If you drink OJ, might it just as well be Orange Crush?

I'm sure you've heard it many times -- fruit juices, even unsweetened ones, are still just glasses of sugar, and you might as well be drinking a soda or Tang (remember that?). According to nutritiondata.com, a cup of orange juice contains 21g sugars.  They don't "itemize" in the OJ entry, but if we look at the ratios oranges we can calculate that of those 21g, roughly 11 g are sucrose, 4.5 g are glucose and 5.5 g are fructose.  Thus for each cup (8 oz) of OJ, you get around 11g of the dastardly fructose poison.  This is roughly the same as you would get in the same amount (small can!) of orange soda.

Certainly in LC circles, giving kids juice is seen as tantamount to giving them a cup and unlimited refills at a Coke dispenser.  Personally, I'm not a big fan of juice for those with weight issues, because I do believe there's much to be said about the fiber and act of chewing and other stuff that comes along with eating the whole fruit with the skin where applicable.  Many of us do not seem to sense liquid calories very well.  Also, this issue is muddied with "juice drinks" -- some with like 10% fruit juice and the rest is flavored sugar water.    

Are juices just as culpable as sodas for trends in diseases of metabolic mahem?  Perhaps it's time to stop demonizing juices and treating them all the same.  Because below is just the first page of a Google Scholar search on OJ and diabetes produces some positive sounding results.  (BTW, those links down the right are to the free full texts.  These are often different from the direct links to the journal where they may be hidden behind a paywall.  For this reason I always do a Google Scholar search on any PubMed link that doesn't offer free full text, and quite often you will find it hosted elsewhere.)

V Tangpricha, P Koutkia, SM Rieke… - The American journal …, 2003 - Am Soc Nutrition
... of orange juice and other juice products would increase vitamin D intake, which would help
prevent osteomalacia and osteoporosis in adults and might provide additional potential health
benefits, such as reduced risk of some common cancers and type I diabetes mellitus. ...

Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis

MF Holick - The American journal of clinical nutrition, 2004 - Am Soc Nutrition
... vitamin D deficiency in increasing the risk of many common and serious diseases, including some
common cancers, type 1 diabetes, cardiovascular disease ... A new dietary source of vitamin D is

orange juice fortified with vitamin D. Studies in both human and animal models add ...

Orange juice or fructose intake does not induce oxidative and inflammatory response

H Ghanim, P Mohanty, R Pathak, A Chaudhuri… - Diabetes …, 2007 - Am Diabetes Assoc
OBJECTIVE—We have previously shown that 300 kcal from glucose intake induces a 
significant increase in reactive oxygen species (ROS) generation and nuclear factor-κB (NF-
κB) binding in the circulating mononuclear cells in healthy normal subjects. We ...

Glucagon-like peptide-1 promotes satiety and reduces food intake in patients with diabetes mellitus type 2

JP Gutzwiller, J Drewe, B Göke… - American Journal of …, 1999 - Am Physiological Soc
... Twelve male patients were recruited for the study who had diabetes mellitus type 2 for at least
1 year. ... A standardized, fixed energy breakfast (2 scrambled eggs served on 2 slices of toast, 100
ml orange juice, 200 ml skimmed milk; energy content 360 kcal) was then served, and ...

Differential effects of cream, glucose, and orange juice on inflammation, endotoxin, and the expression of Toll-like receptor-4 and suppressor of cytokine signaling-3

R Deopurkar, H Ghanim, J Friedman… - Diabetes …, 2010 - Am Diabetes Assoc
OBJECTIVE We have recently shown that a high-fat high-carbohydrate (HFHC) meal 
induces an increase in plasma concentrations of endotoxin (lipopolysaccharide [LPS]) and 
the expression of Toll-like receptor-4 (TLR-4) and suppresser of cytokine signaling-3 ( ...

Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women

MB Schulze, JAE Manson, DS Ludwig… - JAMA: the journal of …, 2004 - Am Med Assoc
... sugar-sweetened soft drinks, 0.73 for diet cola, 0.74 for other diet soft drinks, 0.78 for orange

juice, 0.77 for apple juice, 0.75 for grapefruit juice, and 0.89 for ... with technician-measured weights
(r = 0.96) in the Nurses' Health Study I. 17 Family history of diabetes was reported ...

HDL-cholesterol-raising effect of orange juice in subjects with hypercholesterolemia

EM Kurowska, JD Spence, J Jordan… - The American journal …, 2000 - Am Soc Nutrition
... had to 1) have initial fasting plasma triacylglycerol concentrations in the normal range (0.8–2.6
mmol/L in 24 subjects and 3.4 mmol/L in 1 subject); 2) be habitual or occasional orange juice
drinkers; 3) be free of thyroid disorders, kidney disease, and diabetes; 4) have an ...

