Dentists warn against the drinking of fruit juice and squash, but what are the alternatives?

On Saturday night I was on a plane winging me back to the UK from Kenya where I’ve been for the last week. I was perusing the in-flight magazine and came across an ‘advertising promotion’ for a company making soft and ‘sports’ drinks. The promotion featured some Q and A’s with a UK GP on matters such as hydration and caffeine. There was also a question about the effect of sugar on dental health. I’m embarrassed to say I don’t remember the precise question and answer (fatigue, I suspect, has something to do with this). What I do remember is thinking that when thinking about the effects of sugar, we need to think beyond any damage it can do to the teeth.

I suspect this thought was at the forefront of my mind as earlier that day I had been reading a story on BBC News about the potentially corrosive effects of fruit juices and squashes on the teeth. The story drew our attention not only to the fact that sugar can lead to dental decay, but that the acidic nature of these beverages can lead to erosion of tooth enamel. Again, when I was reading this, I was thinking about focusing on dental health only tells part of the story about why fruit juices and soft drinks should be, generally speaking, avoided by those that value their health and wellbeing.

For instance, fruit juice consumption has been linked with enhanced risk of weight gain in children, and so has (obviously) the drinking of soft drinks.

The effects of fruit juices and soft drinks in the mouth and deeper within the body mean that I don’t generally recommend them for children (or adults for that matter). So what should we be recommending that our children drink? Well, perhaps as expected, the BBC News article concludes by promoting milk and states that: milk in the diet helps the formation of strong teeth and bones.

But do these ‘facts’ stack up? The role that calcium and dairy products play in bone-building was reviewed most recently in the journal Pediatrics [1]. Of 37 relevant studies 27 found no relationship between dietary calcium or dairy product intake and measures of bone health. Of the remaining studies, any apparent benefit was small.

Further evidence for the limited role of dairy products in building bone has come from a study published in the British Medical Journal which amassed evidence from 19 studies in the effects of calcium supplementation in children ranging from 3-18 years in age [2]. This mass of evidence found that calcium supplementation had no effect on bone density in the hip or spine, and very marginal benefits for bone density in the arm.

And what of the effects of milk on teeth? I’m open to the idea that drinking milk is likely to be better for teeth than soft drinks and fruit juices, but I wonder how important it is for healthy dentition. Archaeological remains show that up to about 10,000 years ago, human dental health was generally good (dental problems emerged, it seemed, with the addition of grains to the diet). It is believed that it was only until about 5000 years ago that we started to consume dairy products. This date may be a little out. But even if it is wrong by a few thousand years, the fact remains that for the vast majority of our time on this planet we managed to build strong teeth (and bones for that matter) without the need to consume dairy products from other animals. This basic fact causes me to have grave concerns about the supposed importance of milk in dental health.

I quite often hear from parents that their children ‘refuse’ to drink water. So they often end up giving them fruit juice, squash or whatever instead. What this means is child is now dictating what they drink. I’m a liberal at heart (honest) but this does not extend to letting children determine what they put into their mouths every day. So, if you’d like your child to drink more water, my advice is not to offer alternative or even have them in the home.

This may seem like a hard line and might get some resistance for a day or three, but the long terms benefits in terms of health are usually worthwhile. This approach if applied more globally generally helps meal times go much more smoothly, once a child realises he or she cannot influence the food they are given through refusal, tears or tantrums.

References:

1. Lanou AJ, et al. Calcium, dairy products, and bone health in children and young adults: a reevaluation of the evidence. Pediatrics. 2005;115(3):736-43

2. Winzenberg T, et al. Effects of calcium supplementation on bone density in healthy children: meta-analysis of randomised controlled trials. BMJ 2006;333:775-778

28 Responses to Dentists warn against the drinking of fruit juice and squash, but what are the alternatives?

  1. chris 6 August 2007 at 6:04 pm #

    dietitians have been warning about this for some time – diet drinks have the same effect. In fact sports drinks are a particular problem because they are drunk out of context – they are meant as fuel not really for hydration. They need a waring on them. Along with flavoured waters that may be sugar laden. For once I actually agree with you ! parents need to be firmer and not buy them – I dont for my 3 kids although on special occaisions they are allowed.
    However your remarks re milk I do not agree with and an analysis with 10000 years ago – the reason they had good teeth may be due to the fact that they ate little or no sugar and did not live as long. The problem with milk is that some kids drink to much – 2-4 pints is not un common and in young kids if this is drunk from a bottle makes the enamel erosion worse. I have 3 teenagers who drink milk , no fizzy drinks etc and limited fruit juice only with meals and not a filling in their mouth!

