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Chocolate Milk + Orange Juice - Good Enough or Perfect Public Health?

There are a lot of different thought processes in nutrition. When it comes to employing nutrition research at a population level, there seems to be 2 lines of thought: good enough and perfection.

I title this Chocolate Milk and Juice because these are two areas where the debate gets quite heated and you can see these polarized perspectives:

Chocolate Milk - Milk is a great source of nutrients, like protein, riboflavin, calcium and (fortified) Vitamins A&D. In America, we have food policy that's made milk production super cheap (when compared to other nations, like India) and milk widely available - it's our society's chosen source of readily available calcium. We all know calcium is extremely important for bone health, and its particularly critical to absorb enough calcium throughout growth and development, to achieve peak bone mass and delay the onset of osteoporosis later in life. However, alongside all of the nutrients in milk, chocolate milk contains a significant amount of added sugars, to increase its palatability and encourage individuals, especially children, to want to consume it. It's also been touted as a calcium and protein rich post-workout meal.

Orange Juice - Vitamin C is pretty easy to get - one orange will get you 100% of the RDA. However, there is still evidence for reduced vitamin C status among smokers and low-income person (1).  Orange juice is an excellent source of vitamin C - though it's due to fortification, not the endogenous vitamin C, because ascorbic acid degrades rapidly in stored products (2) - and according to the USDA's Food-A-Pedia (3), contains trace minerals like potassium and magnesium in appreciable amounts, as well as the B-vitamins and vitamin C. Orange juice is often fortified with calcium and may be a great source of drinkable calcium for lactose intolerant individuals.  Orange juice, however, contains none of the fiber that whole fruit contains, and therefore, none of the phytonutrients contained in the skins. Without the fiber, and resulting volume, orange juice lacks the satiety promoting mechanisms that a whole orange has.

How does one recommend the consumption of these calorie+nutrient rich foods?

Nutrition Perfectionism Argument - Both of these foods are high in sugars and contain more calories without promoting further significant satiety than their unprocessed counterparts (skim milk, oranges). Introducing these foods as healthy/regular components of the diet leads to them becoming habits and may have detrimental effects over years of consumption. Being a concentrated source of calories with similar nutrients, these foods can displace other nutrient dense foods with protective components like antioxidants and phytonutrients i.e. if someone drank a glass of milk and ate the equivalent amount of sugar you find in chocolate milk in the form of fruit, they can benefit even further. Individuals should train their palates to become accustomed to the unprocessed forms of these foods or seek out alternative sources of these nutrients. Even as a post workout meal, one could just consume unflavored milk and eat the equivalent amount of added sugar in the form of fruit.

Good Enough Argument - Sufficient evidence does not exist to show that these food items are unhealthy. The palatability and convenience of these foods make for an easily recommendable way to consume relatively nutrient dense foods. In a world with suboptimal calcium intake, chocolate milk and orange juice fortified with calcium are easy ways to obtain significant amounts of this nutrient. Chocolate milk and orange juice can displace less nutrient dense forms of drinkable calories like soda. In the context of a diet rich in whole grains/legumes, vegetables, and nuts/seeds, there is room to fulfill some dairy/fruit recommendations with these sources.

These two lines of thought make enacting public policy rather difficult, and can be confusing to consumers. To some, the obvious answer is that they are high in sugar and highly limited in the diet. To others, the perfection argument is snobby and doesn't leave even wiggle room, to enjoy food while still getting a good amount of nutrition.

I'm partial to the perfectionist argument myself - everyone falls short of their expectations, it's almost expected - i'd rather set the bar at perfection and fall short to great, than set my expectations to have a good enough diet, and fall short to short to sub-par. But i get the good enough argument as well. From a personalized, 1:1 dietetics perspective, it's easy to say 'duh, reduce added sugars, don't consume these foods'. And for some individuals, like the highly active, an RD may not be concerned about a bit of extra sugar - but public health needs to present things as simple: good or bad. The lines get blurred, when it comes to public health's goals of attempting to increase the pretty low fruit consumption and calcium intake.

Keep in mind these perspectives the next time you see these foods in the supermarket - if you were a public health official, what would you recommend? It's easy to sit back and judge when not in their shoes. Public Health always involves trade offs and recommendations are generalized:  they may not apply to you and your lifestyle specifically, and you don't have to follow them if you do not want to. I hear all the time that we shouldn't trust government nutrition recommendations, because, hey look, fruit juice counts as fruit and pizza sauce counts as a vegetable! Let's stop the blame game and acknowledge the different perspectives.

I think it's also important to note the role that food science can play in this argument. In the case of chocolate milk, food scientists have used Monk Fruit extract to sweeten chocolate milk in schools - removing the added calories from sugar while preserving the nutrient and flavor profiles (4). I understand that some see this, still, as doing nothing to train the palate to appreciate non-sweet tastes - but I think we can all agree that chocolate milk is better without the added sugar.

What're your thoughts? Which perspective do you ascribe to?

1.http://www.ncbi.nlm.nih.gov/pubmed/19675106
2. http://onlinelibrary.wiley.com/doi/10.1002/jsfa.1024/abstract
3.https://www.supertracker.usda.gov/foodapedia.aspx?CatgoryID=-1&FoodDescription=orange%20juice
4.http://www.dairyreporter.com/Ingredients/Monk-fruit-solves-big-problem-with-chocolate-school-milk-BioVittoria 


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