Orange juice neutralizes the proinflammatory effect of a high-fat, high-carbohydrate meal and prevents endotoxin increase and Toll-like receptor expression

H Ghanim, CL Sia, M Upadhyay… - The American journal …, 2010 - Am Soc Nutrition
... in MNCs, which increase after an HFHC meal, are reduced by the simultaneous intake of orange

juice. Such a study is important because chronic oxidative stress and inflammation are the 2 basic
mechanisms underlying atherosclerosis (19, 20). Obesity and diabetes are states ...

The reliability and validity of a brief diabetes knowledge test

JT Fitzgerald, MM Funnell, GE Hess, PA Barr… - Diabetes …, 1998 - Am Diabetes Assoc
... 1. The diabetes diet is: a. the way most American people eat b. a healthy diet for most people*
c. too high in carbohydrate for most people d. too high in protein for most people 2. Which of ... a.
Low fat milk* b. Orange juice c. Corn d. Honey 4. Which of the following is a "free food"? ...

Intake of fruit, vegetables, and fruit juices and risk of diabetes in women

LA Bazzano, TY Li, KJ Joshipura, FB Hu - Diabetes Care, 2008 - Am Diabetes Assoc
... 1. To further investigate the association between fruit juice consumption and
development of type 2 diabetes, we subdivided fruit juices into apple, grapefruit, and

orange juices and examined them individually in separate models. ...

Maybe, just maybe, there's something to all the other stuff that comes with the fructose in OJ that's worth considering ... even if we have to do so "despite" the fructose.  Or maybe fructose isn't the issue after all, it's just the delivery method and ridiculous doses for the heavy beverage drinkers that's the problem.  I haven't read all of the above and the last one there makes the case for fruit over fruit juice.  That most certainly makes a packaging case!    

What prompted this post was a study cited by a review paper blogblog mentioned in the discussion of starch vs. sugar.  I'm not all that impressed with that paper because the focus seems to be comparing whole starches with refined sugars, a comparison that's not really fair.  As I mentioned in a comment, I decided to search the doc on "fruit" and only had a few hits.  The one referring to whole fruit was positive:
In a study of 38 moderately hypercholesterolemic free-living men by Turley et al. [69], low-GI carbohydrates were increased by the use of grains, vegetable, legumes and fruit. This increased carbohydrate consumption reduced LDL and the LDL/HDL ratio with minor changes in HDL and triglycerides.
The others seemed to all reference fruit juices, and one "hit" on fruit landed me at cite 106:  Surrogate Markers of Insulin Resistance Are Associated with Consumption of Sugar-Sweetened Drinks and Fruit Juice in Middle and Older-Aged Adults.  Here's what the review paper had to say about that study:
"To determine the association between surrogate markers of insulin resistance (fasting insulin, fasting glucose, homeostatic model assessment of insulin resistance (HOMA-IR), and the insulin sensitivity index (ISI0.120)) and SSB consumption, Yoshida et al. [106] used data from 2500 subjects with an average age of 54 years from the Framingham Offspring Study. 53% of the study population consumed SSB’s and did this with an average of two servings per week. After adjustment for potential confounding variables, the frequency of SSB intake was positively associated with fasting insulin. The associations between the frequency of SSB consumption and fasting plasma insulin and HOMA-IR remained statistically significant after further adjustment for dietary glycemic index, fruit intake, or vegetable intake. No significant associations were found between SSB intake and fasting glucose or ISI0.120. In this study, the HOMA-IR largely reflected fasting insulin concentrations. Both insulin resistance and β-cell dysfunction precede type 2 DM, and thus increased consumption of calorically sweetened beverages containing rapidly absorbable simple sugars may contribute to an increased risk of type 2 DM [106]."
I think the conclusion, despite the wishy-washy "may contribute" is still not warranted by that study and findings.  Indeed I believe the title of that study is outright misleading.  Yes, there are associations, but as you'll see below, the association is "bad" for SSB's but "good" for fruit juices.   Here are the findings from the study itself:   
Sugar-sweetened drink consumption was positively associated with fasting insulin (none vs. ≥2 servings/d, 188 vs. 206 pmol/L, P-trend <0.001) after adjusting for potential confounders. Sugar-sweetened drink consumption was not associated with fasting glucose or ISI0,120.
Fruit juice consumption was inversely associated with fasting glucose (none vs. ≥2 servings/d, 5.28 vs. 5.18 mmol/L, P-trend = 0.006), but not with fasting insulin (none vs. ≥2 servings/d, 200 vs. 188 pmol/L, P-trend = 0.37) or ISI0,120 (none vs. ≥2 servings/d, 26.0 vs. 27.0, P-trend = 0.19) in multivariate models.
So SSB's are associated with slightly increased fasting insulin but not glucose, while fruit juice associated with slightly decreased glucose but not fasting insulin.  The tabulated data with different models is instructive.  I do believe that the review characterizing the study group as 53% consuming more than 2 SSB's per week is  also misleading.  It's true, but it exaggerates the SSB consumption.  I've crunched down Table 2 below (took out the diet soda data), and note that the second models are those corrected for confounders.  Here is the data:

