Fruit Juice: Just Another Sugary Drink?

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Fruit Juice: Just Another Sugary Drink?

Postby JeffN » Tue Feb 18, 2014 11:07 am

Fruit Juice: Just Another Sugary Drink?

Lancet Diabetes Endocrinol 2014
Published Online
February 10, 2014 S2213-8587(14)70013-0

Highlights from the article (which is online and free to subscribers (which is free).

"By contrast with the growing consensus to limit SSB (Sugar Sweetened Beverage) intake, consumption of fruit is regarded as virtuous, with WHO guidelines recommending consumption of fruit and vegetables—eg, in the UK, the guidelines recommend five servings per day, and one of these portions can be in the form of fruit juice."

"However, fruit juice has a similar energy density and sugar content to SSBs: 250 ml of apple juice typically contains 110 kcal and 26 g of sugar; 250ml of cola typically contains 105 kcal and 26·5 g of sugar."

"Additionally, by contrast with the evidence for solid fruit intake, for which high consumption is generally associated with reduced or neutral risk of diabetes,7 high fruit juice intake is associated with increased risk of diabetes.7,8"

"Of course, SSBs and pure fruit juices are not identical— unlike (unfortified) SSBs, fruit juices contain vitamins and minerals, so could conceivably be of value for individuals consuming micronutrient-poor diets."

"However, this micronutrient content might not be sufficient to offset the adverse metabolic consequences of excessive fruit juice consumption—eg, consumption of 480 ml of high-antioxidant concord grape juice per day for 3 months increased insulin resistance and waist circumference in overweight adults in one randomised controlled trial.9"

"Thus, contrary to the general perception of the public, and of many health-care professionals, that drinking fruit juice is a positive health behaviour, their consumption might not be substantially different in health terms from consumption of SSBs."

"We hypothesised that public perception of the healthiness of fruit juices might be based on poor awareness of their sugar content. To test this, we surveyed a nationally representative group of 2005 adults, living across the UK, using validated online polling methods,10 to assess knowledge of sugar content of a range of SSBs, fruit juices, and smoothies. We showed participants pictures of full containers of different non-alcoholic beverages and asked them to estimate the number of teaspoons of sugar contained in the portion shown. Although the sugar content of all drinks presented was similar, the sugar content of fruit juices and smoothies was underestimated by 48% on average, whereas the sugar content of carbonated drinks was overestimated by 12%."

"Thus, there seems to be a clear misperception that fruit juices and smoothies are low-sugar alternatives to SSBs."

"...the inclusion of any fruit juice at all as a fruit-equivalent in this recommendation is probably counterproductive because it fuels the perception that drinking fruit juice is good for health, and thus need not be subject to the limits that many individuals impose on themselves for consumption of less healthy foods. "

"A further, more radical suggestion would be to re-examine whether any fruit intake in the form of juices should be permissible within guidelines for daily fruit and vegetable intake. This change would be in line with calls in the USA that recommend elimination of all fruit juice consumption by children.11"

"Many would now agree that policies and guidance should be put into place to limit intake of SSBs. We suggest that, like SSBs, fruit juices are sugary drinks with a probable net adverse effect on health. A fruit juice tax is probably not warranted; however, in the broader context of public health policy, it is important that debate about SSB reduction should include fruit juice."

1 Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis.
Am J Clin Nutr 2013; 98: 1084–102.

2 Rippe JM. The metabolic and endocrine response and health implications of consuming sugar-sweetened beverages: findings from recent randomized controlled trials. Adv Nutr 2013; 4: 677–86.

3 Sievenpiper JL, de Souza RJ. Are sugar-sweetened beverages the whole story? Am J Clin Nutr 2013; 98: 261–63.

4 Almiron-Roig E, Palla L, Guest K, et al. Factors that determine energy compensation: a systematic review of preload studies. Nutr Rev 2013; 71: 458–73.

5 Bates B, Lennox A, Prentice A, Bates C, and Swan G. National Diet
and Nutrition Survey: headline results from years 1, 2 and 3 (combined) of the Rolling Programme (2008/2009–2010/11). Department of Health and Food Standards Agency; 2012. http://webarchive.nationalarchives. ndns-3-years-report/ (accessed Feb 2, 2014).

6 Academy of Medical Royal Colleges. Measuring up: the medical profession’s prescription for the nation’s obesity crisis. London: Academy of Medical Royal Colleges, 2013.

