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Sugary drinks and cancer risk: results from NutriNet-Santé prospective cohort (bmj.com)
73 points by bookofjoe 9 days ago | hide | past | web | favorite | 98 comments





Soda is poison. It might sound dramatic, but I think we'll come to see it as similar to smoking or heavy alcohol drinking (assuming we aren't there already).

I've been trying to quit for years. I'll likely get mocked, but it is quite addictive once you're hooked (particularly as it makes you tired, which makes you want to drink more to feel "normal").

I'm trying to move to sweetened Iced Tea (40% less sugar) and eventually unsweetened Iced Tea/water. But getting used to less caffeine/sugar actually causes legitimate withdrawal, plus kicking a habit is always tricky.

It has been linked to cancer (stomach, throat, mouth, the whole digestive system), diabetes, heart disease, and beyond.


Soda is addictive. At my worst, I drank 6 Cokes a day. I've been a heavy Coke drinker for a long, long time. I have a psychological dependence on it, so when I'm particularly stressed, I need to guzzle it down.

I'm down to about 1-2 Cokes every week. I will crumble and drink a 20 oz Coke about once a week and drink water or ice tea (either unsweetened or low-sweetened (90 calories)).

The irony is that an equivalent glass of milk has 2x the number of calories as Coke, but I'll drink a glass of milk a day for the calcium, etc.


Congrats on the impressive progress.

How did you get started/what steps did you take? Was it a straight switch to water (with occasional back-slide), or did you just slowly progress away from the soda one drink at a time?


Thanks but it's far from impressive. It's been years. I've gone back and forth and did no-carb a few times (lost 30 lbs once and then fell off the wagon) which helped me break the habit. But then someone stressful would occur and I was back to 1-2 Cokes a day for a while.

Finally I scared myself enough that sugar drinks cause pancreatic cancer (no evidence but I'm still scared) and high fructose corn syrup causes fatty liver disease, which I actually do have, which in turn can lead to cirrhosis and/or liver cancer.

From that I basically scared myself straight. I started drinking a lot of unsweetened tea actually, and then substituted a little sweet tea for Coke. Eventually I've just broken the habit of drinking Coke every day and drinking tea instead and these days a lot of water as well.


Since I don't drink tea or coffee (I dislike warm drinks, especially in summer) I was left with soft drinks, juices or plain water. And since most places don't offer tasty water and each place has different juices I went with soft drinks - Cola is universal!

You could say that I used a lot of it but then one day I decided to see if I would be able to quit and so I just did it. It wasn't hard at all and it did not change the way I feel. I started drinking mostly water instead (it is still hard to get tasty water so I ask for a slice of lemon in it whenever it is available). Now I sometimes go for freshly squeezed juice and from time to time I drink some soft drinks but I do not depend on them like I did before.


Yeah but in milk, calories are much more than just sugar. It's good protein and fats (good fats?). So sodas can't compete.

Honestly you need more than just one or two data points to conclude a substance is addictive. For pretty much anything you could always find a small number of people who have trouble avoiding it.

If you want to ignore the science, you can argue that soda isn't addictive. We know that sugar and caffeine each in isolation are addictive. We also know that the combination is addictive. But all the studies could also be "data points." It really comes down to how many data points you feel qualifies for legitimacy/where the threshold is.

For example

Caffeine:

https://academic.oup.com/ajcn/article/104/4/1144/4557113 https://www.sciencedirect.com/science/article/abs/pii/S18762... https://www.journals.uchicago.edu/doi/abs/10.1086/262054?jou...

Sugar:

https://www.sciencedirect.com/science/article/pii/S014976340... https://www.sciencedirect.com/science/article/pii/S026156140... https://academic.oup.com/jn/article/139/3/623/4670401

Both together:

https://www.ingentaconnect.com/content/ben/cdar/2011/0000000... https://www.sciencedirect.com/science/article/abs/pii/S03069... https://link.springer.com/article/10.1007/s11920-015-0634-5

Soda, specifically, hasn't got many studies that directly look at its addictiveness. But its ingredients (namely sugar and caffeine) have tons of studies and meta-studies that looked into them vis-a-vis food addiction, and most concluded there was some addictive/habit-forming properties.