So less than 10% of the study subjects consumed a full SSB or more daily, and only 3.8% consumed 2 or more per day.    BTW -- weren't we talking how there must be some uber beverage drinkers out there skewing the numbers?!  So for SSB's, there was a difference in fasting insulin from 188.1 pmol/L for non-drinkers to 206.1 pmol/L for 2+/day drinkers.  That hardly seems significant to me, and further, although it's not significant, there is a slight decrease in fasting glucose.  It would seem that whatever the nominal "hyperinsulinemia", there's no hepatic IR going on.  The 18 point insulin is less than a 10% increase over non-consumers

Now look at the juicers.  There are certainly more of them!  Only 12% drink no juice at all, 48% drink less than one serving daily, 31% have one-to-two servings daily, and 9% have two or more servings per day.  Among these there was no stat.sig. association with insulin, but the trend was for an inverse relationship!  In the corrected model, fasting insulin went from 199 pmol/L for non-drinkers to 184.6 pmol/L for the 2+ daily consumers.  Meanwhile there was an inverse association with FBG, 5.28 mmol/L to 5.18 mmol/L.  Granted, this is also not clinically significant (from 95 to 93.2 mg/dL) but there certainly isn't any hepatic insulin resistance going on here.  

The subjects were from the Framingham Offspring study, around 54 yo, average BMI for all around 27.  Note to Gary Taubes and Robert Lustig!  Between non-consumers of SSB's there was a statistically significant difference in BMI in favor of consumers, though that's likely an artifact of that group containing more men.  Maybe that's why they're also more active?  Not significantly by the numbers, but statistically (P<0.001), again in favor of the consumers who were more active!  Imagine that ....


Gabriella Kadar said…
Does fermented grape juice count? ;)
marksuave25 said…
Carbsane, I wonder do you yourself drink oj? Also in your post you say that the body doesn't sense liquid calories well. Why do you think that is? Also, in this post at the very end you say that BMI was less for those who consumed it. Do you really believe that, I think that you were kidding.
Galina L. said…
Well, it looks like everything could be debunked - we could loose weight on a Twinkies diet, sugar is not so harmful for diabetics, drinking OJ is not a problem, eating 20 bananas a day is not a stupid challenge. When a research or a blog post says you can do whatever, the last line of defense is just a common sense. I also remember reading about some research several months ago that overweight children were eating more healthy food than thin children (probably because they were under more diet scrutiny).
In my eyes juices and sugary drinks are a source of liquid calories, which may be not a problem for a very healthy person (mostly for a while) after a meal once a day, but still one of high marks of SAD. Many people nowadays can't imagine drenching thirst with a plain water.
I didn't see much difference between juice and soda when making decisions about feeding my growing child - it was not a staple drink. A healthy person can have whatever he wants in a restaurant or in a fast food place, even multiple refills, but not at home, unless it is some celebration.
CarbSane said…
Hi Mark! No I don't drink OJ, I haven't drank caloric beverages since I was like 16 so see no reason to start (I don't count the cream in my coffee in that distinction, though perhaps I should?). I believe there's something to the act of chewing and fiber/distension at work in the whole energy homeostasis thing, and perhaps we don't sense calories per se. This seems to bear out in studies and the fact that many Americans consume a significant % cals in liquid form and we have this epidemic with people chugging all manner of sugary and fatty beverages (Heck, ever go to Dunkin Donuts and ask for a plain old ordinary coffee with cream? They serve cream with coffee practically!) it's kind of an Occam's razor deal. As to the BMI, that's what the data said, though I think it's an artifact of there being a higher percent males in the SSB consumers.
CarbSane said…
In my eyes juices and sugary drinks are a source of liquid calories,

But this isn't true, apparently. I don't know about all juices, but orange juice seems to contain enough of what's edible in the orange to make a difference.

I'm not suggesting folks start drinking juice. Just that it is wrong to equate it with soda.

LOL -- have you heard Jimmy's latest?? Too much protein is just like eating chocolate cake!!
Anonymous said…
If you low-carb, and take supplements to make up the deficits in your diet, then perhaps some diet coke fortified with vitamin C?

