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

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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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