Where did I ignore science? My whole point was that you need to provide scientific evidence if you want to conclude a substance is addictive, not just 1 data point from yourself. Otherwise I would just cite myself because I stopped drinking soda the day I decided to and my body couldn't care less, and now we're back at square one.

Just because someone says a fact and then a personal anecdote doesn't mean there isn't lots of scientific proof behind that fact. Not every comment needs to be someone stating a fact and then including pages of references supporting that fact.

I quit caffeine. I can say it took about two weeks of hell, and then everything was better after. Had been trying for years before that.

You may or may not have tried cold turkey, but it’s worth a shot if your current taper doesn’t produce results. You could always stock up on oranges, and lemon slices for the water. Something to give you some sugar in food + flavour to the water. It’s hard to overdose on oranges, and it gets the sugar into a solid rather than a liquid form.

YMMV, but I’ve often found cold turkey a relief whenever I had long struggles with something before trying it. I’d marka piece of paper, and relax other responsibilities and focus on stuff like sleep and exercise etc during the period to cushion the blow.


You should try Bai’s soda like tasting drinks as far more healthy, and would make the transition to water or flavored water such as with lime and lemon more manageable. Also working out a lot will make you want to drink a lot more water, though adding a significant workout routine adds it’s own set of challenges.

Good on you for trying. It gets easier, this I swear.

...But between us and Virtue the gods have placed sweat: long and steep is the path that leads to her, and it is rough at the first; but when a man has reached the top, then is she easy to reach, though before that she was hard.

(Hesiod, Works and Days)


I used to drink 6 cans a day, but then I started taking 1 caffeine capsule a day and drinking water. Hopefully normal amounts of caffeine by itself isn't also cancerous, but I guess I wouldn't be surprised.

Club soda works for some people

I've heard that. I tried it, but I just love caffeine too much.

Does anyone know the answer to this question?

If I am going to drink a soda, which soda am I better off drinking? Coke or Diet Coke/Coke Zero?

I know that neither option is good for me, but which would be comparatively better or is the science still out on that?


This study seems to very clearly indicate Diet Coke/Coke Zero is much healthier than Coke.

There are tons of studies like this that concretely show how bad sugar is for you, while most studies show that artificial sweeteners have no (or minimal relative to sugar) adverse health effects.


Some years back there were press articles citing studies (of course you can't believe what you see in the headlines) that claimed artificial sweeteners don't have the same affect on satiety as real sugar, causing you to eat more.

That matches my one-person anecdotal observations, but perhaps that isn't much to go by. Find what works for you. I had much better luck with health and personal fitness by that vs. getting overly worried about what other people say works.


This doesn't invalid that hypothesis. A lot of people drink a mix of both. Artificial sweeteners can confuse your brain/hormone systems and you may consume more other calories (studies show this in mice).

We are more aware than mice though. Sugar is really bad for you .. really bad. Read up on keto diets (staying under 30g or sometimes under 10g of carbs per day .. limiting carb consumption to fruits with high fiber when you do eat them). I had a good friend who got on Ketro while he had cancer .. didn't tell his doctor, but within a few week a tumor shrunk by nearly a cm .. enough they could now operate.

Sugar is a powerful fuel source and modern humans don't need very much of it at all. The findings of this study don't really surprise me. All that extra unneeded sugar can totally feed young cancer cells.


> Read up on keto diets

I politely decline. In 2017 and 2018 I lost 100 lbs in 18 months and the primary staple of my diet was pasta dishes. The low-carb thing is not for me.

Like I said, find what works for you and ignore what people say is supposed to work. Today it is quite trendy to demonize carbs, tomorrow it may be something else, meanwhile plenty of healthy people eat lots of demonized items, but a narrow focus and overemphasis on good/bad may cause you to lose the big picture.


Diet drinks seem to not affect cancer, but the jury is still out on heart disease.

I would agree that the jury is still out on diet drinks and heart disease, but it is pretty conclusive[1][2][3] that regular soda increases your risk of heart disease.

[1] https://abcnews.go.com/Health/daily-sugary-drink-linked-hear...

[2] https://www.eurekalert.org/pub_releases/2018-03/aha-dsd03141...

[3] https://consumer.healthday.com/cardiovascular-health-informa...


Aspartame is bad for your in large quantities. The safe standard is 40mg/kg/day.

So my guess it is safer than sugar.