Spam, fortified with vitamin C, is a decent source of C. So are simmered lung and livers.

Just think, next time you find yourself drinking some cold OJ, you 'coulda had a _____!' (simmered lung, braised liver) Yum!

Galina L. said…
I guess it is ironic, but I relay heavily on your blog to get update on how JM is doing and other news from LC community. So, he is so highly aware of protein consumption nowadays to the point that equals too much protein to eating chocolate cake? May be it keeps him motivated. Jimmy is a religious person, and could have more a need to believe in what he is doing that a rational type of a person. From mine point of view, proteins are less problematic from a weight-loss perspective because even gluttons rarely can eat too much of it, it is more satisfying than chocolate cake, hardly a binge food, and doesn't cause a sugar crash in two hours. There are always exceptions, of course.
Yes, OJ is more a food than a soda, you are right. When it comes to foods, everything is not so much as black and white as often perceived by people who have to watch what they eat for whatever reason. However, black/white point of view may help with simplifying of food choices. It is one of reasons LC diets are so popular. In order to do a diet on a long run, it helps to have it less complicated. It helps even more to have a condition which got improved (like it is in my case).
While being in Russia, I also had a side-trip with my mom to Turkey, and even went to Israel for one day while being in Turkey.
Diana said…
Thought provoking, as usual. Brings out the importance of custom in eating.

Do people chug OJ as they chug sodas, etc? I knew one woman in all my life who did so. She was obese and had psych issues. All day, she'd chug OJ.

But most people drink a glass of OJ with breakfast. That's it. 120 extra calories, if it tops off your breakfast and satisfies you till afternoon, is fine.

And that's where all these studies fail. They don't take into account HOW people really eat. Which is how they get fat. Not why - how.
marksuave25 said…
Thank you for the quick response time.
Unknown said…
What you need to do is add 3 tablespoons of butter and an ounce of MCT* to the orange juice, you now have Bulletproof OJ and are ready for anything, small arms fire just bounces off you like Neo in The Matrix.

*After all this time I still don't have the slightest idea what "MCT" is
Anonymous said…
Ha! Yeah that's really ironic for some people because in that one paper the cream induced endotoxemia and inflammation that can be expected to lead to diabetes whereas the orange juice didn't seem to have any ill-effects, so the bioactives in it must be reducing its so-called detrimental effects because the glucose group did see a worsening of inflammatory markers.

And other experiments show that the way to prevent fat from inducing endotoxemia is to drink orange juice with it, or consume very large amount of fiber. I do both, and when I don't I use grape seed extract, but it's sounding like a lot of people are harming themselves in that way.

References for assertions:

http://ajcn.nutrition.org/content/91/4/940.full <---not cream but they have discerned that bile acid secretion induces intestinal barrier dysfunction.

It's definitely an oxidative mechanism and is prevented by other fruit antioxidants as well http://www.ncbi.nlm.nih.gov/pubmed/21289251

But fiber sequesters bile acids and mostly prevents this http://edrv.endojournals.org/cgi/content/meeting_abstract/33/03_MeetingAbstracts/OR03-1

You can have fiber, and fruit on a high fat diet, so that's good, but I fear that a lot of people are making a big mistake for not making them bigger aspects of their diets.
Amir jamil said…
This comment has been removed by a blog administrator.
Josh said…
The cream, OJ paper is - http://care.diabetesjournals.org/content/33/5/991.abstract?ijkey=2043951e1c20ee455ad4cdff36efb13a29733795&keytype2=tf_ipsecsha

So cream by itself causes inflammatory mischief with increases in SOCS3, TNF-α, IL-1β, LPS concentration and TLR-4 expression.

... and coffee increases gut permeability and may damage gastroduodenal mucosa - http://lfhk.cuni.cz/Data/files/Casopisy/2004/AM-4_04.pdf
Coffee consumption was also found to correlate with around 30% higher CRP and TNF-α in one epidemiological study - http://www.ncbi.nlm.nih.gov/pubmed/15447891

Sounds like you'd need a bulletproof gut to survive the coffee/cream gut bomb, think I'll just stick with the OJ ;)
Gabriella Kadar said…
Isn't real orange juice more expensive than orange soda? Couldn't the other dietary affordables of a person who pays out for orange juice also be significantly different than someone who goes for the bargain priced soda?

Maybe orange juice can be a sort of sentinel food to distinguish between those who pay for healthier food options over those who don't or won't or cannot.

