Babies younger than 1 shouldn't drink fruit juice, the nation's leading group of pediatricians said Monday, revising an earlier policy that said babies could have juice at 6 months.
In a report published in the prestigious medical journal Pediatrics, the American Academy of Pediatrics said fruit juice is high in sugar and calories and contributes to tooth decay, despite its reputation as a healthful beverage.
And the AAP wasn't talking about the ambiguous, factory sweetened "juice beverages" that populate supermarket shelves, but the real stuff: 100 percent fruit juice.
“I think this is a fantastic recommendation for infants, and it’s long overdue. Parents feel their infants need fruit juices, but that’s a misconception," Dr. Elsie M. Taveras, chief of general pediatrics at MassGeneral Hospital for Children in Boston, told The New York Times.
If juice is bad for babies, then what about the rest of the family? The AAP notes that children between the ages of 2 and 18 consume "nearly half of their fruit intake as juice, which lacks dietary fiber and predisposes to excessive caloric intake."
The U.S. dietary guidelines, however, say that 1 cup of fruit is equivalent to 1 cup of fruit juice, which may leave parents wondering what to serve at breakfast and when children come home from school. When it comes to juice, what's a health-conscious family to do?
What the AAP said
The new report, written by Drs. Melvin B. Heyman and Steven A. Abrams, notes that fruit juice contains "a small amount" of protein and minerals, and some varieties contain potassium, vitamin A and vitamin C. Some varieties have synthetic vitamins and minerals added during processing.
But for babies, who need only breast milk or formula, juice offers no "nutritional benefit" in the first year of life, and for toddlers and older children, juice does nothing that whole fruit can't do better, the report said. Juice "has no essential role in healthy, balanced diets of children," the doctors concluded, after offering a litany of ways in which fruit juice can actually be bad for children.
Fruit juice contains three kinds of natural sugar — fructose, sucrose and glucose — leading some health experts to say that, when it comes to sugar consumption, drinking juice is not much better than drinking soda. Children who are given juice in a bottle or sippy cup are at increased risk of tooth decay.
"The practice of allowing children to carry a bottle, easily transportable covered cup, open cup, or box of juice around throughout the day leads to excessive exposure of the teeth to carbohydrate, which promotes the development of dental caries," the authors said.
Toddlers who drink too much juice can come down with diarrhea, and malabsorption can cause flatulence, bloating and abdominal pain in some children.
The report also said that excessive juice consumption can lead to weight gain, and that children at risk for obesity should be eating whole fruit instead. This is especially true for children of women who were overweight before having children, the authors said. They noted, however, that research on the relationship between juice and obesity has been contradictory, and more study is needed.
A "gateway drink"?
"Eat the fruit, don't drink the juice," has become a mantra for many health experts, including Dr. Robert Lustig, a pediatric endocrinologist who crusades against sugar, and Dr. Yoni Freedhoff, a Canadian obesity researcher.
In an interview with the CBS affiliate in San Francisco, Lustig explained why juice is better for us when consumed as part of the whole fruit. It's all about the fiber, which Lustig calls "the stealth nutrient" and one of the most important things we can eat.
The presence of fiber helps slow the absorption of sugar in the bloodstream, he said.
Freedhoff, in his 2014 book "The Diet Fix," notes, "There is no such thing as a juice tree."
"Per drop, juice has the same amount or more of both sugar and calories when compared with sugared soda," Freedhoff wrote. "If you agree that adding vitamins and minerals to Coca-Cola wouldn't make it a healthy choice, then you probably should reconsider that morning glass of orange juice, as that's all it really is — flat soda pop with vitamins, from which the processing has removed the vast majority of the fruit's actual nutrition."
In a 2014 study published in the journal Obesity, researchers asked if juice could be a "gateway drink" that, when given to infants, led to obesity later in life. They found that higher juice intake in infancy was associated with higher body mass indices later in childhood, and that children who consumed juice at age 1 drank twice as much juice later than children who weren't given juice in the first year of life.
But a large analysis of studies published earlier this year in Pediatrics found no association between moderate consumption of juice and obesity in children.
The case for moderation
In a paper issued on juice in 2001, the AAP said parents could give babies juice at 6 months, but even then, when 90 percent of all American infants were consuming juice before their first birthday, the group suggested moderation.
"Fruit juice should be used as part of a meal or snack. It should not be sipped throughout the day or used as a means to pacify an unhappy infant or child," the authors said.
Since 2009, juice has not been included on the list of eligible foods mothers can buy using government benefits (also known as WIC) for a baby's first year.
In its most recent dietary guidelines, issued in January 2016, the federal government allows juice to count as a serving of fruit, but does urge that Americans "make most of your choices whole or cut-up fruit rather than juice, for the benefits dietary fiber provides."
In The New York Times' report, Dr. Man Wai Ng, the dentist in chief at Boston Children’s Hospital, said juice should be only an occasional treat.
"One hundred percent fruit juice should be offered only on special occasions, especially for kids who are at high-risk for tooth decay,” she said.
How about adults?
According to experts at the Harvard T.H. Chan School of Public Health, one 4-ounce glass of juice is the most you should drink in a day.
"Your body would be perfectly content if you drank nothing but water," the Harvard researchers said.