Dr. Tonja Wynn Hampton
Much of a Good Thing
and Fruit Juice
Much of a Good Thing
May 7, 2001 --
Fruit juice tastes sweet and kids love to drink it. But for many, it's
become too much of a good thing -- leading to some serious health
problems. In a revised policy statement, the American Academy of
Pediatrics says that parents need to cut back on how much juice their
infants, toddlers, young children -- even older children -- are
a dramatic increase in the amount of fruit juice, fruit drinks, and
sodas being consumed by children of all ages," says study author
William Cochran, MD, associate professor of pediatric gastroenterology
and nutrition at the Geisinger Clinic in Danville, Pa. Cochran is a
member of the AAP's Committee on Nutrition.
"Juice is a
healthy food when taken in appropriate amounts," he tells WebMD.
"But juice is basically water and carbohydrates, and too much can
cause many health problems." Among them: malnourishment and stunted
growth, tooth decay, obesity, and chronic diarrhea.
statement outlines the difference between fruit juice and juice drinks.
To be labeled as a fruit juice, the FDA mandates that a product be 100%
fruit juice. In general, juice drinks contain between 10% and 99% juice
as well as added sweeteners, flavors, and sometimes fortifiers such as
vitamin C or calcium.
The good news
about fruit juices: some have high contents of potassium, vitamin A, and
vitamin C; some are fortified with vitamin C, which may have beneficial
long-term health effects, such as decreasing the risk of cancer and
heart disease. Also, when drinks that contain vitamin C are consumed
with a meal, they can increase iron absorption by twofold, says Cochran.
And juice contains no fat or cholesterol.
Many fruit juices contain twice the amounts of carbohydrates that human
milk and standard infant formulas have, Cochran says. These are in the
form of sucrose, fructose, glucose and sorbitol -- all sugars. Unless
the pulp is included, it contains no fiber either. Also, fruit juice
contains only a small amount of protein and minerals.
highly-promoted by manufacturers, calcium-fortified juices have
approximately the same calcium content as milk -- but lack other
nutrients present in milk and formula, which are important for bone
The AAP's Recommendations:
should not be given to infants under 6 months of age.
6 months of age, infants should not get juice from bottles or cups
that allow them to consume juice easily throughout the day.
should not get fruit juice at bedtime.
children aged 1-6, intake of fruit juice should be limited to four
to six ounces a day.
children 7-18, juice intake should be between eight and 12 ounces a
children should be encouraged to eat whole fruits.
take in large amounts of juice instead of breast milk or formula -- or
when toddlers drink juice instead of milk or other foods -- the risk is
malnourishment and improper physical development, including short
stature, says Cochran.
no nutritional reason to feed juice to infants younger than 6
months," Cochran tells WebMD. In fact, according to the policy
statement, "Offering juice before solid foods are introduced into
the diet could risk having juice replace breast milk or infant formula
in the diet. This can result in reduced intake of protein, fat,
vitamins, and minerals such as iron, calcium, and zinc."
Tooth decay in
infants and toddlers has been linked with excess juice consumption.
"We do not encourage use of 'sippy' cups or putting infants to bed
with juices because it promotes tooth decay," he tells WebMD.
and young children given too much juice can develop chronic diarrhea,
gas, bloating and abdominal pain, says Cochran. "I see many kids
with chronic diarrhea, and the reason is they're consuming too much
juice," he tells WebMD. "All I do is have them cut back on the
juice and the diarrhea goes away. The reason: they're overloading the
intestinal track with too much carbohydrate, which makes you pass a
lot of gas and get diarrhea."
As kids reach
adolescence, the potential for obesity escalates as kids ingest too many
high-calorie sodas, Cochran says. "A lot of people don't think
about all the calories," he tells WebMD. "We also see problems
in decreased bone mineralization, because they are not consuming
milk." In fact, an estimated 75% of girls are not consuming enough
milk, he says.
Along with the
AAP recommendations that older children and adolescents drink no more
than two 6 ounce servings of fruit juice each day, Cochran says to make
sure that kids eat whole fruit -- for the fiber. "Only half the
fruit they consume should be in the form of fruit juice," he tells
paper," says Karen Cullen, DrPH, assistant professor of pediatrics
and nutrition for the Children's Nutrition Research Center at Baylor
College of Medicine in Houston. "It brings together everything we
have been trying to tell people."
juice does fit into the diet," Cullen tells WebMD. "It is
part of the fruit category on the food pyramid. But we shouldn't be
giving juice to children as a pacifier. They should not be sipping it
all day. We've forgotten that milk is a healthy beverage, especially
with a meal. We've forgotten about water. If kids are thirsty, they
should be encouraged to drink water."
Also, because it
lacks fiber, fruit juice leads kids to drink more than they should.
"It doesn't fill you up like whole fruit does," she says.
"You just don't get the cues that you're full, as you do with whole
fruit. Therefore, you end up drinking more. You can drink six ounces
really fast, and that's about 60 calories a drink - a lot of