Mrs. G. came to our offices distraught: Her primary care doctor had just diagnosed her with diabetes, and she was shocked. She had always been overweight and had relatives with diabetes, but she believed she lived a healthy lifestyle. One habit she identified as healthy was drinking freshly squeezed juice every day. We asked her to stop drinking juice entirely. She left the office unconvinced, but after three months of cutting out the juice and making some changes to her diet, her diabetes was under control without the need for insulin.
Mrs. G. is a common case. As diabetes specialists, we often see patients who believe juice is a health food. In one survey of parents of young children, 1 in 3 believed that juice was at least as healthy as fruit. But even freshly pressed, 100 percent juice is little more than sugar water.
We are inundated with the message that juice is healthy. Juice bars abound in gyms, spas and health food stores, while government programs supply large quantities of juice to low-income children and pregnant mothers. The commercial juice industry is happy to build on this idea. The internet is busy laughing at news of the Juicero juice bags -- which don't actually need the $400, WiFi-enabled Juicero machine to be used - when what people should really be talking about is a much simpler fact: The product takes healthy fruits and vegetable and makes them much less healthy.
At first glance, it is reasonable to think that juice is healthy: Whole fruit is healthy, and juice comes from fruit, so it must be healthy, too. But juice leaves some of the healthiest parts of the fruit behind. The skin on your apple, the seeds in your raspberries, the membranes that hold orange segments together -- all are good for you. They are where most of the fiber, antioxidants, phytonutrients, vitamins and minerals are hiding. Fiber is good for our gut; it fills us up and slows the absorption of the sugars we eat, resulting in smaller spikes in insulin. When our bodies can no longer keep up with our need for insulin, type 2 diabetes can develop.
Too, when we drink our calories instead of eating them, our brain doesn't get the same "I'm full" signal that it does from solid food, even though we wind up consuming far more calories in the process. Whereas an orange may contain 45 calories, an eight-ounce glass of orange juice contains 110 calories, and a large kale, banana and orange smoothie at a leading juice chain contains more than 600 calories. You might feel full immediately after drinking a glass of juice or a fresh smoothie, but that sensation goes away quickly as the liquid empties out of your stomach, and many of those 600 calories you just drank don't get counted in your body's internal calorie counter.
Our perception of juice needs a radical makeover, starting with our kids. Juice comes in easy single-serving, shelf-stable packages. Yet children don't need juice for nutritional purposes, and most juice boxes contain more than the 4-to-6 ounce maximum recommended by the American Academy of Pediatrics for daily consumption by kids under 6. In fact, kids who drink juice regularly are shorter and heavier than kids who rarely drink juice, probably because they consume less milk, something young children do need for healthy growth.
The perception that juice is good for kids comes in part from the Women, Children and Infants Supplemental Food Program, better known as WIC, which provides food assistance to 25 percent of all pregnant women and half of all children in the nation at some point in their first five years of life. While the program has helped to improve birth outcomes and cognitive development in participants, it needs some revision. The WIC program supplies a very narrow range of foods deemed healthy for pregnant women and growing children. This includes healthy staples such as milk and eggs, but surprisingly also includes two gallons of juice per month. When the program started in the 1970s, there wasn't an obesity epidemic, and undernutrition was a major concern. In that context, giving juice rather than fresh fruits and vegetables -- which also didn't have the year-round availability that they do now -- may have made sense. Today, it just feeds the false perception that juice is a healthy choice.
So how can we start fixing this problem? First, recognise juice for what it is: a treat. It doesn't belong at your breakfast table or after your gym workout.
Next, get juice out of your children's lives. Ditch the juice boxes in favor of water or shelf-stable milk boxes. Not only does milk contain about a third of the sugar of juice, it's also a great source of the protein, calcium, vitamin D and magnesium that growing kids need. Make sure that day-care or after school-programs follow current guidelines and serves only milk or water.
Finally, the Institutes of Medicine recently released suggested revisions, including lower amounts of juice, to the WIC program, so write to the Department of Agriculture in support of the revision. While we can't solve the diabetes and obesity epidemics with one simple move, rebranding juice from health food to treat would be a major step in the right direction.
Ferris is assistant professor of medicine in the division of endocrinology and metabolism at the University of Virginia in Charlottesville, Virginia. Isganaitis is assistant professor of pediatrics at the Joslin Diabetes Center in Boston. Brown is assistant professor of medicine and director of the Diabetes in Pregnancy Program at the Joslin Diabetes Center in Boston.
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