I hate juice

The Pediatric Insider

© 2011 Roy Benaroch, MD

“Why do pediatricians hate juice so much? It’s not completely junk like soda. I think kids should have some juice, but my pediatrician says it’s no good for them.”

You’re right: I’ll bet if you survey pediatricians, 4 out of 5 will say “No!” to juice. (There’s always that 5th one, the weirdo who doesn’t prefer sugarless gum and thinks car seats are for sissies. Ignore him.) Why has juice gotten such a bad rap?

Let’s look at the cold facts, comparing fruit juice to Coca-cola:

The main ingredient in both is water.

The second ingredient in both is sugar. Sugar from juice is almost all fructose, and sugar from soda is….all fructose (from high fructose corn syrup.) It’s the same. Fructose is fructose, whether from juice or from an extract from corn syrup.

12 oz of Coca-cola has 140 calories, all of which are from fructose. It has no other nutritional value.

12 oz of orange juice has 170 calories, all of which are from fructose– in fact, there is more fructose sugar in OJ than in soda, as reflected in the higher calories. 12 ounces of apple juice has about 160 calories. All, again, fructose.

OJ does contain plenty of vitamin C, well over a day’s worth in one serving. But vitamin C deficiency is not seen in the USA, ever, except perhaps in cases of mental illness and neglect. There is also a bit of vitamin A in OJ, probably 10% of the RDA in one serving. OJ and other juices provide some folate, an important B vitamin, that’s also available from many other sources, including all fortified grains.

So: juice has more calories, more sugar, and some vitamins C, A, and folate that your child is probably getting from other sources. Nutritionally, it’s similar enough to soda that you might as well think of it as soda. I do.

Some OJ is fortified with Calcium and Vitamin D, and those nutrients are deficient in many children. There are more-healthful sources (like skim milk—it has protein, potassium, phosphorus, vit A, vit D, and calcium in a very bioavailable form.) But if Junior is anti-milk, OJ w/ Calcium to me seems like one reasonable alternative.

Which brings us back to the original question: Why are pediatricians so down on juice? We have to look at The Big Picture. There really is only one nutritional problem in the United States, one problem that is much more common than all other nutritional problems combined. It’s not vitamin C deficiency, or folate deficiency, or any other deficiency. It’s an excess. An excess of calories. When you think about it, the only nutritional problem we commonly see is obesity. Kids getting too many calories are far, far more common than any sort of lack of vitamins. So when a pediatrician thinks about the best advice to give families about feeding their children, we’re first and foremost trying to think of ways to prevent and treat obesity. Sure, there are plenty of slender kids out there, and for those kids some juice (or some soda) really wouldn’t hurt. But many of them have overweight siblings, and many of them will end up fighting with overweight when they’re older. So it really is better for most families to not encourage any kind of extra calories from soda or juice.

To put it another way: I struggle to try to help families with overweight kids every single day. I’ve yet to see a single child with health problems from juice deficiency. So I’m sticking to my guns. Stay away from juice.

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5 Comments on “I hate juice”

  1. aglol Says:

    Thanks for your succinct explanation Roy. As always, no matter the subject, your posts leave me with a smile. You have a wonderful ability to spin the serious content so as to make it more potable. (so to say!)

    I’ve always leaned towards this approach with beverages. We are big in to water in our house, and lucky us… Madeline supports the rule. (not a hard and fast one… i’m sure she’s be drinking soda in the closets if it were the case, i mean sheesh…she’s a tween!)

    I do think it’s important for ALL of us to recognize where those calories are coming from and being more informed is always a good thing. I will use this post to help more people be more informed!

    And as I raise my glass on Rosh Hashana this year- I will consider the calories before I partake! 😉 And all that other new year stuff.


  2. Cal Says:

    My daughter is five years old and does not care for juice or soda, simply does not have a taste for them. She likes water and prefers to drink it at meals and snacks. I was aware of the juice restrictions advised by the pediatricians and followed suit.
    Now, we just moved to south america from the US, and here it is all about bread! Limiting bread consumption to prevent obesity. And the in-laws run around my daughter with cups of juice, trying to persuade her to drink up, as juice is perceived as a healthy choice! Go figure…


  3. Liz Ditz Says:

    With a gang of middle-schoolers, we had a taste testing: juice vs. the actual fruit. If I’m remembering correctly:

    For apple juice, 2 ounces of juice to 4 ounces of water had about the same flavor intensity of a Red Delicious. Granny Smiths are much more tart than apple juice and we couldn’t get the flavors to match up.

    For orange juice, 2 ounces of juice to about 5 ounces of water seemed to match up best.

    Our city water with a splash of lemon juice was more palatable than plain city water.

    Some people really like cucumber water (1 thin-sliced peeled cucumber to a half-gallon of water).

    So to me, the problem isn’t juice per se, but undiluted juice consumed in large quantities.


  4. Leo Says:

    Note: High fructose corn syrup is only about 55% fructose. The remaining 45% is glucose. Sucrose (i.e. table sugar) is 50% fructose and 50% glucose. Plants vary in their proportion of fructose to glucose.

    While you’re right that both juice and soda get their calories from sugars, neither gets them from purely fructose. (Note: This is also why people who use the possible different metabolism of fructose to decry high fructose corn syrup are wrong. Switching soda back from HFCS to table sugar might change the taste a bit, but the only difference will be going from 55% to 50% fructose. Negligible.)


  5. Dr. Roy Says:

    Thanks, Leo.

    Sucrose (table sugar) is a disaccharide of two smaller sugars, fructose and glucose. So if pure it’s 50:50. Whether the metabolism (which requires breaking the simple sugars apart) of sucrose to glucose + fructose changes sucrose’s effect on obesity is arguable.

    HFCS ranges from 42-90% fructose. The most common version, HFCS 55, is 55% fructose. So in terms of fructose content, sugar and HFCS are quite similar.

    In any case: it’s all sugar, and whether it’s from soda or juice it probably doesn’t matter much.


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