  2. Dr John Briffa 6 August 2007 at 6:15 pm #

    Chris – the point I was making is that if adults (whatever age they were) had good dentition before we started drinking milk, then milk is unlikely to be important for the building of strong teeth in childhood.
    Genuinely well done on vetoing fizzy drinks and on keeping fruit juices to a minimum in your home.

  3. Jon 15 August 2007 at 12:58 pm #

    Could you clarify what you were saying about humans having relatively good teeth 10,000 years ago? Its been a while since I read up on this, but – from what I remember – our early ancestors started suffering significant teeth problems when their mouths evolved into something like their current shape. Evolutionary biologists and psychologists have struggled to figure out why this (potentially very detrimental – for early man, bad teeth could stop him/her from eating properly, and would therefore often prove fatal) mutation was able to take hold. For example, Miller argues (controversially) that the development of speech must have accompanied this mutation, in order to make up for its disadvantages.

  4. Dr John Briffa 15 August 2007 at 1:18 pm #

    Can you put some dates to this, Jon?

  5. chris 15 August 2007 at 2:58 pm #

    jon – isnt this the problem – we just do not know what really happened 10,000 years ago – it is based on hypothesis mainly!

  6. Dr John Briffa 15 August 2007 at 3:09 pm #

    Something tells me, Chris, that you still haven’t read my book The True You Diet. If you had, then you’d see that I have referenced quite a lot of evidence which charts our diet throughout our evolutionary history, and the health changes that appeared to coincide with our move from hunter-gatherer to agrarian living some 10,000 years ago.
    And even if it were mere hypothesis (which it is clearly is not), that should not detract from the voluminous research that supports the broad nutritional approaches I advocate here and in my book.

  7. Jon 15 August 2007 at 9:22 pm #

    John- re. dates, interesting piece on the evolution of teeth and diet http://www.cast.uark.edu/local/icaes/conferences/wburg/posters/pungar/satalk.htm

    It was a long time since I read on this area in any (must be 7+ years now) and teeth were marginal to what I was studying. It seems reasonable that when the mouths of our ancestors changed shape, this would have caused dental problems – e.g. Lucas argues that the disordered way our mouths are laid out (the type of thing that people visit orthodontists for nowadays) would itself have caused problems http://www.newscientist.com/article.ns?id=dn7035. Tooth decay has effected humans for some time, though does seem to have increased with the move to eat more carbohydrates – http://www.uic.edu/classes/osci/osci590/11_1Epidemiology.htm There’s now evidence of dental work and tooth decay from 9,000 years ago http://www.nature.com/nature/journal/v440/n7085/full/440755a.html

    Afraid that’s not terribly satisfactory, or well-referenced – not really my area, and something I looked at a fair while ago. Sure you could get a more precise picture if you fancy wading through a load of papers on human fossils, or know a friendly evolutionary biologist ;)

  8. Jon 15 August 2007 at 9:30 pm #

    Chris – certainly, there’s still a lot of debate as to what happened 10,000 years ago, let alone earlier in human evolution (for example, it seems like since I read Miller his work has rather fallen from favour).

  9. chris 15 August 2007 at 11:27 pm #

    John- I am still reading it have had to much on to read it!
    You have to admit it is rather based on alot we do not know! Can you refernce where u base that 70% of humans do not tolerate milk – keep meaning to ask u that. I am not an historian but surely u are basing alot on hypothesis. I am struggling with whole concept because of the gaps!
    One other question do you disagree with vegetarians.

    My feeling our problem with tooth decay now is carb based but clearly from sugar and sugar laden drinks – not from milk.

