Juice vs. Fruit: What’s Better for Diabetes?

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Feb 05, 2007

Juice vs. Fruit: What’s Better for Diabetes?

Amy Campbell

This past week, results of a European study, published in the International Journal of Food Science and Nutrition in 2006, made the news. This study was actually a comprehensive review of the literature on fruit and vegetable juices. And while it may not sound like an exciting paper to read, this study does raise an interesting point. Here’s the crux of the study, according to the authors: “When considering cancer and coronary heart disease prevention, there is no evidence that pure fruit and vegetable juices are less beneficial than whole fruit and vegetables.”

Dietitians may find this study to be a double-edged sword. On the one hand, it's good news. For people who dislike eating fruits or vegetables, downing a glass of grape juice or carrot juice is an easy way to get the vitamins, minerals, and antioxidants they need to help prevent heart disease and cancer. And we need all the help we can get when it comes to battling these two diseases. But, on the other hand, the issue of calories and carbohydrate surfaces when it comes to folks who are trying to watch their weight and/or who have diabetes.

If you've ever met with a dietitian for your diabetes, chances are you've been advised to limit fruit juices. Why? Well, a 4-ounce glass of orange juice, for example, contains about 60 calories and 15 grams of carbohydrate. In the carbohydrate counting method of diabetes meal planning, this is considered "one carb choice." What's 15 grams of carbohydrate, you might argue? It's not a lot of carbohydrate, all things considered. But, if you're pouring yourself a glass of freshly squeezed orange juice, do you really measure out just 4 ounces?

If you honestly do, great. Most people don't, though, and end up drinking more like 8 or 12 ounces, since 4 ounces amounts to about one gulp. So you pour yourself more, the juice calories add up, and the additional carbohydrate is reflected in higher blood glucose readings shortly thereafter. And to make matters worse, some juice drinks have additional sugar added to them, often in the form of high fructose corn syrup (HFCS). This sweetener has its own set of problems, including possible links to obesity and high triglyceride levels. Cranberry juice cocktail and many fruit juice "blends" are examples of sweetened juices (although not all are sweetened with HFCS).

I used to discourage my patients from drinking a lot of juice for these reasons. Instead, I'd advise using juice to treat hypoglycemia and, instead, eating fresh fruit. Fruit is higher in fiber and takes longer to eat, so it's more filling and satisfying. Plus, it's easier to control portions with fruit than it is with juice.

I was a little more lenient with tomato or vegetable juice (such as V8), since these juices have fewer calories and less carbohydrate than fruit juice. And for my die-hard, juice-loving patients, I'd relent a little and recommend "light" juice drinks, such as light-style cranberry juice cocktail or Diet V8 Splash; I'd even suggest "diluting" regular juice with water or seltzer water. All good ideas, I thought.

Now comes along this review of literature with its conclusions that juices are just as good as fruit. On the one hand, I'm glad to hear that there's yet another way for people to fight heart disease, cancer, and possibly even Alzheimer disease by drinking juice. On the other hand, I'm not sure I'd change my recommendations for people with diabetes. I still believe that fresh (or frozen) fruits and vegetables offer something that juices don't, and that's the satisfaction of eating a tart Macintosh apple on a crisp fall day; a sweet, juicy peach in the heat of the summer; or a bright orange, crunchy carrot straight from the garden.

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Great article. I too like to drink juices but as a type II stay away from them for the reasons you described. Instead I have invested in a very nice juicer that I use to get mostly vegetable juices (Carrots, Celery, Lettuce, Spinace, small pieces of Ginger and add an apple or an orange if I want a little sweetness to improve the taste. Does wonders. I would not touch any canned or bottled juices even if they were light.

Posted by: Maithil | Feb 07, 2007 03:53 PM

I think a good way to enjoy the best of both ways and have the benefits of both, juice or whole fruit (liquid or solid),is to peel the big juicy plump naval orange, break it half separate the sections and eat them. The other half toss in a blender with some ice cubes crank it up to high for a few minutes and then pour it into a glass and drink a half glass of cold fresh juice with pulp. The whole orange totally consumed. You can do the same thing with just about all fresh fruits. I think you should stay away from "squeezing" the fruit to produce the juice.

Florian (Type 1, dx 1967)

Posted by: Florian | Feb 08, 2007 09:57 PM

I forgot to mention that a good way to drink clear fruit juice, if you really enjoy it, is to get a 6 pack of juice boxes made for kids lunch boxes. Apple, Grape, or Fruit Punch, about 4 oz, 60 cal, and 16 carbs (built in portion control). They travel well as they don't need refrigeration and I like them to handle those below 60 blood sugars.

