pressure arrives. These are small pre-commitments, and they work because they move the decision out of the moment —
A word on caffeine in the beverage picture: coffee and unsweetened tea are zero-sugar options that count toward fluid, and coffee is the lower-oxalate caffeine choice at about 2 mg per cup. The stone-unfriendly versions are the sweetened ones — sweet tea, flavored lattes, energy drinks — which add sugar to a fluid the kidneys could otherwise use. The beverage ladder handles them the same way it handles soda: water and milk as the base, unsweetened coffee and tea as variety,
One more consideration for parents: the beverage habits children form in childhood are the ones they carry into adulthood, and the stone-relevant payoff compounds across decades. A child who grows up with water as the default and sweet drinks as treats is a teenager who reaches for the water bottle automatically, and an adult with a lower lifetime sugar load. The liver finding adds another reason to set that default early — That is the rare case where one habit change pays dividends across four organs — Water is free, milk is cheap, and both do more for stone prevention than any product in the sweetened aisle.and it is the cheapest prevention available in the entire beverage aisle.the same default that protects kidneys serves the liver, the weight, and the teeth at once.
sweet versions as measured treats. the same mechanism that makes the water bottle on the desk more effective than the intention to drink more. so the liver finding and the stone guidance both get honored by the same default. The liver analysis and the stone research both point the same direction — the drink that carries no calcium and no protective value is the one to treat as an exception.Sugary drinks are not direct stone ingredients — they measure near zero oxalate. The risk is indirect: they displace water and milk, add calories without calcium, and contribute to metabolic conditions that overlap with stone risk. The June JAMA analysis adds a liver-cancer association, strengthening the case for water-first defaults.
The JAMA analysis found no liver-cancer association for artificially sweetened beverages, though the broader sweetener research remains mixed and observational. On the stone ledger, diet soda is zero-oxalate. Water remains the better default; diet soda is a reasonable occasional option.
In small amounts, yes — orange juice measures about 2 mg oxalate per 8-ounce glass. But juice concentrates sugar, and the JAMA finding about sugary beverages generally applies to it. Whole fruit is the better version: fiber slows the sugar, and the measured oxalate of most whole fruit is low.
And a closing thought on the study's scope: 1.5 million adults, 11 studies, 18 years of follow-up — the largest picture yet on sugary drinks and liver outcomes. The stone patient does not need to wait for more research to act: the same beverage change the liver data points toward is the one the stone guidelines have recommended for years. Water and milk first; the sweet drink becomes the exception. Both organs benefit from one simple default.
See how oxalate values are measured and verified on our data methodology page.