  10. Dr John Briffa 16 August 2007 at 8:01 am #

    Jon “Tooth decay has effected humans for some time, though does seem to have increased with the move to eat more carbohydrates
    There’s now evidence of dental work and tooth decay from 9,000 years ago”

    It seems like that your information is broadly aligned with the ideas originally presented above. My understanding is that dental remains from the Palaeolithic era show little or no evidence of decay/caries. However, there is evidence that the Neolithic age (the advent of which was about 10,000 years ago) brought with it a significant deterioration in dental health, with decay becoming much more prevalent at this time (Molleson TI, et al. Dietary changes and the effects of food preparation on microwear patterns in the Late Neolithic of Abu Hureyra, northern Syria. J. Hum. Evol. 1993;24:455-468).

  11. Dr John Briffa 16 August 2007 at 8:05 am #

    Chris
    “You have to admit it is rather based on alot we do not know!’

    Have you read comment 6 Chris? If so, please read it again.

    “Can you refernce where u base that 70% of humans do not tolerate milk – keep meaning to ask u that.”

    Where have I stated that, Chris?

    “My feeling our problem with tooth decay now is carb based but clearly from sugar and sugar laden drinks – not from milk.”

    Where have I stated that problems with dental health are related to milk consumption?

  12. chris 16 August 2007 at 8:57 am #

    John on page 18 you state that 70% of humans will loose te ability to produce lactase ok slightly different wording – please enlighten me.

    i have a few days off so i will finish – might even do your test – some of the questions are interesting ?

  13. Dr John Briffa 16 August 2007 at 9:08 am #

    Chris – ‘lactose’ is not the same as ‘milk’ so your misquoting and misrepresentation of what I have written in my book makes the World of difference.

    And can I ask again, where did I say that dental disease is related to consumption of milk?

  14. chris 16 August 2007 at 9:59 am #

    oh come on john now u are twisting words ! You are good at that

  15. chris 16 August 2007 at 10:07 am #

    how else are u going to consume lactose then in any quantity John? ok some other foods but you constantly repeat your problem with milk all the way thro the book. Can i ask you are you milk intolerant – I do find it quite irritating when patients say that to me but don’t realise they are consuming lactose in other foods! Do you find that ?

  16. Jon 16 August 2007 at 10:58 am #

    “It seems like that your information is broadly aligned with the ideas originally presented above.”

    Certainly, in terms of tooth decay the best available info seems to suggest that rates increased after humans started eating more carbohydrates such as grains. Being picky, though, I’m not convinced that “human dental health was generally good (dental problems emerged, it seemed, with the addition of grains to the diet)”: the odd shape of our jaws would appear to have caused dental problems (even in the absense of decay) largely unrelated to whether or not we ate grains. Fair enough if you meant to focus on decay rather than dental problems per se – understandable, in an article on sugary drinks – but the reference to ‘dental problems’ confused me.

  17. Dr John Briffa 16 August 2007 at 11:09 am #

    Chris
    “oh come on john now u are twisting words ! You are good at that”

    Can I remind you that it was YOU who misquoted ME?

    A couple of basic facts for you:

    1. Just because someone is lactose intolerant does not mean they will not tolerate milk (though this will usually need to be consumed in limited quantities, of course)

    2. Just because someone is lactase sufficient does not mean they will tolerate milk because they may have a sensitivity to another constituent of milk e.g. casein.

    So you seeing lactose intolerance and milk intolerance as essentially one and the same thing is not logical. And instead of getting irritated with your patients, you might want to enhance your understanding of this important and very real issue.

  18. Dr John Briffa 16 August 2007 at 11:20 am #

    Jon – You may be interested to read Weston Price’s ‘Nutrition and Physical Degeneration’: it contains photos which Price claims show a strong link between dietary change and alteration in anatomical features such as tooth alignment. Though, just to be clear, I was not referring to this in my piece above.

  19. chris 16 August 2007 at 11:39 am #

    john – u really are a patronising man – I clearly know he difference but your ref in your book states lactose – please re read it as u wrote it I think! Perhaps you lack of carbs means your seratonin levels are low – u do not like any critiscm. I also note u hoose toignore any ref to reseach that disagrees – i ahve some ref from a few weeks ago re cholesterol and heart attacks and the med diet with benefit diabetics – ref nutrition review Aug 3rd

    Are u also slectivley forgetting the lactose in foods like biscuits etc or do you not have alist! I can supply you with one if you like.

    Milk intolerance is very trendy I think and books like yours are promoting it .

  20. John Briffa 16 August 2007 at 6:17 pm #

    Chris
    “I clearly know he difference but your ref in your book states lactose – please re read it as u wrote it I think!”

