Is your toddler is getting pudgy? Is your preschooler shorter than the other kids? Are your kids’ teeth sprouting white spots or brown stains?
If so, the culprit may be the juice craze that’s sweeping the nation, as well-meaning parents stuff lunchboxes and backpacks with juice boxes and kids guzzle the stuff all day.
Last week, a study published in the journal Pediatrics found that kids who drank more than 12 ounces of fruit juice a day were more likely to be short or fat, though not both, than kids who drank less than 12 ounces.
The American Academy of Pediatrics quickly chimed in with a different warning — that too much juice with a type of sugar called sorbitol, found in pear and apple juice, can cause diarrhea, abdominal pain or bloating.
And last year, the American Dental Association published yet another study that showed that drinking too much fruit juice, which often contains fluoride, can trigger a process called fluorosis that leaves white or dark brown spots on kids’ teeth.
Health researchers have long been appalled at America’s worsening dietary habits, in part because 22 percent of kids and teen-agers are now overweight, up 47 percent from 30 years ago.
But while fast foods, take out meals and the usual no-nos like potato chips and cookies get most of the blame in the public mind, researchers are increasingly recognizing that what kids drink — from the obviously non-nutritious soda pop to the seemingly innocuous fruit juices — can contribute, too.
Last fall, a study by researchers at New York Hospital-Cornell Medical Center’s Nutrition Information Center concluded that “liquid nutrition,” including high-calorie fruit juices and soft drinks consumed by kids and teen-agers, may play a key role in the growing problem of childhood obesity.
It’s not just that juices have lots of calories — 155 of them in an 8-ounce box of grape juice, for instance — but that juices may be “replacing other more important nutrients,” says Dr. William Dietz, director of clinical nutrition at the Floating Hospital for Children at New England Medical Center.
“Consumption of juice and soda has increased and milk has decreased,” says Dietz, who is a consultant to the Milk Processors Education Program and its “milk mustache” campaign. “I don’t think there is any reason why children should drink more than one glass of juice a day, about eight ounces.”
In fact, the emerging consensus from those concerned about kids’ health is that many children would be better off drinking a little less juice and a little — or even a lot — more skim or lowfat milk and plain old water. Not to mention eating more real fruit, which has fiber and other goodies, too.
But before you dump the fruit juice out with the bathwater, consider the finer points of all this.
Last week’s study in Pediatrics, conducted by Dr. Barbara Dennison, a pediatrician at Bassett Hospital in Cooperstown, N.Y., is somewhat less scary than it sounds at first.
Dennison’s team studied 168 healthy kids — 94 two-year olds and 74 five-year olds, recording weight, height and dietary habits, including how much juice they drank. The researchers counted only the real stuff — 100 percent fruit juice, including mixed juices like Juicy Juice — not juice-flavored drinks.
Only 19 kids (11 percent of the study group) drank 12 ounces of juice a day or more, a tiny number on which to make weighty dietary recommendations. But of these 19, eight (or 42 percent) were short. Of those who drank less than 12 ounces a day — the rest of the kids in the study — only 14 percent were short.
The team also found that those few kids who drank 12 ounces of juice a day or more were tubby. About half of them — that’s 10 kids — were in the 75th percentile for body mass index, a commonly used measure that includes both height and weight. By contrast, among those who drank less juice — all the other kids — 32 percent were overweight.
Dennison has several hypotheses to explain her results. Perhaps, she says, kids who drink lots of juice don’t get other nutrients they need: “That would explain why they are short.”
Other kids may gain weight because they drink juice on top of everything else they normally consume, she says, thus consuming more calories per kilogram of body weight than other kids. Although kids who dranks lots of juice and those who didn’t consumed roughly the same amount of calories, the high juice drinkers gained weight because they took in more calories than their metabolisms needed.
Few of the kids in Dennison’s study drank soda pop, she adds, because they were so young and because “a lot of parents go out of their way to get 100 percent juice.” Because preschoolers need two servings of fruit a day, she says, it’s fine for one to be a glass of juice, but the other should be real fruit.
Needless to say, the National Food Processors Association is less than thrilled by Dennison’s findings. Rhona Applebaum, the group’s executive vice president for scientific and regulatory affairs, notes that this was only an observational study and could not establish cause and effect. Applebaum also objects to calling “excessive” anything over 12 ounces of juice a day: “That is arbitrary.”
If Dennison’s study were the only concern, this might be just a tempest in a juice box. But it’s not.
It’s long been known, for instance, that if you put a baby to bed with a bottle of juice (or even milk), the result can be rampant tooth decay. Sugars in the drink cause bacteria in the mouth to release toxins that break down tooth enamel, a process that is accelerated because saliva that would normally wash away the sugars is decreased during sleep.
And then there’s all that fluoride.
A team of dentists, led by researchers at the University of Iowa, last year contacted manufacturers of 532 ready-to-drink juices, frozen-juice concentrates and juice-flavored drinks to see how much fluoride was in their products. More than half of products contained too much fluoride, they found, although parents would never know this because package labels say nothing about fluoride concentrations.
In the right amounts — 0.3 to 0.6 parts per million — fluoride prevents tooth decay, according to the Academy of General Dentistry. That’s why many towns add fluoride to drinking water, why toothpaste makers put fluoride in their products and why dentists give kids fluoride treatments.
But with fluoride, “sometimes you could have too much of a good thing,” says Dr. William Chase, a dentist in Adrian, Mich., and a spokesperson for the dental academy. If juice drinks are manufactured in communities where the water supply has high fluoride levels, the result can be an excess of fluoride — and white or brown spots on the teeth.
The dental study found that 43 percent of juice products had fluoride concentrations above the recommended maximum (0.6 parts per million) and 19 percent were above 1.0 part per million.
White grape juice, the researchers found, had the highest fluoride concentrations, probably because the skins from grapes contained fluoride from pesticides. Grape juices made after skins were removed had no detectable fluoride.
Tea and prune, cranberry, pear, red grape, cherry and apple-grape juices all had mean fluoride concentrations greater than 0.6 parts per million, the researchers found. The mean fluoride level in straight apple juice was just under 0.6 parts per million. Orange juices, lemonades, fruit nectars and pineapple juices usually had less.
Because excess fluoride can be harmful, especially for 6-to-9-year-old kids whose permanent teeth are still forming, parents should say no to fluoride treatments at the dentist’s office if their children drink a lot of juice, says Chase. Another thing you can do, he says, is join forces with dentists to get manufacturers to list fluoride content on juice labels.
But this doesn’t mean kids should switch to soda. Even sugar-free soda can be harmful because the carbonation attacks tooth enamel.
The bottom line, say the New York nutrition researchers, is to get kids and teen-agers to cut their overall consumption of high-calorie fruit juices and soft drinks.
You can get there by diluting juices 3 to 1 with water, putting kids’ favorite cups near a water cooler and putting water bottles in kids lunch boxes at least several times a week.
And when your child gets thirsty, offer water. “That’s what the body wants,” says Dietz. “There’s no need to accompany water with calories.”