drug metabolism, orange juice, grapefruit juice

Choosing healthful foods and beverages has become increasingly controversial. For years, nutrition experts recommended a breakfast of cold cereal, toast with margarine and a glass of orange juice. We now know that the trans fats in margarine were worse than butter for your heart. Sugar-sweetened cereal is also problematic, as are all foods with added sugar. A new study even questions the benefit of orange juice.

The Problem with Fruit Juice:

More than 13,000 people participated in the REGARDS study (JAMA Network Open, May 17, 2019). (The name stands for Reasons for Geographic and Racial Differences in Stroke).  During the six years of follow-up, people who drank the most fruit juice or sugar-sweetened beverages were significantly more likely to die than those who drank the least. Although people  think of fruit juice as nutritious, people drinking juice were just as likely as those consuming soft drinks to die prematurely. 

Fruit Juice Contains Fructose: 

This is not the first study to note that sweet drinks are not good for your health. Most people realize that sugar-sweetened beverages are bad for the waistline. A review of research suggests that they are also bad for the heart.

What’s the Evidence?

Two Harvard nutrition scientists did a thorough review of the research (Journal of the American College of Cardiology, Oct. 6, 2015). They reported that increased sugar and high-fructose corn syrup in the US diet has contributed to obesity. In addition, people consuming such foods are more likely to have type 2 diabetes and cardiovascular disease. They based their conclusion on both observational studies and controlled trials. Apparently, when people consume sugary drinks, their bodies fail to compensate for the calories they have taken in. Consequently, these beverages can add extra pounds.

Fructose Is a Special Problem:

The way fructose is metabolized contributes to the problem. In addition to its effect on caloric intake, fructose stimulates the liver to make extra fat that gets packed around the abdominal organs. That adds to the cardiometabolic risk.

In an editorial in the same issue, Dr. Robert Vogel points out the complications that arise in trying to study the impact of food on health. His article is cleverly titled Pharma Versus Farmer.

Drinking Less Soda and Lowering Blood Pressure:

A previous study showed that people who cut back on soft drink consumption are able to lower their blood pressure. The trial included more than 800 adults and lasted a year and a half (Circulation, June 8, 2010). When it began, average soda consumption was just about one serving a day. The volunteers in the study were offered advice on healthy lifestyles, and those who reduced their sweet beverage consumption also lowered their blood pressure. Drinking one less soda pop or glass of juice drink daily corresponded to a drop of almost two points in systolic blood pressure, the upper number in the reading, and of about a point in diastolic blood pressure. The investigators controlled for caffeine consumption and weight loss and concluded that reduced sugar consumption had an independent blood pressure benefit.

Fruit Juice, Soda and Gout:

Other research showed that women who frequently consume sugar-sweetened beverages are more prone to gout, an exceedingly painful inflammation of the joints (JAMA, Nov. 24, 2010). The Nurses Health Study provided data from almost 80,000 women for more than 20 years. Dietary analysis shows that women who have two or more servings of sweetened soft drinks or fruit juice daily have double the risk of developing gout. This inflammatory condition leads to painful joints caused by uric acid crystals precipitating in soft tissue. Fructose raises uric acid levels, especially in people who have a history of gout. Because high fructose corn syrup is inexpensive, it is widely used to sweeten soft drinks and fruit juice. 

The research demonstrates that even fruit juice that does not contain added sugar may have enough fructose to disrupt metabolism. There is no doubt that the healthiest beverage is plain water, although unsweetened coffee or tea would probably also get a pass on this criterion.

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  1. Vahsi

    We only drink fresh squeezed orange juice. Is this also bad?


    I appreciate the comment from FACSRFRIENLY. Since I enjoy a large glass of orange juice in the morning, I found these two citations ( https://www.google.com/search?q=HOW+MUCH+fructose+DOES+ORANGE+JUICE+HAVE%3F&oq=HOW+MUCH+fructose+DOES+ORANGE+JUICE+HAVE%3F&aqs=chrome..69i57j33.18826j0j7&sourceid=chrome&ie=UTF-8) :

    “The amount of fructose in fruit juices varies from 0.5 to 7g per 100g and is similar to what you would see in the whole fruit per 100g. A 200ml glass of orange juice provides around 6g of fructose which is well below the levels considered to have adverse effects on health. ” (there are roughly 7 oz in 200 ml)


    “While a majority of drinks widely sold in stores contain abnormal high levels of sugar, orange juice does not. Orange juice is full of other highly beneficial components and the sugar in orange juice is a combination of fructose, glucose and sucrose. Roughly half is sucrose, which is what is in table sugar.Feb 12, 2014”

    (there are roughly 7 oz in 200 ml)

  3. Jennifer

    So glad to see this article. I am diabetic (Type II) and I know all about fruit juice. In fact, I used to drink a gallon of juice every week–sometimes in less time. It was always non-sweetened, natural juice. This may have contributed to my diabetes in the first place. As a diabetic I have learned that fruit juice–even 100% juice that I can make at home–is about the worst thing I could consume.

  4. Kassy

    One problem with this study is that it equates fruit juice with sugar-sweetened beverages. Perhaps they are not equally as unhealthy. I would like to see a study comparing those who drink fruit juices and NO sugar-sweetened beverages, compared to those who drink NO fruit juice but do drink sugar-sweetened beverages.

  5. Mary

    I looked at the tables in the journal article you linked to, and it is impossible for me to get an idea of how much juice these people were drinking. I drink 8oz of juice each morning, but eat an otherwise low-carb (Paleo-ish) diet. I am at my ideal weight, non-diabetic, and cholesterol numbers are great. I would like to know if there is a safe threshold for juice drinking, or if the moral of this article is never to touch juice.

  6. Northwest resident
    WA state

    The article about juice & the negative effects of fructose juice contains. How about fresh squeezed orange juice or lemon juice or any other fruit juice? Do they have the same type & amount of fructose. Thanks for a response.

  7. Jerry

    I have a Navel Orange tree, and I pick and juice these beauties. I drink 1 cup (10oz) every morning with my breakfast. I haven’t experienced any backlash from this. This is a non-processed drink, no added sugars, just natural. I don’t get any colds during the winter.

  8. John
    Decatur, GA

    I’m wondering if the kind of orange juice would make a difference. What if we drink juice with the pulp still in it? Did these studies take this into account?

  9. Pepi
    Harrison, OH

    The article did not mention anything about drinking fresh squeeze orange juice. Does it have the same results?

    • Terry Graedon

      Presumably. It is a delightful luxury, however, and as such could be enjoyed occasionally.

  10. FacsRfriendly

    Without the alarmist “fruit juice” primary reference in your headline, the article would probably not elicit much of a response. I read the JAMA article and yes fruit juice was included, but in a minor way. You emphasis or focus is that fruit juice is as bad as sweetened beverages. This was obviously done to create readership of the piece. Don’t try to be sensational or you will lose credibility.

    • Tim

      That’s weird, because I read the study too, and on my screen the explicitly stated “Objective” of the study is as follows:

      “Objective: To assess the association of SSBs and 100% fruit juices, alone and in combination (sugary beverages), with mortality.”

      But maybe my screen is broken? It sometimes renders the wrong thing as the stated objective in the abstract of JAMA articles. It also then sometimes repeats the same error in nearly every single paragraph of the abstract, mentioning the same fictitious focus of the study 39 times throughout the page.

      Maybe it’s time for me to get a new screen.

      Or maybe it’s time for you to concern troll somewhere else. Maybe…

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