Why 100% fruit juice should carry a sugar warning label

Apples, oranges and grapes are healthy fruits. But when they’re turned into juice, they can contain as much — or even more — sugar than some sodas or energy drinks. 

Under South Africa’s proposed food-labelling regulations, 100% fruit juices won’t be required to carry a high sugar warning on their packaging because their sugars are considered “naturally occurring”. But because of their sugar content, nutritional experts say, when people consume too much, there isn’t really a healthier choice between soda, flavoured water or energy drinks. 

“Coke has too much sugar, but fruit juices also have too much natural sugar,” says Edzani Mphaphuli, executive director of Grow Great, a nonprofit which works to shape childhood nutrition policies.

Sugar is helping drive South Africa’s obesity rise. More than one in 10 children under five are already overweight, and researchers have found that drinking just one sugar-sweetened beverage a day raises the chances of a child being overweight by more than half.

That’s part of what these proposed food-labelling regulations are meant to combat. 

Under the current draft — which the health department is still reviewing, according to spokesperson Foster Mohale — fruit juices will fall through a definition loophole. But that’s not what researchers who gave input on the rules recommended, or what many public health experts advocate.

“Our evaluation used the criteria of ‘free sugars’, under which all 100% fruit juices would have carried a warning label,” says Tamryn Frank, a researcher at the University of the Western Cape who was part of the technical team. “That highlights the importance of reconsidering the best term to include when the final regulation is published.”

The World Health Organisation (WHO) says “free sugars” are sugars added to products such as sodas and energy drinks, as well as those naturally found in fruit. But the current draft proposal says only products with “added sugar” will be required to carry a warning label.

The draft regulations say any drink with more than 5g of sugar (just over one teaspoon) per 100ml, or any amount of artificial sweetener (such as the calorie-free chemicals aspartame or sucralose), must display a black and white triangle with the word “warning” in bold capital letters. 

If these regulations are passed in their current form, researchers say, almost six in 10 of all sodas, energy drinks and juices sold at supermarkets in the country would carry a warning label. But while 94% of soft drinks and 97% of energy drinks would need warning labels for high sugar or artificial sweeteners, just 30% of juices would be labelled. 

Pure 100% fruit juices won’t carry a warning because their sugar is natural. But not all juices are completely natural; some contain added sugar or sweeteners, so those with more than a teaspoon of sugar per 100ml will still require a “high in sugar” warning.

We did the sums to work out which drinks contain the most sugar and which will — or won’t — need a warning label, under the current version of the regulations.

Fruit juices

While none of the juices we compared contained artificial sweeteners, Frugo sparkling apple juice, Ceres orange and Rhodes red grape juice all had more sugar than the other drinks we compared, except for Coke. 

“Because they come straight from nature, people think they must be healthy. But it’s not the same thing as eating a single fruit,” explains Mphaphuli. “Juice is highly concentrated and you need to dilute it with water if you’re going to give it to a child [to reduce the sugar content].”

Whole fruits are filled with fibre, which slows digestion and helps control blood sugar. But that fibre is shed when fruit is turned into juice. Without it, sugar reaches the bloodstream faster, which can cause spikes and drops in energy. 

Research has shown that swapping a fruit juice for some types of whole fruit three times a week can lower the risk of type 2 diabetes — likely because juice raises blood sugar faster and has less fibre.

A study published in the South African Journal of Clinical Nutrition this year found that almost three-quarters of fruit juices have more sugar than the proposed limit. But as regulations stand now, only 17% would require a warning label because most of the sugar is natural, not added (as the regulations consider total sugar only in products with added sugar, not those with natural sugars).

Sodas

Among the three sodas, Coke contains the most sugar and is the only one that includes caffeine, a stimulant that speeds up the messages travelling between the brain and the body and can interfere with sleep. Too much caffeine can lead to anxiety, restlessness and irregular heartbeat. 

The WHO recommends that adults should not consume more than six to 12 teaspoons of sugar per day. A can of original taste 440ml of Coke contains 2.65 teaspoons of sugar per 100ml, which means an entire can contains 11.66 teaspoons of sugar — more than the maximum WHO daily limit. 

Sodas are some of the sweetest drinks on the market and, research shows, South Africans love them: we drink an average of 254 Coca-Cola products per person per year, almost triple the global average of 89.

Before South Africa’s tax on sugary beverages was introduced in 2018, which requires manufacturers to pay 2.1c tax for every gram of sugar over 4g of sugar per 100ml, the average 330ml can of soda had about 10 teaspoons of sugar. But to avoid the tax, some producers reformulated ingredients in their drinks. For example, says Frank, Sprite and Fanta drinks lowered the sugar content but added non-nutritive sweeteners to keep the sweetness.

While chemical sweeteners, which are often used in “diet” drinks, can help people with short-term weight loss, the WHO says they should “not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases” such as obesity in the long run. Meanwhile, the International Agency for Research on Cancer has listed aspartame, a sweetener found in diet drinks such as Fanta Zero, as a possible cause of cancer, though more research is needed. 

The new regulations will require sugary drinks containing artificial sweeteners to carry the following warning on the front of the container: “This product contains artificial sweeteners. Excessive consumption may be detrimental to your health.” Manufacturers will also not be allowed to market such products to children.   

“None of these products are recommended as part of a healthy diet because they don’t contain any nutrients other than sugar and energy,” says Makoma Bopape, a nutrition researcher and lecturer at the University of Limpopo. Bopape was part of the technical group that worked on the labels. “What makes it worse is the fact that some contain sweeteners.”

Energy drinks

Monster contains nearly four times more sugar than Dragon and Power Play, and all three have artificial sweeteners. 

A 500ml can of Monster contains about 13 teaspoons of sugar — more than the maximum sugar intake the WHO recommends for adults per day.

Energy drinks aren’t just packed with sugar, like many sodas, they also contain caffeine. Experts say teens who weigh between 40kg and 70kg shouldn’t consume more than 100mg-175mg of caffeine a day. At an average of about 150mg, all three drinks contain almost the maximum amount of caffeine recommended per can per day. 

Under the proposed regulations, all three would need a warning label for either high sugar or artificial sweeteners.

Flavoured water

Of the three flavoured waters, Bonaqua Pump lemon has the least sugar and no artificial sweeteners.

Even though they’re often marketed as “healthier” options, the flavoured waters Bhekisisa looked at had sugar and sweetener levels similar to sodas. One option contained both sugar and three artificial sweeteners — making it more soda than water.

aQuellé naartjie and Thirsti berry use artificial sweeteners to keep the sugar content low, but they also contain nearly two and four full teaspoons of sugar per 500ml bottle, respectively. Bopape says plain, not flavoured, water should be the preferred drink of choice.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.