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Experts advise that children 6 and under should drink no more than four ounces of fruit juice a day, even if it is 100-per-cent pure.FamVeld/Getty Images/iStockphoto

The Question

Should I let my kids drink 100-per-cent fruit juice? I've heard it's as bad as pop. How can that be true? How much is too much?

The Answer

When I was a kid, four ounces of orange juice was a breakfast staple. (Remember those tiny appropriate-sized juice glasses?) Fruit juice wasn't, though, something my brother and I packed in our lunch or quenched our thirst with after school.

That's doesn't seem to be the case today.

According to a study published in 2012, Canadian kids are drinking plenty of fruit juice, at least 50 per cent more than current guidelines. What's more, many two- and three-year-olds guzzle 2.5 times more than the Canadian Pediatric Society's recommended maximum limit of four ounces (120 millilitres) per day.

That doesn't surprise me considering that fruit juice is often perceived as being just as healthy as whole fruit. (Juice comes from fruit, right?)

Health Canada seems to think it is. Canada's food guide positions fruit juice as a nutritionally equivalent alternative to whole fruit.

To be clear, I am referring to unsweetened fruit juice, not fruit drinks, punches and cocktails that contain added sugars.

That doesn't mean, though, that the naturally occurring sugars in pure fruit juice are harmless. I'll get to that in a moment.

What fruit juice doesn't deliver

Squeezing juice from fruit leaves behind the skin and the pulp, which contain nearly all the fibre, a nutrient that keeps you feeling full, slows the absorption of fruit's natural sugar and helps promote regularity.

Processing fruit into juice can also strip away disease-fighting phytochemicals that, along with fibre, reside in the skin and pulp.

Apple juice, for instance, contains only a fraction of the flavonoids (antioxidants) found in the skin of apples.

Some but not all research has linked regular fruit juice consumption to a greater risk of Type 2 diabetes.

Increased consumption of whole fruit, on the other hand, has been associated with a lower risk. It's thought that the lack of fibre and phytochemicals in juice many contribute to diabetes risk.

Sugar, calories and weight gain

When it comes to sugar and calorie content, fruit juice is pretty much identical to sugar-sweetened soft drinks.

Consider that a 12-ounce serving of 100-per-cent orange juice delivers 165 calories and 34 grams of sugar (8.5 teaspoons worth). The same amount of regular cola contains 156 calories and 36 grams of sugar.

(One large orange, by the way, has 86 calories and 17 grams of sugar, along with 4.4 grams of fibre.)

The World Health Organization deems 100-per-cent fruit juice to be a "free sugar" even though it contains naturally occurring, not added, sugars. That's because fruit juice is a concentrated source of simple sugars that the body absorbs quickly.

(Free sugars are the sugars that you and manufacturers add to foods, including white sugar, cane syrup, high-fructose corn syrup, brown rice syrup, honey, maple syrup and many others.)

Based on evidence linking excess free sugars to obesity and tooth decay, the WHO advises that everyone – adults and kids – limit free sugars to less than 10 per cent of daily calories, and even better, the organization says, less than 5 per cent of daily calories. For a 2,000-calorie diet that means no more than 25 grams of free sugar.

Fruit juice is often blamed as a culprit in childhood obesity. Yet, a systematic review and meta-analysis published earlier this year in the journal Pediatrics found that drinking one serving (six to eight ounces) of unsweetened fruit juice was not tied to weight gain in kids 1 and older.

Even so, there did appear to be a risk of gaining weight the longer kids drank fruit juice. And, among the eight observational studies included in the review, three found significant weight gain in toddlers drinking one serving per day.

One concern is that it's easier to consume a lot of calories from juice than it is from whole fruit. It takes less time to gulp down two eight-ounce glasses of apple juice, for instance, than it does to eat a medium-sized apple. The surplus: 133 calories, an amount that adds up over time.

Another concern: portion size. A typical juice box contains 200 ml, more than the Canadian Pediatric Society's upper limit of 120 ml. A single-serve bottle of fruit juice can deliver 450 ml along with 220 calories and 40 g of sugar.

Plus, the brain doesn't register liquid calories the same way as calories from food. Research shows that people don't offset liquid calories by eating less food later on.

What about fruit smoothies?

A smoothie made by blending whole fruit delivers more fibre, nutrients and phytochemicals than fruit juice.

A 2014 study revealed that juices prepared by blending fruit (apple, pear, orange, persimmon) had stronger antioxidant activity and contained more phytochemicals than juices made by juicing only the flesh.

Keep in mind, though, that pulverizing fruit in a blender or Vitamix changes the structure of fibre in whole fruit, an effect that diminishes its filling factor. And it's still a liquid that you can consume faster than the time it takes to eat the whole fruit it's made from.

Advice for kids (and adults)

Pure fruit juice (unsweetened) isn't a substitute for the real thing (whole fruit). If you drink 100-per-cent juice, don't substitute it for more than one of your daily fruit and vegetable servings.

Limit portion size to four ounces per day for children 1 to 6 and eight ounces for older kids, including teenagers. Avoid giving fruit juice to children before their first birthdays; some experts advise no juice before 2.

Better yet, eat an orange, an apple or a handful of grapes and save fruit juice for a treat.

When thirsty, encourage kids to drink water to hydrate. Replace juice boxes in lunches with water or shelf-stable unsweetened milk or soy milk boxes, which also deliver protein, calcium and vitamin D.

If you juice your own fruit, include vegetables, too. Use a 3:1 vegetable-to-fruit ratio to maximize nutrients and dilute sugar and calories.

Leslie Beck, a registered dietitian, is based at the Medisys clinic in Toronto.

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