Claims that artificial sweetners are bad fall into the category of drinking litres of water in a short period of time.


Bad how? Please substantiate the claims. I remember the intake limit being based on some very conservative theory on handling excess uric acid.

Well I meant as bad as drinking too much water.

When your weight is 70kg you can safely consume 2800mg per day. And that's a lot!


I would drink Mexican coke over regular coke. This is sucrose vs high fructose corn syrup.

There is plenty of evidence that artificial sweeteners spike your insulin in the same way that sugars do[1], leading to adverse effects.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772345/


Are you sure that's what it says? It seems to talk a lot about psychological pavlovian responses, but I see this:

> Artificial sweeteners alone do not stimulate insulin or incretin release in vivo

> Unlike caloric sweeteners, artificial sweeteners do not augment insulin or incretin release in response to meals


If you are just going to drink it once, there is no difference.

If you are going to drink them habitually then we need to know more about the contexts in which you drink them, how often, etc. If you were to only drink one per week for example and you are otherwise living a healthy life, then probably you would find something like “they are about dead even but maybe the Coke is ever so slightly healthier?”—this sort of thing gets dominated by the really little things like some people have phenylketonuria which means they shouldn’t consume proteins containing the amino acid phenylalanine, and aspartame is a really simple protein (only two amino acids, I think?) containing phenylalanine.

On the flip side, if you drink a lot of Coke or fruit juice, each dose is giving you about as much calories as a glass of beer or wine and a similar analysis results; a bunch of those calories in both cases need to be processed by your liver and your liver can get overworked and even if it doesn’t get overworked you are likely not hitting the gym once for each sugary drink and so the surplus energy increases your equilibrium weight until you start burning the extra calories by merely existing.

By contrast the research on artificial sweeteners tends to not show negative effects here. There are some potential risks; I know a guy who is very DIY-health-ish who used to taste his urine because of some prediabetic condition where he would pee out sugars; he said that he would never drink Diet Coke again because it made his urine taste sweet (most of it passed through unharmed) but unnaturally foul (some of the aspartame was getting converted into something really nasty).

But the key thing is that most artificial sweeteners are thousands or tens of thousands of times more sweet than sugar, so there's actually surprisingly few molecules in the drink that are artificial, so you tend to get an unusually low dose of any toxicity. This is also why artificial sweeteners have a huge problem matching the natural taste of sugar—amplification of a weak signal always makes it really hard to replicate a target signal.


If you just rely on the news media, you'd be convinced that drinking anything but purified water would kill you. Even though there's a lot of news stories about diet sodas, doesn't mean there's solid evidence they're bad for you [1]. A lot of journals won't even publish articles that have negative results (e.g. do not show a link), so you can't rely on the number of studies backing one way or another.

So, if diet soda isn't bad for you, is a surgary drink worse. Since the difference between the two is sugar vs. artificial sweetener, the question can be changed to "is sugar worse for you than artificial sweeteners". Again you probably won't find any definitive evidence one way or another. The actual settled science would just boil down to whether you're consuming too many calories.

[1] https://www.webmd.com/diet/news/20170505/diet-soda-health-ri...


> The consumption of sugary drinks was significantly associated with the risk of overall cancer... The consumption of artificially sweetened beverages was not associated with the risk of cancer

According to the study, diet drinks are not associated with cancer


This study says: With respect to cancer, you’re better off with Diet.

It does not say whether you’re better off with Diet from non-cancer perspectives - such as diabetes, obesity, endocrine system disorders, osteoporosis, tooth cavities, and so forth.

Generally people say “healthier” to mean “will I die sooner”, so the study you should be looking for to answer “healthier” is likely a relative comparison of mortal causes and age of death between soda and diet drinkers.


Now that's surprising.

I would have guessed artificial sweeteners would have had more cancerous effects than "natural" sugars, but I guess that's just a logical fallicy where I assume lab synthesized chemicals are automatically worse for your body than plant synthesized chemicals.


The "... but it's natural" argument is insane.

"Natural" poison Ivy, sharks, and fire vs "unnatural" antibiotics, chemotherapy, insulin shots.


Some people are bad at logical reasoning.

There is not enough data in this study to conclude either way about artificial sweeteners

It’s literally in the conclusion section.

It wasn’t though. They state they didn’t find an association but take it with a grain of salt due to low statistical power. Therefore, we shouldn’t really say either way.

