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Heavy Metals in Fruit Juice
Here’s How to Counsel Parents
By Hadley Turner

Juice is almost as ubiquitous in early childhood as teddy bears, crayons, and blankies. In a Consumer Reports (CR) survey of 3,000 US parents, 80% of parents of children aged 3 and younger provide their kids with fruit juice at least sometimes, and 74% of those parents give their kids juice at least once a day.

It’s no wonder, then, that media outlets have been abuzz since the release of a CR report in late January wherein researchers found “concerning levels” of arsenic, cadmium, and lead in almost one-half of apple, grape, pear, and fruit blend juices tested. While these findings are undoubtedly scary for parents, RDs can help lead the charge in putting the results into context and providing actionable steps to keep children healthy and safe.

CR’s Findings
CR tested 45 popular fruit juices from 24 brands for arsenic, cadmium, mercury, and lead, as these heavy metals are fairly common in foods and beverages, including infant and toddler foods, rice and rice products, protein powder, and in the environment. The report claims that, at certain levels, these heavy metals can put children at risk of lowered IQ, behavioral problems such as ADHD, type 2 diabetes, and cancer.

CR decided which juice brands to sample based on sales and marketing data from the New York and New Jersey area and which brands were available nationally. Samples were purchased nationwide and some online.

For the testing, “concerning levels” were defined by health-based exposure limits set by the US Environmental Protection Agency for inorganic arsenic and mercury, California’s Office of Environmental Health Hazard Assessment for lead, and the European Food Safety Authority for cadmium.

The following are some of CR’s findings:

• All juices tested contained some arsenic, cadmium, lead, or mercury.
• Twenty-one (47%) of the 45 juices tested contained concerning levels of arsenic, cadmium, and/or lead.
• Seven of the 21 juices with concerning levels could pose a risk to children who drank more than 4 oz per day, and nine could be harmful at 8 oz per day.
• Grape juice and juice blends contained the highest average levels of heavy metals.
• Five of the juices with concerning levels are sold in 4- to 6.75-oz boxes or pouches and pose a risk to children at more than one box or pouch per day.
• Heavy metal levels in organic juices and those marketed as being for children didn’t differ from conventional juice or those marketed to adults.

CR notes that its results “were a spot check of the market and should not be used to draw definitive conclusions about specific brands.”

Recommendations for Clients
“Juice is something that’s really alarming for parents,” says Isabel Maples, MEd, RDN, a spokesperson for the Academy of Nutrition and Dietetics (the Academy) based in Washington, D.C., who specializes in children’s nutrition. “When there’s a food scare like that, then dietitians should be the trusted voice.” So how can RDs help parents who are feeling afraid or helpless about these findings?

For starters, it’s essential for RDs to let clients know that heavy metals are found in all produce. When plants take in water from the soil, heavy metals that naturally occur in the soil are absorbed as well. Some soil has more heavy metals due to pollution from industry or agriculture, but it’s rare that the levels are high enough to be of concern; typically, varying which fruits and vegetables one eats is an easy way to reduce exposure. In addition, Maples points out that the FDA tests foods for heavy metals multiple times per year, focusing especially on products often given to children, such as juice. “We have one of the safest food supplies in the world,” she says.

But imparting this message isn’t always easy; Maples says that during food scares, people’s concerns are high, but their trust is low, meaning their ability to take in messages is reduced. She emphasizes keeping recommendations clear, simple, and actionable.

RDs can encourage parents to do the following:

• Mix up the kind of juice offered. For example, parents “don’t always have to give kids apple juice or a juice blend,” Maples says. Switching varieties regularly should limit kids’ exposure to heavy metals present in any one type of juice.

• Change the portion size. Maples points out that the Dietary Guidelines for Americans recommend no more than one-half of children’s daily fruit calories come from juice, and this guideline is supported by the American Academy of Pediatrics (AAP). Wesley Delbridge, RDN, a Phoenix-based spokesperson for the Academy specializing in child and school nutrition, views juice as a sweet treat, a “sometimes food” he allows his own son to consume maybe once per week. “Juice is really sweet, so kids can get used to that sugary taste over time and want more and more of it,” he says, suggesting parents offer less juice and more water or fat-free or low-fat milk over time.

• Don’t just rely on juice for fruit intake. CR’s report “gives dietitians the opportunity to say, ‘Yes, you need fruit, but you don’t have to rely on juice,’” Maples says. She says RDs can help parents incorporate fruit into meals and snacks, such as offering sliced fruit dipped in peanut butter or adding raisins to a peanut butter sandwich.

Delbridge recognizes that juice can be convenient for parents but says that more nutritious and/or lower-calorie options, including small containers of milk and water and presliced, prebagged fruit such as apples or grapes, can be just as quick and easy to throw in a lunch bag or grab on the way out the door.

Maples provides an important caveat: “We have to meet people where they are. If people aren’t eating any fruit, then juice is a better choice than a fruit they’re never going to pick up, like a whole apple,” she says.

• Use strategies to minimize lead absorption. If reducing juice intake isn’t an option or can’t be done overnight, RDs should empower parents to take steps to reduce their kids’ lead absorption. Maples says calcium in foods such as milk, yogurt, and green leafy vegetables competes with lead for absorption. She says kids with empty stomachs are more likely to absorb more lead as well, so parents should be sure to feed them regular healthful snacks.

Maples also points to adequate iron intake as a preventive measure. Lead and iron attach to the same transport protein in the small intestine that deposits them throughout the bloodstream, brain, and body; consuming too little iron ramps up that protein’s activity, causing it to absorb more lead than if iron intake was sufficient. RDs can recommend iron-containing foods such as lean red meats, iron-fortified grain foods, dried fruit, and beans and lentils, and let clients know they can pair these foods with vitamin C–rich foods such as tomatoes, citrus fruits, and peppers for maximum iron absorption.

Bottom Line
Delbridge and Maples agree that, in spite of CR’s findings, RDs need to keep the big picture in mind and focus on the positives when counseling patients.

“It’s not clear in the report how much [juice] over time is too much,” Delbridge says, so it’s hard to draw conclusions about the true risk. He’d rather see a focus on “alternatives”—such as more nutritious beverages and whole fruit consumption—than trying to pinpoint juice as “good” or “bad.”

Maples says that, in the big picture, CR’s report doesn’t change what RDs already know about the benefits of whole fruit consumption. It also doesn’t undermine the recommendations on limiting kids’ juice intake from the AAP, the Academy, and the FDA. Maples recommends RDs quote these reputable third-party sources when counseling clients.

“This is an opportunity for dietitians to talk in unison” to encourage more whole fruit consumption, Maples says. RDs know, “despite this food scare, what’s really important is that people increase their fruits and vegetables,” she says. “No matter what study you look at, it shows that people who eat more fruits and vegetables are going to be healthier.”

— Hadley Turner is an editorial assistant for Today’s Dietitian and RDLounge.com, the blog written for RDs by RDs.