7 Muraki I, Imamura F, Manson JE, et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ 2013; 347: f5001.

8 Odegaard AO, Koh WP, Arakawa K, Yu MC, Pereira MA. Soft drink and juice consumption and risk of physician-diagnosed incident type 2 diabetes: the Singapore Chinese Health Study. Am J Epidemiol 2010; 171: 701–08.

9 Hollis JH, Houchins JA, Blumberg JB, Mattes RD. Effects of concord grape juice on appetite, diet, body weight, lipid profile, and antioxidant status of adults. J Am Coll Nutr 2009; 28: 574–82.

10 Sparrow N. Developing reliable online polls. Int J Mark Res 2006; 48: 659–80.

11 Wojcicki JM, Heyman MB. Reducing childhood obesity by eliminating 100% fruit juice. Am J Public Health 2012; 102: 1630–33.
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Re: Fruit Juice: Just Another Sugary Drink?

Postby JeffN » Tue Feb 18, 2014 11:25 am

Mass Media article on the above ... rinks.html

My comments on the published article

Besides the points made above...

Juice is not food it is a "substance/ingredient" extracted from food.

The problem with fruit juice is not so much the fructose, though that can be an issue if large amounts are consumed, it is the calories which are liquid calories that lack fiber, are very low in satiety and also the overall calorie and sugar concentration that are the issues.

The article references 150 ml as a serving which is 5 oz. In America, a serving of fruit juice is 4 oz or about 120 ml. If someone had 4 oz on occasion it is probably not a big deal.

We often hear that juice is "better" because it has more vitamins and minerals than other sugar sweetened beverages (like coke cola). While this is true, it is missing the point.

The main health problems we are facing (overweight, obesity, diabetes, CVD, etc) are not cause by the lack of a few nutrients and most people following my recommendation are already consuming a highly nutrient rich diet. So, nutrient deficiencies are not the main issue... excess calories, lack of fiber, and to some degree, excess sugars are as are excess weight, obesity, metabolic syndrome and diabetes. Adding a few nutrients to coke would not make it a health food.

In regard to vegetable juices, they generally have less calories & sugar than fruit juices, & as such their recommended serving size is 6 oz, not 4 oz as for fruit juice. However, some veggie juices, like carrots & beets, have almost as much sugar as many fruit juices (and even more than some fruit juices), so, for them, the concerns are the same.

Other veggie juices, especially green veggie juices like those made with kale, can be fairly bitter so most people will not drink them without something sweet added. Usually this ends up being sweet veggies (carrot, beet, etc) or fruit juice (apple, orange etc) or coconut water, so we are back to the same issue as with fruit juices. Just look at all the ones sold over the counter in supermarkets, most all the veggies & green juices are loaded with fruit juices.

This is why i always have said...

A serving of fruit juice is 4 oz & veggie juice 6 oz. Having a serving on occasion is probably not a big deal for most. Realize though that most juice servings/containers today are now 12-24 oz which is 3-6 servings. So, be careful because once we open them, we tend to drink the whole container.

However, if excess weight, diabetes, blood sugar, A1c, triglycerides are an issue, it may be best to skip juices completely.

It is interesting to note that the American Academy of Pediatrics does not recommend juice for infants & has defined set limits for it for younger & older kids. ... /1210.full

"Intake of fruit juice should be limited to 4 to 6 oz/d for children 1 to 6 years old. For children 7 to 18 years old, juice intake should be limited to 8 to 12 oz or 2 servings per day."

I think we should follow their lead though in doing so, also remember that most all the people who come to us (or this diet) for help are fairly unhealthy people, not healthy kids, So, for this audience, I recommend the following limits....

1 serving per day at most on occasion. I would also prefer if it is not consumed on its own (ie, just drinking a glass of juice as a snack or a meal) but used as flavoring/condiment as part of a recipe or included with other food (in a healthy recipe) and/or used to get you to eat more healthy low calorie dense foods (ie, if a little juice is used in a salad dressing so you eat more salad or added to oatmeal as a flavoring so you eat more oatmeal, or a veggie juice added to a soup or chili recipe so you eat more soup and or rice and beans, etc) but within the recommended limits.

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Re: Fruit Juice: Just Another Sugary Drink?

Postby JeffN » Sat May 03, 2014 4:00 pm

Rethink drinking juice vs. eating whole fruit.
[No authors listed]
Harv Health Lett. 2013 Dec;39(2):8. No abstract available.


