Oz conjures up an apple juice arsenic scare

The Pediatric Insider

© 2011 Roy Benaroch, MD

Either Dr. Mehmet Oz is an idiot, or he’s a shameless media-hound more interested in ratings and impact than in sharing useful information.

In September, The Dr. Oz show featured a scary show about deadly arsenic in apple juice. On his own web site, he trumpets “Dr. Oz’s Extensive National Investigation”, and claims “After testing dozens of samples from three different cities in America, Dr. Oz discovered that some of the nation’s best known brands of apple juice contain arsenic.”

His show further claimed that based on his independent testing, many brands of apple juice contain well over 10 parts per billion (ppb) of arsenic, which is over the EPA-determined safety threshold for arsenic in water.

Now, I’m no fan of juice. But there’s another side to this story, one that Dr. Oz chose to ignore. He played fast and loose with the guidelines, the testing, and the chemistry.

The EPA’s upper limit of arsenic content in water is 10 ppb. There is no “official” rule for the upper limit for apple juice. However, as the EPA explained to Dr. Oz prior to his airing the show, they do test apple juice regularly, and if any product has more than 23 ppb they do further safety testing. The safety threshold for apple juice is higher because—duh—people consume far less apple juice than water. Fudging the guideline allowed Oz to claim that his testing showed that arsenic levels were above a threshold, but not above the threshold. Of the five brands he tested, only one had a total arsenic level above 23, but four had a level above 10. Now we know why he used the water guideline instead of the apple juice criteria.

What about Oz’s testing? His own web site has posted a letter from the FDA—they retested the same brands of apple juice, and found far lower arsenic levels at reference standard labs.  In fact all of the FDA’s testing found total arsenic levels below Oz’s incorrect 10 ppb threshold. The FDA told Oz about his questionable lab results prior to the show running. He chose to ignore their information, and even now his inflammatory “findings” are still featured on his web site. To his credit, Oz does link to the FDA’s letter, but visitors to the site will have to dig to find it.

What about the chemistry itself? Oz again decides to play it loose. Although, to paraphrase Barbie, “Chemistry is hard,” it’s not too difficult to explain the difference between total arsenic and toxic arsenic. Arsenic is a natural element, abundant on earth. It exists in two forms—organic arsenic, which unless consumed in tremendous quantities is non-toxic, and inorganic arsenic. Inorganic arsenic is used in pesticides and industrial chemicals, and it’s poisonous. Oz’s chemical assays measured levels of total arsenic. This isn’t a trivial point. Chloride itself is a toxic gas that will burn your eyes and kill you; combine it with sodium and you get something that makes popcorn taste better. Methanol consumption will leave you blind and dead; ethanol might make you act stupid, but unless you’re driving is generally safe. The anti-vaccine propagandists like to confuse ethyl mercury (non toxic) with methyl mercury (toxic)—the names sound similar, but only the non toxic form was used as a vaccine preservative, and even that use mostly ended about ten years ago. Oz could have used his platform to explain the important difference between organic and inorganic arsenic to reassure his audience, but instead chose fear-mongering. Ratings trump science.

So Oz ignored the established safety guidelines, used a lab that apparently provided inflated results, and combined toxic and non-toxic forms of arsenic to come up with eye-catching results. The FDA told him about these issues prior to his show, and he ran with it anyway. When it comes to medical reporting, this Oz is a lot like another Oz Wizard. He ought to stop the trickery, set the record straight, and stick to the truth.

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 5^th 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.