>The consumption of artificially sweetened beverages was not associated with a risk of cancer, but statistical power was probably limited owing to a relatively low consumption in this sample.


Artificially sweetened drinks are extremely bad. Refer to https://www.ncbi.nlm.nih.gov/pubmed/30802187

I quickly scanned the study you linked and its conclusions, but it doesn't seem to draw any reliable conclusions at all. It specifically mentions the results need to be reproduced, are purely observational, depended on self-reported intake quantities, and did not correct for possible factors that correlate with intake of artificial sweeteners (such as obesity). Last but not least the test group was purely women in a relatively narrow age range above 50.

I always get somewhat triggered by people claiming artificial sweeteners are provably bad, because so far I have not seen a single study that conclusively claims this without a long list of reservations. All while the health effects of artificial sweeteners are one of the most researched topics in nutritional science.

I don't have a stake in this game at all (I rarely eat/drink things that have artificial sweeteners, or actual sugar, for that matter), but the fact that after decades of research there still is no smoking gun tells me the supposed adverse health effects of artificial sweeteners are way overblown.


Some caution needs to be used when interpreting these results. The ASB intake was self-reported with a lot of potential errors. The authors state:

"Additionally, women with high intakes of ASB of all types may have differed systematically in many ways from women with little or no intake, most especially since they were more likely to be obese and have a higher energy intake."


>postmenopausal US women

How long have artificial sweeteners been on the market? How many people only drink artificially sweetened drinks?

I'm type II and other than the odd fruit juice, only drink artificially sweetened drinks. More and more stevia sweetened drinks recently, which I guess doesn't qualify as artificial though.

For those who think this study says "all clear" for artificial sweeteners:

> Null results observed in this study regarding the association between artificially sweetened beverages and the risk of cancer does not support the hypothesis of an adverse effect of artificial sweeteners. However, caution is needed in interpreting this finding because statistical power might have been limited to investigate this association owing to the relatively low level of consumption in this population study (median=6.9 mL/d). Some experimental studies suggest a possible carcinogenic effect for some artificial sweeteners, but this point is debated.767778 In order to evaluate accurately these associations in humans, it will be necessary to distinguish the different types of artificial sweeteners (eg, aspartame, sucralose, acesulfam K), and also to take into account all dietary sources for these additives (eg, yogurts, candies) and not only artificially sweetened beverages.

It should be pointed out that the label "artificial sweetener" encompasses a wide variety of chemical entities, each of which can be expected to have its own risk profile.

For comparison:

> Median daily consumption of sugary drinks was greater in men than in women (90.3 mL v 74.6 mL, respectively; P<0.001, not tabulated).

And later (although the numbers seem to have been reversed):

> However, the median consumption of sugary drinks was lower in menopausal (88.2 mL/d) compared with premenopausal (43.2 mL/d) women.

So, the median volume of consumption was about 10:1 favoring sugar in this study.


This is the kind of study you would have thought would have been done decades ago. Super relevant. I wonder why it’s taken so long.

Obviosuly nobody with the necessary money was interested in funding such a study.

Interesting results... so sugary drinks AND 100% fruit juices are associated with an increase in cancer risks. I guess I'm not surprised at all about the sugary drinks, but fruit juices... maybe.

Artificially sweetened beverages showed no increase.

I guess now we watch for headlines like "Soda Causes Cancer" which is not what this really says.


Fruit juice and soda are effectively the same to your body. They’re both high-fructose liquids which spike blood sugar and lead to insulin resistance. The only meaningful difference is that a fruit juice probably also includes some vitamins that the soda doesn’t.

Sources: anything published by Dr. Robert Lustig @ UCSF


Most fruit juices have a GI of ~50, which is moderate (about the same as a sweet potato). They don't really spike blood-sugar. Fructose is low-GI. They also contain other phytonutrients and flavenoids which may aid health in appropriate doses (e.g. hesperetin and naringenin in citrus juices).

Fructose interferes with satiety, mediated by leptin, ghrelin, etc.

This is well-documented in the literature. High-fructose, low-fiber diets make people overeat.


And GI is linked to morbidity endpoints how?

Aside from naturally occurring micronutrients, fruit juice isn't that different from soda. I'm not a chemist, but I think it's largely just different ratios of sucrose/fructose/glucose.