Florian (Type 1, dx 1967)

Posted by: Florian | Feb 08, 2007 10:11 PM

You can get the benefits of 15 fruits and vegetables with Juice Plus+ I have taken it for years. It only has 2 carbs for all your fruit and veggie needs for the day.
Of course I do eat additional especially veggies cause I like them and usually an apple because I'm not a big fruit eater

Posted by: JO | Feb 09, 2007 10:46 AM

I HAD TO LAUGH AFTER READING YOUR OPINIONS ON EATING FRUITS INSTEAD OF FRUIT JUICE,,,,,MY HUSBAND ALWAYS TELLS ME TAT I DRINK TOO MUCH ORANGE JICE,,IGH IN CARBS AND CALORIES,,,,,,,NOW I AM EATING ORANGES AND HAVE TO ADMIT IT DOES HAVE LESS CALORIES AND CARBS,,,,,,,,,I AM GOING TO SHOW HIM YOUR THOUGHTS ON THIS SUBLECT,,,,,,THANK YOU FOR THE INFO,,,,,,,,,MYRNA FRUITT NEWTON MA

Posted by: myrna fruitt | Feb 09, 2007 05:59 PM

yes, I agree with Jo that Juice Plus is a great gap-filler for those of us not getting the 9-13 recommended servings. No salt, water or sugar

Posted by: u2girli | Apr 09, 2007 04:39 PM

Have you ever heard of someone being prone to diabetes if they have had a sexually transmitted disease? I'm in a health psych class and my instructor said the above. I have never heard this before. Also she said that diabetics that won't change their lifestyle of not eating fruit, adds to the problem. I have never heard that either, now fruit juice adds to the problem.

(I mentioned at the beginning of class that If the doctor had told me what hypoglygemia was then maybe I would not have got the diabetes, and I was eating an apple at the time. Maybe she didn't like it that I was eating.)

Posted by: Jo | Apr 17, 2007 10:48 AM

Hi Jo,
I'm not aware of research that points to an increased risk of diabetes if one has had an STD. However, women with diabetes are at a higher risk of yeast infections (which some consider to be a type of STD). I'm also not clear on what your instructor meant about how not eating fruit adds to the problem. You might ask your instructor, after class, if she can elaborate on what she meant. Of course, it's important for people with diabetes (and people without diabetes, too!) to eat a healthy diet that includes plenty of fruits and vegetables. Fruit needs to be counted in your meal plan because it contains carbohydrate, but this doesn't mean you can't eat it. Also, it's okay for people with diabetes to drink juice, but again, it needs to be counted as a carb choice. Fruits and vegetables contain many nutrients that are important for overall good health, and that can help lower cholesterol and blood pressure levels. Talk to your physician or an educator if you still have questions.

Posted by: acampbell | Apr 18, 2007 01:14 PM

I know of a diabetic and he is concerned about eating fresh fruit. Is it okay for him to eat fresh fruit. Also he had a concern last week reguarding popcorn. if he could eat popcorn and how much?

Posted by: rmalley | May 15, 2007 02:39 PM

Juice Plus? That pyramid scheme multivitamin has gotten nothing but bad publicity. It's a scam and it definitely doesn't provide "all your fruit and veggie needs for the day". That is false advertising! It's sad that so many distributors of this product have chosen to spam health forums like this one. They are like predators, stalking us and just waiting to find someone ignorant enough to pony up the dough for their overpriced garbage vitamin pills.

Posted by: Ben Hunter | Nov 12, 2007 07:36 PM

OK I HAVE JUST BEEN FOUND WITH SUGAR ,BP 2WEEKS AGO AND MY FAMILY HAS A HISTORY OF CHOLESTROL
MY AGE IS 33 AND I WEIGHT 100KGS AND I WANT TO KNOW WHAT WOULD BE MY RIGHT FRIUTS JUICES I CAN HAVE AND WHAT SORT OF A DIET SHOULD I GO ON SO I CAN CONTROL MY DIESESE WITH EATING THE RIGHT STUFF AND BEING HEALTHY WITHOUT TAKEING MEDICATION .

