Get the Squeeze on Juice and Diabetes

May 23, 2023

Can juice be a safe part of your diet when you have diabetes? Experts weigh in on all types of juice and how it can be a treat – as well as a treatment.

For most people living with diabetes, juice is a forbidden food – something we’ve sworn off for eternity, with no chance of reprieve. Just look at the bad rap the stuff gets on social media, for example, where comments like these abound.

"Juice is the disappointing warm box of medicine on my bedside table that I occasionally have to stab a plastic straw into in the middle of the night," someone with diabetes recently posted on Reddit.

"I used to love OJ and apple juice, but once I was diagnosed as type 2, I knew with the highs I would get from drinking it that I had to give it up entirely. Now, it has been removed from my life completely. I cringe when I see normies buying or drinking it," wrote another.

"I avoid juice except when I'm low," said a third. "I have a stash of small juice bottles and boxes for low blood sugar. But otherwise, no sane type 1 would drink juice without a good reason like hypoglycemia. It's a simple sugar that raises your glucose way too fast."

But is this really how we should all be thinking? Are all juices created equal? Should we be boycotting an entire group of beverages from our lives – or is there a way to enjoy juice responsibly, at least from time to time in small quantities?

The average grocery store or supermarket stocks dozens of different types of juices and juice drinks. None of the experts we contacted said that people living with diabetes need to completely avoid all of these beverages – especially when they may have vitamins, minerals, and antioxidants.

Instead, experts say the key to including juice within your diet is making smart decisions.

"I like to remind people living with diabetes that all foods and drinks can fit in a well-balanced diet," said Mary Ellen Phipps, a registered dietitian, nutritionist, and author of "The Easy Diabetes Cookbook."

"When we are managing diabetes, we just need to be more strategic about certain higher sugar foods and beverages like fruit juice," she said.

Alison Massey, a registered dietitian and spokesperson for the Association of Diabetes Care & Education Specialists, agreed.

"I’ve certainly had those individuals who just have a hard time letting go of juice. But drinking juice is a choice, just like anything else – and you should be in control of your choices," she said. "The difference when you're living with diabetes is that you also have to recognize that those choices can affect your body and health, and you have to make your choices accordingly – in the smartest way possible."

Reluctant to give up your favorite grape juice or that morning sip of orange juice? It is possible to work juice into your ongoing healthy meal plan – if you do it wisely.

"For somebody who loves juice, including it in your meals all comes down to portion size, what else you’re eating at the same time, and the frequency with which you’re having it," said Jill Weisenberger, a registered dietitian and author of the recently released book "Prediabetes: A Complete Guide."

In general, remember that 4 ounces of juice can contain anywhere from 12-15 grams of carbs – about the same amount as in a slice of bread or a small piece of whole fruit. That serving size is small, just half a cup. But those carbs are absorbed much more quickly into the bloodstream, so their effect on blood sugar is immediate and can trigger spikes if you’re not careful.

A helpful tip is planning your meal around that knowledge. What foods are you most excited to eat? What fills you up the most? How many carbs are you eating at this meal? Are you making sure to also include a good mixture of protein and fat along with those carbs?

If juice is important to you, Weisenberger said, include it in place of something else you don't like as much. Sip it (don't chug it) and enjoy the small treat as part of a responsible day of eating.

The variety of juices in the world is astronomical. So if you’re going to have it, how do you pick the best option?

For Massey, the first and easiest step is inspecting the label on any bottle of juice you’re considering. Look at the carbs and sugars, of course, but also all of the other ingredients and how many other nutrients the product contains.

"Also check to see if you’re buying 100% juice or a ‘juice drink beverage,’ which is likely to have fewer nutrients and more sugar," she said.

And don't forget to look at the fiber content of the drink as well. In general, drinks with higher fiber (whether from fruit pulp or added in the form of chia seeds or some other high-fiber source) are a better and more nutritious choice overall.

For Sandra Arévalo Valencia, registered dietitian, nutritionist, and national spokesperson for the Academy of Nutrition and Dietetics, picking a good juice comes down to something even more basic: has it been processed in some way?

She said making juices at home by blending fresh fruit and water (don't add sugar) is a great juice option for a person living with diabetes.

"These types of juice are always going to be more beneficial than processed juices, which usually don't have pulp and tend to be very high in carbohydrates and sugar," Valencia said.

Angela Manderfeld, dietitian and diabetes educator who runs the website Outsmart Your Diabetes, agreed. She lives in Alaska, where access to fresh fruits and vegetables can be a challenge.

While she's not a fan of juices because of their high sugar content, she said you should maximize the vitamins, nutrients, and antioxidants you get from every food you eat.

