It’s well established that fruit is good for you. But is this also true of fruit juice?
Introduction
In 2017, poor diets were estimated to cause 11 million deaths (1). Of this total, 2 million deaths were estimated to be caused by a diet low in fruits (Figure 1). This is a big reason why fruit consumption is recommended by national food-based dietary guidelines across the globe (2).
Figure 1. Number of global deaths attributable to individual dietary risks in 2017 (1).
But what about fruit juice? Is it similarly healthy, or is Joe Rogan* correct in saying that orange juice is basically Coke with vitamin C? Let’s walk through the arguments for or against this proposition and see if we can come to an answer by reference to the scientific literature. And just to note: I'm talking about 100% fruit juice in this article; not fruit-based sugary drinks.
Argument For Fruit Juice
Fruit juice contains similar quantities of vitamins, minerals, and phytonutrients (e.g., polyphenols) as whole fruits (3). Therefore, fruit juice can be an important source of these nutrients for people, particularly if they don’t eat much (or any) whole fruit. In addition, the consumption of phytonutrients may offer independent health benefits (4).
Argument Against Fruit Juice
When you strip the fibre from fruit, it’s much easier to consume. This has been demonstrated in a controlled feeding study, where people ate ~180 more calories (kcal) at lunch after drinking fruit juice compared to when they ate a whole apple instead (5). In fact, fruit juice is similar to sugar-sweetened beverages like Coke in terms of its energy and sugar density (i.e., the amount of kcal and sugar per millilitre (mL) of liquid) (6), which may increase the likelihood of weight gain if consumed regularly. Perhaps Joe Rogan is correct that fruit juice is not good for us?
Source: The Healthy
Fruit Juice Consumption and Health Outcomes
Arguments for or against a proposition are all well and good, but to answer an empirical question (i.e., what is the relationship between fruit juice consumption and health?), we need to go directly to the empirical data. When we do, there’s some nuance to consider.
If you recall our article from a few weeks back, the dose of food consumption is important when considering its healthfulness. This holds true for fruit juice: while low-to-moderate intakes are associated with a reduced risk of hypertension (high blood pressure), cardiovascular disease, and metabolic syndrome, high intakes are not (6,7,8). What this means is that the relationship between fruit juice and such health outcomes is non-linear (Figure 2), where a reduced risk for cardiometabolic outcomes is observed from intakes up to about a cup (~150 mL) per day (6).
Figure 2. Non-linear relationship between fruit juice consumption and cardiovascular disease risk (from 6; based on data from 9).
If you contrast this to the data on sugar-sweetened beverage consumption—which if you believe Joe Rogan, is basically the same thing as fruit juice—you’ll notice a linear relationship between consumption and an increased risk of hypertension, cardiovascular disease, metabolic syndrome, type 2 diabetes, and death from any cause (Figure 3) (6).
Figure 3. Linear relationship between sugar-sweetened beverage consumption and risk of death from any cause (from 6; based on data from 10).
Summary
It’s evident that fruit juice is not the same thing as Coke. But it’s also probably not as healthy as whole fruit—at least at higher doses. However, at intakes of about a cup or so per day (i.e., roughly one serving), it appears to reduce the risk of many chronic diseases. This is why many national food-based dietary guidelines include fruit juice as an option to meet fruit and vegetable intake recommendations (2).
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*As a general rule-of-thumb, take anything Joe Rogan says about nutrition with a BIG pinch of salt
Patrick Elliott, BSc, MPH
Health and Nutrition Science Communication Officer at Training121
Instagram: @just.health.info
Twitter: @PatrickElliott0
References
(1) GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393(10184):1958–72. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899507/
(2) Herforth A, Arimond M, Álvarez-Sánchez C, Coates J, Christianson K, Muehlhoff E. A Global Review of Food-Based Dietary Guidelines. Adv Nutr. 2019;10(4):590–605. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628851/
(3) Clemens R, Drewnowski A, Ferruzzi MG, Toner CD, Welland D. Squeezing fact from fiction about 100% fruit juice. Adv Nutr. 2015;6(2):236S–43S. Available at: https://www.sciencedirect.com/science/article/pii/S2161831322006494
(4) Aune D. Plant Foods, Antioxidant Biomarkers, and the Risk of Cardiovascular Disease, Cancer, and Mortality: A Review of the Evidence. Adv Nutr. 2019;10(Suppl_4):S404–21. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855972/
(5) Flood-Obbagy JE, Rolls BJ. The effect of fruit in different forms on energy intake and satiety at a meal. Appetite. 2009;52(2):416–22. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664987/
(6) Khan TA, Chiavaroli L, Zurbau A, Sievenpiper JL. A lack of consideration of a dose-response relationship can lead to erroneous conclusions regarding 100% fruit juice and the risk of cardiometabolic disease. Eur J Clin Nutr. 2019;73(12):1556–60. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954109/
(7) Liu Q, Chiavaroli L, Ayoub-Charette S, et al. Fructose-containing food sources and blood pressure: A systematic review and meta-analysis of controlled feeding trials. PLoS One. 2023;18(8):e0264802. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10427023/
(8) Semnani-Azad Z, Khan TA, Blanco Mejia S, et al. Association of Major Food Sources of Fructose-Containing Sugars With Incident Metabolic Syndrome: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(7):e209993. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348689/
(9) Scheffers FR, Boer JMA, Verschuren WMM, et al. Pure fruit juice and fruit consumption and the risk of CVD: the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) study. Br J Nutr. 2019;121(3):351–9. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390400/
(10) Malik VS, Li Y, Pan A, et al. Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation. 2019;139(18):2113–25. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488380/
Technical Terms
Phytonutrients: Also known as plant nutrients, this is an umbrella term for a class of nutrients only found in plants. These include polyphenols and carotenoids, which each have their own subgroups (e.g., flavonols and carotenes, respectively).
Polyphenols: These are a group of phytonutrients—or plant nutrients—that may act as antioxidants and improve our health. Health benefits from polyphenol intake include reductions in low-density lipoprotein (LDL) cholesterol, improved cognition, and other metabolic improvements.