I am not familiar with the quality of the water in Eastern Kentucky. My patients who live in Zanesville and McConnellsville, Ohio, have safe municipal water supplies, yet many of them get almost their entire daily fluid intake, and sometimes more than half of their daily calories, from Mountain Dew or other brands of pop. I saw the same thing in Beckley, West Virginia, when I lived there and, again, the safety of the water supply was not the problem. (I drank the water there for 11 years.) Drinking a liter of pop a day is fairly common among my patients and some report drinking 2 liters a day. I have "cured" insomnia, dyspepsia, or hyperglycemia in a few patients by persuading them to switch to water. All of my patients had already heard that drinking so much pop is unhealthy, so I conclude that this is not an educational issue.

Buying all that pop is expensive, yet I see excessive consumption at least as often among the poor as among wealthier patients. Water is cheaper than pop everywhere, even in eastern Kentucky. Even if the region lacks potable tapwater, bottled water costs the same, or less than, pop. If this is a poverty issue, it is a strange one.   

Since many national convenience store chains and fast-food restaurant chains sell pop in single servings of 32 and even 64 ounces, and since Zanesville is not Appalachian, I conclude that excessive pop consumption is not specifically an Appalachian issue.

I don't know the solution. I plan to ask my patients if food stamps can be used to buy pop. I'll let you know. It might be of interest that, when I have asked my patients why they drink so much pop, they say it is because they like the taste, because they don't like water, and because they want the caffeine.

Kent