PHOTO BY Tatomm
Two years ago, Dr. Uma Pisharody made waves when she successfully campaigned for the removal of juice from her hospital’s kids menu. In doing so, she became the first doctor in the country to get juice off a hospital menu. For Dr. Pisharody, it was a no brainer. She was telling kids suffering from metabolic disorder to curb their fructose and juice intake, and yet it was still being served at the treatment center.
Dr. Pisharody, is still an advocate, as an advisor for Yumi and as an active member in her community, where she coaches other medical professionals about the dangers of a high-fructose diet. We recently asked her to explain why she’s wary of juice, particularly for young children:
I regard the sugar in juice, even 100% fruit juice, very similar to the way in which I regard the sugar in soda or sugar-sweetened beverages. All of these drinks contain excessive amounts of “free sugar,” which describes sugar not bound to fiber. It’s important to remember how much free sugar is present in just a single serving of 100% fruit juice1. Consider that eight ounces of 100% apple juice has just as much sugar as eight ounces of cola!
Remember that sugar found in fruit comes from two molecules: fructose and glucose. While glucose can be used by every cell in our body, providing energy, most of the fructose we ingest and absorb is used exclusively by the liver. Research shows that excessive fructose uptake by the liver leads to harmful metabolic effects such as insulin resistance and cardiovascular disease2, 3.
The relatively small amount of fructose found in whole fruits is harmless, with a balanced diet. That’s because whole fruit also contains fiber. The protective layer of fiber (which unfortunately gets pulverized when fruit is juiced) keeps the fructose from getting absorbed too rapidly. In addition, a child typically consumes no more than one or two servings of fruit at any given time, chewing and swallowing slowly and gradually. On the other hand, since most children can easily drink four to eight ounces of a juice in just a few minutes, a large bolus of the sugary essence of several servings of fruit gets delivered to the intestinal tract. This leads to rapid absorption followed by increased uptake by the liver.
Over the last couple of decades, pediatric gastroenterologists like me are seeing a dramatic rise in the number of children developing a dangerous liver disease that was once primarily seen in adults suffering from chronic alcoholism. Since this disease is developing in children (and adults) who’ve never drank any alcohol, it’s been termed “nonalcoholic fatty liver disease” (NAFLD). Mounting evidence has linked excessive consumption of sugar (specifically the molecule fructose) with NAFLD 4-6.
This is why I educate families to remove juice and other sources of excessive fructose from the diets of children. As far as the liver is concerned, I feel that the risk of excessive fructose in our diet is the same as the risk of drinking too much alcohol.
Dr. Uma Pisharody specializes in pediatric gastroenterology at the Swedish Medical Center. She is a board member of the Institute for Responsible Nutrition and is an advisor for Yumi and the Hypoglycemia Support Foundation. She’s pretty awesome.
Editor’s note: The American Academy of Pediatrics recently tightened their guidelines on juice, and announced in May 2017 that parents should “completely avoid the use of juice in infants before 1 year of age.” See: “Fruit Juice in Infants, Children, and Adolescents: Current Recommendations.”
Below is a run-down of Dr. Pisharody’s References:
- Walker RW et al. Fructose content in popular beverages made with and without high-fructose corn syrup. Nutrition. 2014 Jul-Aug; 928-35.
- Lim JS, Mietus-Snyder M, Valente A, Schwarz JM, Lustig RH. The role of fructose in the pathogenesis of NAFLD and the metabolic syndrome. Nat Rev Gastroenterol Hepatol. 2010; 7(5):251-64
- Luc Tappy, Kim-Anne Lê. Physiological Reviews 2010 Jan: 90; 23-46.
- Vos MB, Lavine, JE. Dietary fructose in nonalcoholic fatty liver disease. Hepatology. 2013 Jun; 57(6):2525-31
- Schwarz JM, Noworolski SM, Erkin-Cakmak A et al. Effects of Dietary Fructose Restriction on Liver Fat, De Novo Lipogenesis, and Insulin Kinetics in Children with Obesity. 2017 Jun; 1(17)35685-8.
- Lustig RH, Mulligan K, Noworolski SM, et al. Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome. 2016 Feb; 24(2):453-60