But when it comes to the commercially produced orange juice, as opposed to the stuff a person could squeeze out at home on one of those old fashioned grandma's style juicers, isn't there more orange oil from the peel and whatever liquid is in the pith in the commercial product? It tastes like it. Tropicana doesn't even look like freshly squeezed home made orange juice.
Gabriella Kadar said…
I guess this must be it. I love coffee. Coffee does not love me back. I figure since the body is refluxing the coffee, it's trying to tell me: "not good. get it the hell out of me."

It must be the caffeine/type of acid in coffee combo because decaf is fine, tea is fine.

At the same time, as we get older, the stomach lining isn't as robust as when we were youngsters.
Anonymous said…
In this large US cohort, coffee was inversely associated with colon cancer, particularly proximal tumors. Additional investigations of coffee intake and its components in the prevention of colorectal cancer by subsites are warranted.

In this large prospective study, coffee consumption was inversely associated with total and cause-specific mortality. Whether this was a causal or associational finding cannot be determined from our data.

In conclusion, CGA treatment resulted in beneficial effects on blood glucose response, with alterations seen in GIP concentrations. Given the widespread consumption and availability of coffee, CGA may be a viable prevention tool for T2D.
CGA=chlorogenic acid

Coffee use is inversely associated with RRI. Habitual coffee users have risk protection to higher RRI; lower serum albumin, insulin resistance, and renal insufficiency are associated with greater RRI.
RRI=Renal Resistive Index

We postulate that coffee drinking may have an acute detrimental effect in triggering coronary events and increasing infarct size in selected patient groups, rather than promoting the development of atherosclerosis in the general population, and we propose an alternative approach to explore such an effect in epidemiological studies.

The present study suggests a beneficial effect of coffee drinking against coronary calcification, particularly in women.

These findings suggest that the effects of CAF and RCOF are not identical and may provide a partial explanation as to why acute CAF ingestion impairs glucose tolerance while chronic RCOF ingestion protects against type 2 diabetes.
CAF=acute alkaloid caffeine RCOF=chronic coffee ingestion

Unfiltered coffee increases plasma homocysteine concentrations in volunteers with normal initial concentrations. It is unclear whether the effect is caused by the cholesterol-raising diterpenes present exclusively in unfiltered coffee or by factors that are also present in filtered coffee.

Consumption of 720 mL/d of filtered, caffeinated coffee leads to a statistically significant increase in the plasma level of total cholesterol, which appears to be due to increases of both low-density lipoprotein and high-density lipoprotein cholesterol levels.

Coffee: a mixed bag...

Galina L. said…
When in doubt, go for your personal experience. In my guts I know coffee is not great for me, especially second cut during the day. It may give me a headache, a quizy feel in my stomach, even a Rosacia flare from some robusta-containing low-quality mixes. But I really enjoy my first cup in the morning. It is true for many things - avoid simple pleasures to be overdone.
Unknown said…
I start the day with a full pot of coffee, if it kills me it kills me.

I offset the risk by refraining from using crack cocaine.
Galina L. said…
We often refer to studies done on rodents in order to form a hypothesis how one thing or another will affect humans. I have some fruit tries in my back-yard, and I have a chance to notice that highly opportunistic squirrels(rodents) who live in the forest behind my garden treat oranges like it contain a poison. They sometimes dare to chew through the skin of grapefruit in order to get to the sweet inside, but do it rarely. Tannines in a pomegranate skin are not squirrel-protective. As I know from my husband who works in a fragrance industry, most of the oil is removed (and later sold) from the orange juice after extracting before it is packed for sale. May be having an extra peel oil in your glass of OJ is not an advantage after all? May be squirrels have a good reason to be repelled? I can't eat oranges even when not on a LC diet because it gets me an eczema flare, but couple times a week I squize a glass of OJ for my husband because he seems to be fine consuming it in a such frequency. It takes 5 medium oranges to get a glass of juice.
CarbSane said…
Oh my folks! Don't take away my coffee!!
Galina L. said…
It is not bout "coffee is a poison", it is about"listen to your body". Sometimes your body may tell you to not to eat one food or another everybody else is raving about, and there are research to prove such food will keep your mind sharp and waist thin. I guess only dose makes thing a poison (with an exception of real strong allergies and some poisons),too much water is a poison, it is possible to end own life with too much aspirin, and the wrong dose varies individually. So, if more than one cup a day is too much for me, and her coffee doesn't like Gabriela back, it all doesn't mean that your coffee in the current amount is bad for you if you feel no negative effect.
Tsimblist said…
Did someone mention diabetes? I have wondered why the A1c test is not used to diagnose diabetes. This morning I accidentally discovered that it is indeed a recommended diagnostic tool.


Don't know what that has to do with OJ though.
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