PLEASE HELP

Posted by: SAJID | Nov 15, 2007 09:12 AM

Hi SAJID,
I'm assuming you were diagnosed with diabetes, along with high blood pressure. While things can seem overwhelming right now, the good news is that making some lifestyle changes can help both your blood glucose and blood pressure levels at the same time. My main piece of advice for you is to make an appointment with a dietitian for a meal plan. Ask your doctor for a referral or go to www.eatright.org to find a dietitian in your area. In the meantime, I'd suggest you eat fresh fruit rather than drink fruit juice. Try to eat your meals at about the same times each day, and aim to eat about the same amount of carbohydrate at each of your meals. Also, check out one of my previous postings on the plate method, another good tool to get you started with meal planning. Eating a little less at meals will help. And, if possible, try to start being more active - even doing small amounts, like walking for 15 minutes each day can help. Eventually you'll be able to build up and do more.

Posted by: acampbell | Nov 15, 2007 09:34 AM

Is fresh orange okay to eat. I know that orange juice is good to have around if blood sugar gets too low. Mine never gets too low and I sure do not want to raise it with eating oranges.

Posted by: lena in wisconsin | Jan 16, 2008 07:25 AM

Hi Lena,

Yes, fresh oranges are fine to eat. In fact, any kind of fruit is okay to eat. The key is just knowing how much. One small, 6 1/2 ounce orange contains about 15 grams of carb - the same amount of carb in 1 slice of bread or 1/3 cup cooked pasta. Oranges are an excellent source of vitamin C, and also contain potassium, folate and fiber. As long as you know how much carb to aim for at each of your meals and snacks, you can fit any kind of carb food (including oranges!) into your eating plan.

Posted by: acampbell | Jan 16, 2008 09:24 AM

hi,i want to know which fruits can be taken in diabetics and which are not

Posted by: shireesha | Mar 07, 2008 02:08 AM

Just a note to give the correct information about Juic Plus in response to the post by Ben Hunter. Juice Plus is NOT a pyramid scam,a multivitamin, nor does it claim to be all the fruits and vegetables you need in a day. That being said, any distributor that makes these claims is WRONG! I am a distrubutor for Juice plus and can tell you that it is a good product. It is plain to read in our literature that Juice Plus is a whole food based product, not a vitamin, and we are to tell people that is is intended to be a supplement to our diet as a way to get more fruits, veggies, and fiber in our diet for those of us that, for numerous reasons, do not get all that we need. I would suggest to anyone wanting to know the real facts about this to contact NSA directly. The company has been in business for over 35 years, no pyramid scams last continuously for that long. There is a great deal of credible research out there, just look for it.

Posted by: healthygirl | Mar 09, 2008 03:46 PM

Hi shireesha,

People with diabetes can eat any kind of fruit. You might want to read my response to Lena's question, above, as she asked a similar question to yours. As with any carbohydrate food, the key is knowing how much carb you can have at a particular meal or snack, and then how much carb is in the fruit you wish to eat.

Posted by: acampbell | Mar 10, 2008 09:17 AM

Hi healthygirl,
Thanks for your posting. My understanding is that Juice Plus is sold by NSA through a multi-level marketing network, and that taking this supplement can cost up to $40 per month. While the intent may be for Juice Plus to supplement one's diet (certainly better than not getting any fruits or vegetables at all), I'm not aware of any unbiased evidence that these fruit and vegetable powders are helpful in disease prevention, for example. And is there information as to how many servings of fruits/vegetables is in one serving (4 capsules) of Juice Plus?

Posted by: acampbell | Mar 11, 2008 07:58 AM

Hi Amy,
Actually, Juice Plus at a minimum costs slightly more than $40/month -- a ripoff given that it contains mostly vitamin additives. The Center for Science in the Public Interest has filed with the FDA to halt the marketing of JP because the product is misbranded, adulterated and deceptively labeled. The company that makes JP does not disclose the amount of fruit and vegetables in it because they know that it is insignificantly low. A study in 1996 (Chambers et al. Food Chem. 1996;57:271-274) showed that 4 capsules have the equivalent antioxidant capacity to about 30 g of fresh produce -- that's less than half a serving, and that's after the product has been spiked with antioxidant vitamins. Every independent expert that has reviewed the product (over 30 now) gave it the big thumbs down. It certainly has no place in a discussion about diabetes. Ethical distributors would never make illegal claims that suggest JP can prevent or treat diseases, and yet such claims are everywhere.