The article focuses on a Harvard University study which revealed that drinking a serving of fruit juice every day is associated with as much as a 21% increased risk of developing diabetes..

When it comes to adding fruit to your diet, go with the whole fruit but not juice. A Harvard study in the Aug. 29, 2013, BMJ found that drinking a serving of fruit juice every day was associated with as much as a 21% increased risk of developing diabetes. Why? “The juicing processes lead to lower contents of beneficial phytochemicals and dietary fiber. In addition, juice fluids are absorbed more rapidly and lead to more dramatic changes after eating in blood sugar and insulin levels than solid whole fruits,” explains senior author Dr. Qi Sun, assistant professor in the Department of Nutrition at the Harvard School of Public Health. The good news is that eating at least two servings per week of whole fruits especially blueberries, grapes, and apples—was associated with a 23% lower risk of developing diabetes.

Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies.
Muraki I, Imamura F, Manson JE, Hu FB, Willett WC, van Dam RM, Sun Q.
BMJ. 2013 Aug 28;347:f5001. doi: 10.1136/bmj.f5001. Erratum in: BMJ. 2013;347:f6935.
Free PMC Article ... .f5001.pdf


OBJECTIVE: To determine whether individual fruits are differentially associated with risk of type 2 diabetes.

DESIGN: Prospective longitudinal cohort study.

SETTING: Health professionals in the United States.

PARTICIPANTS: 66,105 women from the Nurses' Health Study (1984-2008), 85,104 women from the Nurses' Health Study II (1991-2009), and 36,173 men from the Health Professionals Follow-up Study (1986-2008) who were free of major chronic diseases at baseline in these studies.

MAIN OUTCOME MEASURE: Incident cases of type 2 diabetes, identified through self report and confirmed by supplementary questionnaires.

RESULTS: During 3,464,641 person years of follow-up, 12,198 participants developed type 2 diabetes. After adjustment for personal, lifestyle, and dietary risk factors of diabetes, the pooled hazard ratio of type 2 diabetes for every three servings/week of total whole fruit consumption was 0.98 (95% confidence interval 0.97 [corrected] to 0.99). With mutual adjustment of individual fruits, the pooled hazard ratios of type 2 diabetes for every three servings/week were 0.74 (0.66 to 0.83) for blueberries, 0.88 (0.83 to 0.93) for grapes and raisins, 0.89 (0.79 to 1.01) for prunes, 0.93 (0.90 to 0.96) for apples and pears, 0.95 (0.91 to 0.98) for bananas, 0.95 (0.91 to 0.99) for grapefruit, 0.97 (0.92 to 1.02) for peaches, plums, and apricots, 0.99 (0.95 to 1.03) for oranges, 1.03 (0.96 to 1.10) for strawberries, and 1.10 (1.02 to 1.18) for cantaloupe. The pooled hazard ratio for the same increment in fruit juice consumption was 1.08 (1.05 to 1.11). The associations with risk of type 2 diabetes differed significantly among individual fruits (P<0.001 in all cohorts).

CONCLUSION: Our findings suggest the presence of heterogeneity in the associations between individual fruit consumption and risk of type 2 diabetes. Greater consumption of specific whole fruits, particularly blueberries, grapes, and apples, is significantly associated with a lower risk of type 2 diabetes, whereas greater consumption of fruit juice is associated with a higher risk.
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Re: Fruit Juice: Just Another Sugary Drink?

Postby JeffN » Thu May 22, 2014 9:02 am

A few more

1) Potential nutritional and economic effects of replacing juice with fruit in the diets of children in the United States.
Arch Pediatr Adolesc Med. 2012 May;166(5):459-64. doi: 10.1001/archpediatrics.2011.1599.


OBJECTIVE: To estimate the nutritional and economic effects of substituting whole fruit for juice in the diets of children in the United States.

DESIGN: Secondary analyses using the 2001-2004 National Health and Nutrition Examination Survey and a national food prices database. Energy intakes, nutrient intakes, and diet costs were estimated before and after fruit juices were completely replaced with fruit in 3 models that emphasized fruits that were fresh, inexpensive, and widely consumed and in a fourth model that partially replaced juice with fruit, capping juice at recommended levels.

SETTING: A nationwide, representative sample of children in the United States.

PARTICIPANTS: A total of 7023 children aged 3 to 18 years.