Does the fiber in the fruit negate the cancer risks? If not, would it be logical to say fruit is now linked to cancer?

Pure speculation, but: I imagine the processed nature of the fiberless fruit juice (with all the other ingredients/preservatives/crap they add into it) adds to the cancer risk. I'd also guess that were one to juice the fruit themselves, that would be better than the processed kind, but you're still drinking liquid sugar and bypassing the benefits of ingesting fruit in the first place.

Solid fruits are not linked to cancer, although the pesticides in them can be carcinogenic.

In addition to the fiber, I wonder if it's also a quantity issue. It takes about 4 oranges to make 1 cup of orange juice.

There's often no fiber in "fruit juice". It's just sugar-water derived from fruits instead of sugar cane.

Fructose is not great for the human body.

Fructose in actual solid fruits in moderation is fine.

Yes, but if you freeze the fruit, or do anything to remove or damage the fiber, like baking it, then it's just candy.

I ate two pounds of strawberries this week. I wonder how much fructose that is, comparatively.

Eat sugar (glucose), get glycation endproducts impairing immune system, ultimately increase cancer risk and age yourself.

I'd like to see if this is the exact mechanism or there's still more. Perhaps oxidative damage? I suppose they controlled for weight and fat percentage right?


I don't understand, maybe due to a language difference. Does 100% fruit juice mean the store bought 100% fruit guice (the premium brands?) or literally freshly squeezed orange, immediately drank? Wouldn't also eating fresh fruits be linked?

Out of curiosity what do you see as the difference? Is it just how long the juice sat there? Or are you suggesting they add something to (not-from-concentrate) "100% fruit juice" that isn't listed in the ingredients?

I'm no food technologist but squeeze an orange and put it in a glass, which is pure orange guice (100%?) and leave it on a table, and do the same with the 100% store bought one. The one from a bottle or cardboard box, not the "squeezed today" ones which are refrigerated. There will certainly be a difference, the freshly squeezed one will be stale, possibly ransid within a day. The bought one, not so sure... So there is obviously "something" else. Either preservative or some process done to the fruite.

Not to mention the taste.


Have you actually tried this? What did you find? Because I actually conducted something very similar to this experiment with someone else once, because they said the same thing as you just did and I was skeptical. We left the one we squeezed in the fridge for several days (I want to say almost a week, but it's been a few years so I don't remember exactly) and it was fine when we drank it after. We did cover the whole glass to avoid constant air exchange etc. (I didn't try doing it without that) but it was a fairly decent debunking as far as I was concerned.

Not intentionally, but generally yes, just by forgetting a glass. However, it also has not happened recently, I don't drink any kind of bought juice any more. I squeeze it myself.

Well next time you squeeze one, try this yourself intentionally. Fill a glass with orange juice, put some plastic wrap tightly over it, leave it in the fridge for a week (or however long you think is the average selling period for your local store), then try drinking it and seeing if it tastes rancid like you expect. Then ask yourself honestly if what you observed is significant support for the notion that the store-bought ones have preservatives or something.

I have done this repeatedly over the last few years (I drank a lot of freshly squeezed orange juice for a while and squeezed it in bulk) and I can therefore say with certainty that orange juice that is fresh will start tasting weird after 1-2 days in the fridge (kind of tingly, like it's fermented). This doesn't happen with fruit juice of any kind from a carton, to say nothing of the fact that orange juice from a carton is fairly disgusting.

How much air contact do you let your squeezed juice have while it's in the fridge? Also, what do the labels on your carton say? (Like ingredients, "from concentrate", "pasteurized", anything else potentially relevant?)

I've tried pasteurized and from concentrate. It should surprise nobody that those don't really grow things, but then I store both types in whatever carton they come in or that I decant them into (I had bottles for the squeezed orange juice). I kept neither completely open in the fridge, as that makes everything smell like orange juice and the orange juice itself taste like fridge.

If your question is merely why yours only lasts a couple days when mine lasted a week, it might've just been due to a difference in air contact or something, since in my case I think I pretty much filled a glass to the brim, put plastic wrap over it, and left it like that in the fridge for a week. I think my goal in that particular experiment was just to show orange juice doesn't inherently need special treatment to last that long.