Posted by: Ben Hunter | Mar 26, 2008 11:01 AM

Actually there are not vitamin additives added to Juice PLUS. It is not a vitamin supplement but a whole food based product that is made from concentrating fruits and vegetables that have been juiced into powers using a low temperature process. There is A LOT more current research that can be found at www.juiceplus.com that supports the use of Juice PLUS in helping provide good nutrition needed to be healthy. The company clearly advertises that it uses 7 different fruits for the Orchard Blend and 10 different vegetables for the Garden Blend. That seems a pretty clear and disclosed amount.
The distributors are trained to share the research and the rest is pretty easy because it only makes sense since the clinical studies are everywhere.

Posted by: Maria | Apr 01, 2008 04:36 PM

Regarding Juice Plus - most of the research that I've seen posted on the company website doesn't point to improvement in health outcomes. As an example, many of the studies (using a small number of subjects), show increased blood levels of vitamins and antioxidants - but that doesn't meant health is improved. Also, to my knowledge, no studies have compared Juice Plus with other supplements. Finally, at a cost of $500 per year, one needs to question if the same "benefits" can be obtained by a combination of fresh fruits and vegetables (which contain fiber), along with a good multivitamin supplement. Just some food for thought.

Posted by: acampbell | Apr 04, 2008 08:43 AM

I was just diagnosed with high BP and prediabetes. I want to reduce my weight and sugar levels. I have never been much of a vegetables lover unless cooked, but love fruit juice. I have been drinking v-8 fusion for a while which blends vegetabel and fruit juice and really like it. Do you think this is a good choice if I do not over-do the portion? Also instead of bread for breakfast (which is usually toast) I have been having a protein cappuccino flavored smoothie drink from bolthouse farms sweetened with apple juice. Is that a bad choice? One 8 oz. serving has 10g of protein, 2.5g of fat and 28g of sugar, again from the apple juice.

Posted by: gford | Jul 16, 2008 10:53 AM

Hi gford,
V-8 V-Fusion can be a good choice, in moderation. An 8 oz. glass of the strawberry banana flavor provides 120 calories and 28 g carb (which is the same amount of carb in two slices of whole grain bread). The light version has only 50 calories and 13 g carb, so that would be a better choice. The downside is that neither of these juices contains any fiber. I'm not sure how much carbohydrate is in your smoothie drink, either, as the sugar is only one type of carb. So, I'd suggest either drinking the light version of the juice, or limiting your intake to 4 ounces, and then try to boost your fiber intake with either whole grain toast or cereal.

Posted by: acampbell | Jul 17, 2008 03:15 PM

I DID NOT FIND MY ANSWER. I WANT TO KNOW WHAT ARE THE FRUITS TO BE TAKEN AND NOT TO B TAKEN BY A PATIENT WITH DIABETICS AND HIGH BP.

Posted by: rameesha | Oct 14, 2008 08:53 AM

Hi rameesha,
It's actually hard to answer your question, other than to say that people with diabetes can pretty much eat any kind of fruit. As I've mentioned above, the key is watching portions of whatever fruit you choose to eat. Typically, people with diabetes will often aim to eat 15 grams of carbohydrate worth of fruit, which is considered one fruit serving. A small apple or orange, one half of a banana or about 1 cup of berries all contain 15 grams of carb. You can drink fruit juice too (1/2 cup) but whole fruit has more fiber and is more filling. As far as high blood pressure goes, a diet rich in fruits and vegetables can help lower blood pressure, so that means eating at least 5 servings of fruits and vegetables daily. If you take certain kinds of blood pressure medicine, you may need to watch your potassium intake. Please ask your doctor if this is the case, and see my posting on potassium.

Posted by: acampbell | Oct 14, 2008 01:39 PM

I am diabetic n m on insulin.my age is 26.i like to drink orange juice alot instead of raw.would u please advice me is it good for me a i am under weight also.

thanks
erum

Posted by: erum | Nov 17, 2008 03:05 PM

Hi erum,
It's okay to drink juice, but as with any food or beverage that contains carbohydrate, the key is fitting it into your eating plan. Are you counting carbohydrates? Please realize that juice is quite high in carbohydrate and may quickly raise blood glucose levels. So, much of the answer to your question depends on if you have a meal plan and how good your diabetes control is. It's a good idea to meet with a dietitian who can teach you about carb counting, recommend carbohydrate goals that are appropriate for you, and help you safely gain weight, as well.

Posted by: acampbell | Nov 18, 2008 08:12 AM

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