Step away from the juice bar.
Mrs. G. came to our offices for her first visit distraught. Her primary-care doctor had just diagnosed her with diabetes, and she was here for advice. She was shocked by the diagnosis. She had always been overweight and had relatives with diabetes, but she believed she lived a healthy lifestyle. One of the habits that she identified as healthy was drinking freshly squeezed juice, which she saw as a virtuous food, every day. We asked her to stop drinking juice entirely. She left the office somewhat unconvinced, but after three months of cutting out the juice and making some changes to her diet, her diabetes was under control without the need for insulin.
Mrs. G. is not an uncommon patient. As diabetes specialists, we see patients like her all the time, who for one reason or another believe that juice is a health food. The truth is that fruit juice, even if it is freshly pressed, 100 percent juice, is little more than sugar water. Yet many Americans believe that juice is good for them. In one survey of parents of young children, 1 in 3 believed that juice was at least as healthy as fruit. We are inundated with the message that juice is healthy. Juice bars abound in gyms, spas and health food stores, while government programs supply large quantities of juice to low-income children and pregnant mothers. The commercial juice industry is happy to take advantage of this idea, as with POM Wonderful’s tagline “Drink to your health” or Juicy Juice’s labels extolling the (mostly added) 120 percent of recommended daily vitamin C in the products. While the Internet is busy laughing at the Juicero juicing system — in which, it turns out, your hands work as well as the $400 WiFi-enabled machine — what people should really be talking about is a much simpler fact: The product takes healthy fruits and vegetables and makes them much less healthy.
At first glance, it is reasonable to think that juice has health benefits. Whole fruit is healthy, and juice comes from fruit, so it must be healthy, too. But when you make juice, you leave some of the most wholesome parts of the fruit behind. The skin on an apple, the seeds in raspberries and the membranes that hold orange segments together — they are all good for you. That is where most of the fiber, as well as many of the antioxidants, phytonutrients, vitamins and minerals are hiding. Fiber is good for your gut; it fills you up and slows the absorption of the sugars you eat, resulting in smaller spikes in insulin. When your body can no longer keep up with your need for insulin, Type 2 diabetes can develop.
Finally, when you drink your calories instead of eating them, your brain doesn’t get the same “I’m full” signal that it does from solid food, even though you wind up consuming far more calories in the process. Whereas an orange may contain 45 calories, an eight-ounce glass of orange juice contains 110 calories, and a large kale, banana and orange juice blend at a leading juice chain contains 380 calories. We always counsel patients to chew their food; people tend to overconsume liquid calories. In addition, you might feel full immediately after drinking a glass of juice or a fresh smoothie, but that sensation goes away quickly as the liquid quickly empties out of your stomach, and many of those calories you just drank don’t get counted in your body’s internal calorie counter contributing to that bulging waistline the gym was supposed to help fix. When researchers gave adults an apple to eat — either as a whole fruit, fresh applesauce, apple juice or apple juice with the fiber added back — followed 15 minutes later by a meal, on the day they ate the apple, they ate fewer calories at the meal than if they consumed the same number of calories from applesauce or apple juice. The chewing really counts.