But I thought the whole debate here is whether they're doing something to commercial juice that's different from what you get when you squeeze your own. In which case... shouldn't you be comparing home-squeezed vs. the store-bought ones that are not pasteurized or from concentrate? The ones that are claiming they're absolutely nothing but just squeezed orange juice? If the label already says it's been treated differently then there's nothing to investigate...


I will readily admit that I don't believe such a juice exists in any shops close to me. Anything that claims to be fresh is from concentrate, pasteurized or barely the juice that it claims to be (eg 90% apple juice, 7% the juice that you want, 3% unaccounted for).

Ah I see. It depends on where/which country you are I guess. As a couple examples, if you're somewhere with a Target, Simply Orange [1] claims to be pasteurized, whereas Tropicana does not [2], and neither is from concentrate. Although it's possible they both are pasteurized and the labeling isn't required... I don't know if it is.

However, if your next-best option is pasteurized juice, that sounds... just fine, if not even better? I mean I hope you're not finding pasteurization a horrifying Big Ag conspiracy of some sort. And pasteurization seems like a pretty plausible explanation of the difference you see compared to what you squeeze yourself... so then what's the huge worry?

[1] https://www.target.com/p/simply-orange-pulp-free-juice-52-fl...

[2] https://www.target.com/p/tropicana-pure-premium-no-pulp-oran...


Have you actually tried this?

Store bought juice is just pasteurized. Exactly like milk. You can also apply UHT process and do either at home with basic tools.

Probably it means store-bought.

One key thing about squeezing your own juice is that typically you get more fiber in your diet and fiber usually has a negative impact on cancer, which I would strongly suspect would mitigate the impact of the sugars... in addition there is a health consciousness effect where you might notice that some man or woman who is that committed to fresh-squeezing fruit juice for themselves and their kids, probably has other healthy habits that would tend to discourage cancers.


Can't you just buy juice with pulp if you want fiber?

No, that's the same mistake as thinking that simply having a condom in your pocket will protect you from unwanted effects during sex.

Fiber only works to limit the rate of fructose absorption when it's intact and the fructose is bound up inside it.


It doesn't matter if you squeeze it fresh or make it from concentrate.

In either case, you're drinking lots fructose that's been separated from fiber. Without fiber, there is nothing to slow digestion of that fructose, so you end up with a massive glycemic impact. Alongside that, fructose directly causes leptin resistance, resulting in overeating.

Also beware of eating too much fruit all at once. Fiber can only do so much, and a stomach full of oranges will also lead to the same result.


Probably as it is about the amount of sugar. It would be difficult to eat enough fruits to intake the same amount of sugar as drinking juice made from fruit.

One very intuitive explanation I've heard:

It's very difficult to eat 5 oranges in one go.

It's very easy to drink the same 5 oranges as a fresh squeezed drink.

So it's basically a question of quantity, eating it makes you full very quickly, unlike drinking it.


Possibly, but two oranges usually fill up a glass nicely.

Orange juice from the grocery store isn't fresh. It's squeezed, then boiled until it's white, with orange dye added. Sugar and flavor packets are added to it.

Truly fresh, unpasteurized orange juice only lasts a few days.


Does it ever say how much the participants were drinking?

When I've been in Bangalore, I was surprised that there's no sugar-free sodas at all.

So people who drink coffee are doubly impacted due to the acrylamide and the sugar.

Not quite. They're supposed to be drinking coffee without sugar.

But the acrylamide in coffee is a cancer risk also.

There is no evidence that the content of acrylamide in coffee is concerning. Nevertheless I agree that acrylamide is a general concern, and its levels in foods and drinks including coffee needs to be regulated better.

That's an unwarranted assumption! e.g., I drink lots of coffee, but I never contaminate it with fructose.

Milk sugars (lactose, glucose, galactose) don't affect leptin or ghrelin, so there's no risk of overeating as a result. (I also tend reduce my intake of these healthy milk sugars by using heavy whipping cream instead of whole milk.)


I switched to Galliano and Diet Dr. Pepper and never looked back.

Sorry

Warburg Effect on wikipedia if anyone is curious.


http://news.mit.edu/2016/how-cancer-cells-fuel-their-growth-... - this more recent study theorizes that amino acids, rather than glucose, supply most building blocks for tumor cells

[citations needed]

Many types cancers can use ketones as fuel.



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