Fruit Juices - Yay or Nay? Mostly Gray

Disclaimer: I don't regularly drink fruit juice. I thoroughly enjoy mimosas.

Update: a recent review found here comes to similar conclusions that there is sparse evidence suggesting 100 percent FJ is detrimental to nutrition/health/weight status.

Everybody seems to be talking about fruit juice today, so I thought I'd jump on the bandwagon. The role of fruit juice in the diet has garnered a lot of controversy. Some have gone as far as saying it's metabolic poison, and as bad as soda. Others, including the USDA, state that fruit juice can count as a serving of fruit. Where does fruit juice fit, if anywhere?

First let's take a look at what the Dietary Guidelines from 2010 (1) say:

Screenshot, DGA 2010, health.gov

Sounds like a pretty solid/realistic recommendation to me?

Let's look at the nutrient differences. I grabbed the nutrient profiles of a typical orange (i picked the smaller of the two USDA options), 1 cup of orange juice, and Coca-Cola from the USDA's database (1).

The first thing that's clear is that, if we're talking about nutrient dense options to consume on a daily basis, I think most would agree that soda is the loser here, regardless of minimal caloric differences. An orange or a cup of orange juice is significantly more nutrient dense. 

When it comes to oranges vs orange juice, we've got some things to consider. An orange has more fiber and less sugar than a cup of orange juice. These are two things many are concerned with in the modern american diet - too little fiber, too much sugar.  There are minimal differences in some micronutrients. The only notable ones I see are that orange juice has considerably more vitamin C, Potassium, Folate and Vitamin A. I think it's important to note that while fiber is something that's highlighted to increase intake of, Americans also have abysmally low potassium intake and the dietary guidelines highlight potassium, alongside fiber calcium and vitamin D, as nutrients of concern. I think it's also important to note that many orange juices are supplemented with added calcium and vitamin D, an alternative way that individuals (especially for the lactose intolerant) can consume these nutrients. Consumers of orange juice, ages 2-18, were more likely to have a greater percentage of individuals hitting the EARs for vitamin A, C, folate and magnesium, without a greater risk of being overweight in recent analyses of NHANES data (8). From a public health perspective, looking at the abysmal percentage of individuals hitting the DRI's for nutrients- see Colby Vorland's post here - I can certainly see how public health officials would want to give the green light on moderate, 100% fruit juice consumption. 

It's also important to note that juices may serve a role in providing antioxidants to consumers. The amount of antioxidant left in the juice depends on processing techniques/storage time (2), but they still have been shown to contain several bioactive components (polyphenols, flavan-3-ols, anthocyanins) (3,4,5). It's important to note that commercial juices contain less antioxidants than fresh juice or whole fruit (losing some in the skin, like quercetin). However, there's interesting/limited data from the Kame project that found an inverse relationship between fruit/vegetable juice consumption and Alzheimer's disease, particularly stronger for those with the ApoE4 genotype and non-physically active individuals (6). While the science hasn't nailed down particular dosages of specific non-essential antioxidant compounds, I don't think we should toss aside the role that juice can play in providing some of these, especially for those who don't readily have access to fruits.

Screenshot, DGA 2010, health.gov

I'm still on board with the dietary guidelines statement above: Whole fruit is better than commercial 100% fruit juices. The real question, for me, is why this focus on juices? NHANES data included in the 2010 dietary guidelines showed that fruit juice doesn't even make the top 25 sources of calories for americans older than the age of 2. For adolescents ages 2-18, 100% fruit juice that was not orange/grapefruit accounted for 35kcals/day, on average. For adults age 19+, 100% fruit juice doesn't make the top 25 list either (fruit drinks do, contributing 29kcals/day). In addition to not really contributing to total kcal intake, data from those who do consume OJ finds that they have healthier lifestyles and a lower BMI, despite higher carbohydrate and sugar intake (7). A 2011 study (9) in diabetes found an increased risk of diabetes in women from consuming fruit juice (the study doesn't indicate 100% fruit juice though). However, a recent systematic review and meta-analysis (10) found no increased risk of type 2 diabetes from consuming 100% fruit juice, although it did find an association for sugar sweetened fruit juice (a read of its introduction nicely discusses the differences between data for SS-fruit juice and 100% fruit juice). It's not even all epidemiological evidence that leaves me not too concerned about current fruit juice intake - a recent meta-analysis of fruit juices effect on fasting glucose/insulin from RCTs (albeit small sample size) found no overall effect (11). We could certainly use more RCTs on this topic but there's little evidence to get all worked up about this again.

I hear the concerns from individuals who don't like that fruit juice counts as a serving of fruit. Most fruit juices aren't sold in containers that promote only drinking 1 cup, and liquid calories are better absorbed/less satiating. The idea of a cup of orange juice alongside a sugary breakfast cereal and a couple pieces of bacon seems like the iconic SAD breakfast; the idea of a cup of orange juice,fortified with calcium + vitamin D, alongside a scrambled egg mixed with veggies, some whole grain bread with a tbsp of peanut butter feels like another story to me. I can certainly see concern about how this effects food policy, school lunch programs, and how food can be marketed to kids (i'd rather there just be no marketing to kids) - I don't think anyone wants individuals to replace all of their fruit with fruit juices. The American Academy of Pediatrics certainly doesn't - see here and here. And the USDA doesn't want you to either - see here for the many suggestions it gives.

Much of this debate seems to be 1:1 clinical nutrition VS public health, and whether, as public health recommendations, we should advocate any fruit juice consumption at all. Public health seems to be taking a "good enough" approach here -100% fruit juice is better than no fruit at all- I've discussed this before here. I can see where public health is coming from, looking at data where individuals have sub-par fruit consumption, and very little data to suggest that those who drink juice have negative outcomes. 100% fruit juice can certainly play a role in areas where there is limited access to whole fruit, or individuals can't/don't think they can afford it. I'm actually okay with the recommendations being what they are- it seems most of the concern lies within theory. In teaching individuals about consuming adequate fruit and vegetable intake, enough fiber, and maintaining energy balance, I think there's room for discussing the role of fruit juice, it's limitations and it's benefits (I personally have made veggie/fruit juices when I had more produce than I'm going to eat before it'll go bad, and I love using OJ in some baked goods in place of sugar). 

If you're a regular reader, you'll know I'm a fan of food science - I don't pretend it's the savior, but I think it has roles to play. There's a whole line of Tropicana drinks that have had half their sugar replaced with with low calorie sweeteners - see here. The nutrients are obviously going to be watered down some, but it's still a good source of vitamin C and potassium, and versions are made with calcium + vitamin D. Not perfect but better (at least in my mimosas?).

As an aside, let's make a bigger stink about getting beans back into an individuals diet. If we're concerned with fiber, we should be concerned about legumes.  

References:

http://www.health.gov/dietaryguidelines/dga2010/dietaryguidelines2010.pdf

1. http://ndb.nal.usda.gov/ndb/foods
2. http://ajcn.nutrition.org/content/79/5/727.full
3. http://www.ncbi.nlm.nih.gov/pubmed/17362029
4.http://www.emeraldinsight.com/journals.htm?articleid=1927480
5. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2621.2003.tb12340.x/abstract
6.http://www.ncbi.nlm.nih.gov/pubmed/16945610
7. http://www.ncbi.nlm.nih.gov/pubmed/22433835
8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545988/
9. http://care.diabetesjournals.org/content/31/7/1311.full
10. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0093471
11. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0095323