When I treat kids who have a condition called non-alcoholic fatty liver disease (NAFLD), the first thing I tell them is that the fat in their liver comes from the added sugar in their diet. After I go on to explain how fructose gets metabolized into fat and stored in the liver, we review possible sources of added fructose in these kids’ diets. First and foremost, I make sure they eliminate all juice and sugar-sweetened beverages. And I explain how even 100% juice has a lot of free fructose in it, explaining what Dr. Lustig’s research has shown on the interaction between fiber and fructose. I remind kids that it’s perfectly fine to eat fruit, but that “drinking fruit” is not healthy.
Sometimes, these kids with NAFLD need to have a liver biopsy, most often done while the child is sedated using anesthesia. This requires the child to come into the hospital, of course. One day, the mother of one of my patients who had just had a liver biopsy, remarked that she found it strange when the first thing a nurse offered him, shortly after he had awoken from anesthesia, was a glass of apple juice. Mom questioned why the child was routinely offered juice in the health care setting, when the family had been advised to avoid it completely at home.
Needless to say, this incident hit a nerve with me. That day, I decided to see if I could do something about changing the hospital’s policy. Dr. Lustig and the principles of the IRN motivated me to write to the hospital’s administrative directors, who replied almost immediately in complete agreement with my suggestions! Their positive encouragement led me to present my formal plans for a policy change, before our hospital’s Pediatric Quality Improvement Committee who not only went on to approve the plan, but even took the advice one step further, to recommend eliminating juice completely from the pediatric menu. With the help of nursing administrators and other physicians, the campaign to eliminate juice is now in effect at my hospital’s main campus, and soon to be implemented across the remaining four.
Following in the footsteps of the Health Beverage Initiative, I’m proud to say that Swedish Medical Center has decided to set a healthy example for our pediatric patients and families. I hope to see this trend continue among community hospitals far and wide, improving global metabolic health!
Uma Pisharody, MD, FAAP is a Pediatric Gastroenterologist practicing at Swedish Medical Center in Seattle. She is a passionate patient advocate effecting change in the hospital and in her patients' lives. Dr. Pisharody is a true champion for childhood metabolic health!
We're sharing a series of three blogs by Dr. Pisharody this week. For more insight into her clinical inspiration, read Nine Days to Metabolic Health and to read about her diet prescription for metabolic syndrome, read Let Food Be Thy Medicine.
For more brilliant articles on an even greater variety of topics, visit Dr. Pisharody's Swedish blog.
Seattle's Swedish Hospital First in U.S. to Take Juice Off the Menu