    Yes, of course it states ‘lactose’ Chris – that’s precisely the point I made to you after you had confused lactose with milk.

    Nice comment re my supposed lack of carbs and low seratonin [sic] levels. Bearing in mind the garbled English, poor spelling and general incoherence typical of your posts, one can only wonder what might be going on with your own diet….

  21. chris 16 August 2007 at 7:54 pm #

    John- you are a man of double standards – hypocritical and completely dismissive of anything other than your own writings. So i cannot type is that a crime – I have met arrogant doctors like you before – pity you did’nt stick to the discipline you were trained for – when I have finished reading your book i might come back – it is actually no wonder so few people bother to post who are not part of your fan club! Can I ask why you do not answer questions about whether you practise what you preach ? I have asked repeated practical questions – which you do not answer . you also did not answer questions about kids and food ?

    Nutrition whether you like it or not is a very practical subject so i wish your clients well.
    Oh and by the way I am not bothering to post on here again because it gives a very onesided view point – yours!

  22. chris 16 August 2007 at 7:55 pm #

    oh an ps the fact that you cannot answer practical questions is indicative ofthe fact that you are not a Nutritionist but a Doctor dabbling!

  23. John Briffa 17 August 2007 at 11:57 am #

    Chris
    It’s not your inability to type, but your thinking (or, more specifically, your LACK of thinking) that is the issue here. You have misrepresented me, have confused lactose intolerance and milk intolerance, appear not to understand the clinical significance of these disorders, and then claim the diagnosis of milk sensitivity is ‘trendy’.

    My pointing out of your erroneous thinking is labeled by you as ‘arrogance’. And it seems you are content to ignore the plight of perhaps genuine sufferers on the basis that you know better (even though it’s clear from your postings here that you don’t).

    As I stated in a previous post, I’m not sure you’re doing the reputation of your profession (dietetics) much good.

  24. Ruby 17 August 2007 at 1:57 pm #

    I’ve got all sorts of ills and stresses today but I wasn’t confused about the point Dr Briffa was making about the introduction of dairy foods not improving our dental and bone health. I am just a mother with an interest in good health for myself and my family and if you- Chris- represent the general attitude of your hallowed Nutritionists then I’ll stick with the dabbling doctor here. I thank the trend for bringing us someone who doesn’t just swallow conventional wisdom and endlessly regurgitate it. I don’t have to be a member of a fan-club to appreciate someone making this science more accessible and provoking thought which might just benefit my health- not just preaching. And frankly I don’t see self-promotion and making ones point clear as anything less than reasonable.

  25. chris 17 August 2007 at 4:37 pm #

    no one is swallowing conventional thinking – what I have asked you are questions and you will not answer them – on alot of issues. Your views are rather unconventional in my humble opionion. If you remember you started this by denouncing the work of dietitians – a profession I will stand up for always.
    I am not promoting myself after all! I am certainly not confused about lactose etc – it is you that has tried to make me look an idiot by misrepresenting me. You have a problem with healthcare professionals who are trained – that is not my problem. I hope in the futuer that will be some regulation in the nutrition field in order to protect the public – Dietitians are regulated and there is a strict code of conduct.
    You only choose to highlight research that suits your cause and to be honest ther is no point in commenting on anything else – I have better things to do and am not going to bother again posting on a website that such as this!

  26. Dr John Briffa 17 August 2007 at 4:48 pm #

    More rhetoric, but as usual, no substance nor science. (And I didn’t try to make you look like an idiot…)

  27. chris 17 August 2007 at 7:02 pm #

    you did and you try to do it to anyone who offers practical info or who does not research pub med , med line etc. Any one can do that – did you look for the heart attack study and sat’d fat or the the study from ox on the med diet?

    When a dietitian who was a phd student gave you a wealth of studies you chose to ignore them.

    Anyone can offer research – I like to offer some practical info as that is what nutrition actually is. You scoffed at cooking, shopping etc – obviously not important to you!

  28. Jon 22 August 2007 at 3:08 pm #

    a strong link between dietary change and alteration in anatomical features such as tooth alignment

    sure – my understanding is that current thinking is that dietary change (e.g. cooking/cutting up foods so that we could get by with relatively ineffective teeth) is likely to have at least been a factor in changing tooth alignment.

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