"If you want orange juice, go ahead and have it – but make your own," she said. "Peel the entire fruit, remove the seeds, and drop the whole thing into a powerful blender. That way, you’re getting the flavor you crave but you aren't missing out on all that natural fiber content."

Whether they’re citrus, berries, or something else you love, whole fruits are always going to be better than processed juices. Don't be afraid to throw any of these whole into a blender with some water and ice to make your own juice rather than buying the pre-made stuff.

With so many fruit and vegetable juices available, it's easy to forget that there are many great fruits out there that we can't always buy conveniently at the supermarket.

"I like pomegranate juice because it's really good for digestive health," Manderfield said. "Tart cherry juice is another good option, because it may help to fight inflammation in the body. And coconut water – which is kind of a juice – is a bit lower in sugar than some other juice options. It's also a good source of magnesium."

And don't forget vegetable juices, such as celery juice, cucumber juice, or juices made with leafy greens like kale or spinach. As long as they don't have added sugars, all of these juices can be good options for people living with diabetes, experts say.

"I love tomato juice," Weisenberger said. "It's so filling and it really takes away the hunger pangs for me. It can be higher in sodium, but one cup has just 10 grams of carbs, so you get a lot more juice with less sugar than you do with some other juice types."

Her advice: mix regular tomato juice and low sodium tomato juice 50/50 and then add celery, fresh herbs, or black pepper to really make it special.

For people with type 1 diabetes in particular, the most common reason you might reach for juice is to help spike a low when your blood glucose levels drop.

In that case, Elizabeth Hanna, a registered dietitian and director of nutrition for the American Diabetes Association, recommends following the "15-15 rule."

"When blood glucose levels are low, have 15 grams of carbohydrates, which you can get by drinking a half cup of 100% fruit juice," she said. "Then check your blood glucose after 15 minutes. If it's still below your target range, have another half cup of juice."

"Some juices do have fiber so if your blood sugar is low, stick with pulp-free juices like apple or grape juice," Phipps said.

Or, in the case of a low, go juice-free if you can, said Manderfeld.

"The fructose in fruit juice doesn't tend to raise blood sugar quite as quickly as a glucose tablet will," she explained. "If you need to get your sugar up and only have juice, that's fine. But it's also easy to overdo it with juice in this situation – you’re dizzy, sweaty, and shaky, and you want that feeling to go away so you pour and chug a big glass of juice. That's just going to leave you with high blood glucose levels in the end. It's much harder to overdo your sugar intake during a low if you are eating a glucose tablet."

As with everything you eat and drink, moderation is key. It's okay to drink a small serving of juice from time to time, but you shouldn't drink it with every meal or in large amounts. And avoid juice as a source for staying hydrated on a hot summer day. If you’re thirsty, drink water instead.

"Most fruit juice and other sugar-sweetened beverages contain high amounts of added sugars and have been linked to a higher incidence of type 2 diabetes," cautioned Hanna. "Adults with diabetes are advised to limit their intake of beverages with added sugar. The American Heart Association recommends that women consume no more than 25 grams and men no more than 37.5 grams per day of added sugar."

If you’re looking for a good low- or no-calorie alternative to juice, Hanna and the American Diabetes Association endorse a number of options: carbonated waters like seltzer, zero sugar or sugar-free lemonade, unsweetened tea and coffee, and low-fat dairy or non-dairy milk.

There are also some easy at-home hacks can you try to create a drink with that fresh fruit juice flavor you love, with fewer carbs and added sugar.

Dilute any pre-made juices you buy with water. This is a great trick endorsed by a number of experts, and the payoff can be huge depending on how much water you add. Go with a 50/50 blend of juice and water for example, and you’ve cut the carb count of your juice in half.

Consider infusing a pitcher of water with pieces of your favorite fresh fruit, cut up and dropped inside to add natural flavor. "Infused waters are a great refreshing low-sugar option for people living with diabetes," said Manderfeld. "If people need something different to drink, by all means, go for it!"

Mix a bit of fresh fruit juice with seltzer or sparkling water. "I know a lot of people do this on airplanes," said Weisenberger. "It's great with cranberry juice, grape juice, and a lot of other fresh juices. Just add around 2 ounces to a full glass of water – you’ll get that sweet flavor you love and a drink that's very reminiscent of juice with just a handful of calories and carbohydrates.

Juice can be a delicious treat, so no one should think they can never drink it again – or only use it as "medicine" when blood glucose levels are low.

The key to including juice in your diet is picking a juice you love or one that is especially loaded in fiber, vitamins, and other nutrients, and then smartly building it into an overall healthy, low-carb meal plan. Your body (and your taste buds) will thank you.