Healthy Living: August 8, 2017

By: Amy Movius, MD - Eastern Maine Medical Center

In June, the American Academy of Pediatrics addressed a subject dear to my heart by publishing recommendations against giving any fruit juice to children less than one year of age. In addition to avoiding juice completely in infants, these guidelines also advise limiting the amount of juice toddlers and older children drink as well. The reason for this is simple; fruit juice just isn't that healthy.

If this surprises you, you are not alone! Juice is largely perceived - and marketed - as a health food. To be clear fruit is very healthy, but when the juice is separated out it ends up mostly being a source of simple sugars that is easily overconsumed because 1) it tastes good, 2) is convenient, and 3) easily transportable in bottles, sippy cups, and commercial containers. Children are the top consumers of fruit juice (and juice "drinks") and this consumption is associated with a variety of health problems including malnutrition, dental caries, and common medication interactions.

Excess juice can lead to malnutrition in a variety of ways. Over nutrition from extra calories can lead to obesity and its many associated health problems the same way soda does. Under nutrition can also occur when juice - which contains no fat or protein and little to no fiber - is consumed in place of other nutritious foods. Again, this is usually well-intentioned because of its reputation as healthy. Juice can also cause under nutrition by nutrient malabsorption and GI upset. Simply removing it from the diet of young children will frequently cure "toddler's diarrhea." Tooth decay is clearly associated with juice intake, especially for children who consume it throughout the day in bottles or other easily transportable containers which results in the teeth being constantly "bathed" in sugar.

Lastly, many juices affect the activity of enzyme systems in the liver that are responsible for metabolizing a wide variety of medications. Depending on the juice and the medication, these interactions can be quite dangerous. Babies need only mother's milk (or formula) to meet all their nutritional needs for the first six months of life. After that, mashed or pureed whole fruit can be introduced along with other solids. Toddlers 1-3 years should have no more than 4 oz. (1/2cup) per day and it should be given in a finite time with a meal or snack. It should never be given in a bottle, never given at nighttime, and cups/cartons containing juice should not be carried around. Children 4-6 years should limit juice intake to 4-6 oz. /day and 7-18 year olds to no more than 8oz. or one cup per day. Any juice consumed should be 100% fruit juice. If it contains pulp, there will be a little bit of fiber in it. Juice should always be pasteurized. Unpasteurized products can be contaminated with bacteria and are considered dangerous. Fruit juice offers no health benefits over whole fruit. Whole fruit is healthy, and should be consumed daily as part of a balanced diet. As the old saying goes, an apple a day keeps the likes of me away!

Reference:
Policy Statement, American Academy of Pediatrics:
Fruit Juice in Infants, Children, and Adolescents: Current Recommendations. Melvin B. Heyman, Steven A. Abrams, SECTION ON GASTROENTEROLOGY, HEPATOLOGY, AND NUTRITION and COMMITTEE ON NUTRITION. Pediatrics Volume 139, number 6, June 2017