Fruit Juice is Not a Health Food


Healthy Living - December 22, 2015
Amy Movius, MD
The holidays are a natural time to think about avoiding dietary excess – food and alcohol being the obvious culprits. However, many of us unknowingly provide such excess to our children regularly with fruit juice, often with the idea of teaching healthy habits. While most people have heard of health risks associated with drinking “sugar sweetened beverages” such as soda and sports drinks, the fact that fruit juice should be included in this group is often overlooked or downplayed. Hopefully this is changing – in fact Swedish Hospital in Seattle WA has recently removed fruit juice from its hospital menu because of the associated health concerns. It all comes down to sugar, specifically the sugar fructose. Table sugar (sucrose) is 50 percent fructose; high fructose corn syrup is unsurprisingly even more. There is also a LOT of fructose naturally in fruit juice AND “100% juice” products are often further sweetened with fruit juice concentrates that increases their fructose content even more. The bottom line is the amount of fructose in fruit juices is similar to the amount in soda and sports drinks. In the last 3 decades, the amount of fructose ingested by Americans has more than doubled, and this increase is largely attributed to sugar containing drinks. Children are the top consumers of all these beverages and so take in the highest amounts of dietary sugar. As for fruit juice specifically, about 90 percent of infants drink it.

So why is fructose “evil”? When the body processes fructose it causes fat deposition in the liver. This can result in NAFLD or Non Alcoholic Fatty Liver Disease – which has become the number 1 pediatric liver disease and is estimated to affect 1 in 10 children. Do me a favor and read that last sentence again, ok? NAFLD often starts out deceptively quiet, causing few symptoms. Over time, these children are at increased risk of hepatitis (liver swelling), cirrhosis, liver failure and possible liver cancer as well as type 2 diabetes, and cardiovascular disease. A study that followed 66 children with NAFLD for 20 years found that 4 went on to develop diabetes (16%), 2 required liver transplant (8%) and 2 died of liver cirrhosis (8%). There is no cure for NAFLD. NAFLD is more common in obese children (maybe as high as 50%) but is also found in people with normal weight. This brings us back to sugar intake.

Not all calories are created equal! This is not about “a sensible diet and exercise” program, nor is it about weight loss. It is about limiting extra sugar intake. Not “drinking” sugar – including fruit juice – is usually the quickest way to reduce sugar intake in children. Unsurprisingly, some members of the food industry aren’t eager to discourage us from buying these products and have argued that excess weight rather than excess sugar explains the increase in NAFLD and associated health problems. An AMAZING study published this October (and then reported in the NY Times) goes a long way towards eliminating this argument. Forty-three obese kids were followed for just 9 days with only one ingredient in their diet replaced -fructose. The removed sugar was replaced calorie for calorie with starch so total daily calories and carbohydrates were the same. In this short time, these children had several statistically significant metabolic improvements including a 10 point reduction in LDL (aka “bad” cholesterol), a 5 point reduction in blood pressure, and a 33 point reduction in triglycerides (another “bad” fat) among others. All that in a week and a half, with no change in exercise habits or decrease in calories! Lastly, don’t throw out the whole fruit with the juice! Eating fruit is great for you. We are only talking about eliminating fruit juice and juice products. An apple a day really will help keep the doctor away:) Happy and Healthy Holidays!

1. NAFLD. American Liver Foundation, January 14th, 2015
2. Pediatric Nonalcoholic Fatty Liver Disease. Contemporary Pediatrics September 2013
3. Fructose content in popular beverages made with and without high-fructose corn syrup.
Walker et al, Nutrition (30)2014 928-935
4. Isocaloric Fructose Restriction and Metabolic Improvement in Children with Obesity and
Metabolic Syndrome. Lustig et al, Obesity, October 2015.
5. Cutting Sugar Improves Children’s Health in Just 10 Days. Anahad O’Conner, The New
York Times, October 27, 2015
6. Seattle’s Swedish Hospital first in US to take juice of the menu. KOMO news, December 10,
7. Just Nine Days to Metabolic Health. December 8, 2015 Uma