MAIN EXPOSURES: Systematic complete or partial replacement of juice with fruit.

MAIN OUTCOME MEASURES: Difference in energy intakes, nutrient intakes, and diet costs between observed and modeled diets.

RESULTS: For children who consumed juice, replacement of all juice servings with fresh, whole fruit led to a projected reduction in dietary energy of 233 kJ/d (-2.6% difference [95% CI, -5.1% to -0.1%]), an increase in fiber of 4.3 g/d (31.1% difference [95% CI, 26.4%-35.9%]), and an increase in diet cost of $0.54/d (13.3% difference [95% CI, 8.8%-17.8%]).

CONCLUSIONS: Substitution of juice with fresh fruit has the potential to reduce energy intake and improve the adequacy of fiber intake in children's diets. This would likely increase costs for schools, childcare providers, and families. These cost effects could be minimized by selecting processed fruits, but fewer nutritional gains would be achieved.

PMID: 22566547

2) Reducing childhood obesity by eliminating 100% fruit juice.
Am J Public Health. 2012 Sep;102(9):1630-3. doi: 10.2105/AJPH.2012.300719.
Epub 2012 Jul 19. ... %3dpubmed&


The Healthy Hunger-Free Kids Act of 2010 presents an opportunity to change the nutritional quality of foods served in low-income childcare centers, including Head Start centers. Excessive fruit juice consumption is associated with increased risk for obesity. Moreover, there is recent scientific evidence that sucrose consumption without the corresponding fiber, as is commonly present in fruit juice, is associated with the metabolic syndrome, liver injury, and obesity. Given the increasing risk of obesity among preschool children, we recommend that the US Department of Agriculture's Child and Adult Food Care Program, which manages the meal patterns in childcare centers such as Head Start, promote the elimination of fruit juice in favor of whole fruit for children.

PMID: 22813423
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Re: Fruit Juice: Just Another Sugary Drink?

Postby JeffN » Tue Nov 04, 2014 8:09 am


Habitual intake of fruit juice predicts central blood pressure
Appetite. Volume 84, 1 January 2015, Pages 68–72
DOI: 10.1016/j.appet.2014.09.019 ... 6314004620

• We examined the association between fruit juice consumption and blood pressure.
• Blood pressure was measured in the brachial artery and aorta.
• Frequent fruit juice consumption was associated with higher aortic blood pressures.
• There were no differences in brachial blood pressures.
• Limiting juice consumption may reduce aortic blood pressures and aortic stiffness.


Despite a common perception that fruit juice is healthy, fruit juice contains high amounts of naturally occurring sugar without the fibre content of the whole fruit. Frequent fruit juice consumption may therefore contribute to excessive sugar consumption typical of the Western society. Although excess sugar intake is associated with high blood pressure (BP), the association between habitual fruit juice consumption and BP is unclear. The present study investigated the association of fruit juice consumption with brachial and central (aortic) BP in 160 community dwelling adults. Habitual fruit juice consumption was measured using a 12 month dietary recall questionnaire. On the same day, brachial BP was measured and central (aortic) BP was estimated through radial artery applanation. Frequency of fruit juice consumption was classified as rare, occasional or daily. Those who consumed fruit juice daily, versus rarely or occasionally, had significantly higher central systolic BP (F (2, 134) = 6.09, p < 0.01), central pulse pressure (F (2, 134) = 4.16, p < 0.05), central augmentation pressure (F (2, 134) = 5.98, p < 0.01) and central augmentation index (F (2, 134) = 3.29, p < 0.05) as well as lower pulse pressure amplification (F (2, 134) = 4.36, p < 0.05). There were no differences in brachial BP. Central systolic BP was 3–4 mmHg higher for those who consumed fruit juice daily rather than rarely or occasionally. In conclusion, more frequent fruit juice consumption was associated with higher central BPs.

Mass Media Article

Fruit juice consumption linked to higher blood pressure
By Nathan Gray+, 04-Nov-2014

Habitual consumption of fruit juice may be a predictor for high blood pressure, according to new research. ... d-pressure
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Re: Fruit Juice: Just Another Sugary Drink?

Postby JeffN » Wed Jun 15, 2016 7:29 am

As usual, CSPI gets most of it right.

In Health

These Fruit Smoothies Are Pretty Slick
But not in a particularly good way.
David Schadt
June 15, 2016 ... smoothies/
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