Apple juice: what a glass does to your medicine and your LDL

The best tested thing about apple juice is what it does to certain drugs. In a randomized crossover trial on 14 healthy Japanese adults, apple juice drunk once with a single 60 mg dose of the allergy drug fexofenadine cut exposure to its two forms by 49 and 59 percent compared with water. In 12 healthy Korean volunteers who all drank in the same fixed order, 20 fl oz (600 ml) of juice brought the blood pressure drug atenolol down to 42 percent of the level seen with water, and 41 fl oz (1200 ml) to 18 percent. The second finding is about form. In a crossover trial on 23 healthy adults, 17 fl oz (500 ml) a day of clear juice for four weeks raised LDL cholesterol by 6.9 percent compared with eating whole apples or pomace. The sample was small, and the falls with whole apples and cloudy juice stayed at the level of trends. Clear juice loses its pectin and other cell wall material when it is clarified, and the authors tie that loss to the difference.

The numbers, per 3.5 oz (100 g)

As people eat it, per 3.5 oz (100 g)

How much is actually in it

• In 30 men with impaired fasting glucose, 17 fl oz (500 ml) of ordinary apple juice gave a glucose response about three times higher than enzyme-treated low-glucose juice. — 30 male adults with impaired fasting glucose, 17 fl oz (500 ml) drink; control juice had 8.5 g free and 6.7 g bound glucose (n = 30) Evidence B source
  Glucose iAUC120 198 +/- 80.9 (untreated) vs 63.6 +/- 46.7 min x mmol/l (treated), p<0.001
• Clear apple juice in the UK composition tables has 9.7 g sugars per 3.5 oz (100 g), of which 5.5 g fructose, 2.4 g glucose and 1.8 g sucrose, with 37 calories and 26 mg vitamin C. — UK retail clear apple juice, ambient and chilled Evidence E source
  Per 100 g: total sugars 9.7 g, fructose 5.5 g, glucose 2.4 g, sucrose 1.8 g, energy 37 calories, vitamin C 26 mg, potassium 89 mg
• USDA analysis of 8 samples of shelf-stable apple juice found about 5.7 g fructose against 3.2 g glucose per 3.5 oz (100 g). — US retail samples of apple juice with added vitamin C, from concentrate, shelf stable (n = 8) Evidence E source
  Fructose 5.699 g/100 g (range 5.3-6.76); glucose 3.208 g/100 g (range 2.83-3.68)

What a real portion looks like

• In US dietary survey coding, a juice box of apple juice weighs 7.4 oz (209 g), a 10 fl oz bottle 310 g and an unspecified amount 248 g. — US dietary recall coding, FNDDS food 64104010 Apple juice, 100% Evidence E source
  Juice box 6.75 fl oz = 209 g; fun size box 4.23 fl oz = 131 g; bottle 10 fl oz = 310 g; quantity not specified = 248 g

What your body absorbs

• A single intake of apple juice taken with fexofenadine cut drug exposure (AUC) by 49 to 59 percent in 14 healthy adults. — 14 healthy Japanese adults, single 60 mg dose of fexofenadine with water or apple juice (n = 14) Evidence B source
  AUC0-24 of (R)- and (S)-fexofenadine down 49% and 59% vs water, P<0.001
• In 21 children aged 4 to 7, iron absorption from a fortified muffin was 5.5 percent with apple juice and 8.2 percent with orange juice. — 21 children aged 4.0 to 7.9 years, muffin with 4 mg iron as ferrous fumarate (n = 21) Evidence B source
  Iron absorption 5.5% +/- 0.7% with apple juice vs 8.2% +/- 1.2% with orange juice, P<0.001
• In 21 children aged 3 to 6, median iron absorption from a meal was 7.17 percent with apple juice and 7.78 percent with orange juice, with no significant difference. — 21 healthy children aged 3 to 6 years, identical meals with apple or orange juice on consecutive days (n = 21) Evidence B source
  Median 7.17% vs 7.78%, P=.44
• In 40 healthy adults, 12 oz of apple juice produced four times more breath hydrogen than white grape juice, a sign of unabsorbed fructose. — 40 healthy adults, fasted, 12 oz apple juice or white grape juice (n = 40) Evidence B source
  Breath hydrogen AUC 23.3 ppm/hour (95% CI 13.0 to 33.6) vs 5.8 (95% CI -4.6 to 16.1), P<0.001; no difference in GI symptoms

What cooking and storage change

• In 23 healthy adults over 4-week periods, 17 fl oz (500 ml) a day of clear apple juice raised LDL cholesterol by 6.9 percent compared with whole apples and pomace. — 23 healthy volunteers, 5 x 4-week crossover: whole apples 550 g/day, pomace 22 g/day, clear or cloudy juice 500 ml/day, or nothing (n = 23) Evidence B source
  LDL +6.9% with clear juice vs whole apples and pomace; whole apple -6.7%, cloudy juice -2.2% (trends)
• Clarifying apple juice strips out pectin and other cell wall components, which the authors of a 23-person crossover trial tie to the loss of the cholesterol effect of whole apples. — 23 healthy volunteers, 4-week periods of whole apples, pomace, clear or cloudy juice (n = 23) Evidence B source
  Clear juice free of pectin; LDL rose 6.9% vs whole apples and pomace
• In a double-blind crossover trial of 90 healthy adults, adding 10 g a day of apple pomace fiber back into apple juice for 4 weeks did not change bowel movement frequency. — healthy free-living adults randomized by baseline bowel movement frequency, apple juice (0 g fiber/d) or apple juice plus apple pomace (10 g fiber/d) for 4 weeks (n = 90) Evidence B source
  No influence on bowel movement frequency; apple juice plus pomace tended to increase flatulence (P = 0.089)
• In a 4-week crossover trial of 12 children with chronic non-specific diarrhea, clear enzyme-processed apple juice promoted diarrhea while cloudy apple juice and extra fluids did not change stools. — children formerly diagnosed with chronic non-specific diarrhea, five-day periods of extra clear fluids, clear apple juice or cloudy apple juice (n = 12) Evidence C source
  Clear apple juice significantly promoted diarrhea; cloudy juice and extra fluids no change in stool frequency or consistency

What it does to your health

• In the same meta-analysis, whole fruits raised stool frequency by 0.36 bowel movements a week more than psyllium, mainly kiwifruit, while prunes did no better than psyllium. — adults with chronic constipation in RCTs comparing fruits with psyllium (n = 232) Evidence A source
  MD +0.36 bowel movements/week (0.25-0.48) for fruits vs psyllium; kiwifruit MD +0.36 (0.24-0.48), n = 192; prunes no difference
• In a placebo-controlled randomized study of 20 adults aged 20 to 29 with chronic constipation, apple juice enriched with 12 g of inulin per 300 ml increased bowel movement frequency. — volunteers aged 20-29 with symptoms of chronic constipation, apple juice beverage with highly polymerized inulin (12 g per 300 mL) (n = 20) Evidence B source
  Significantly increased bowel movement frequency and easier defecation (p <= 0.05); size not given in abstract
• In a randomized study of 104 healthy children aged 1 to 5, one serving of apple juice was incompletely absorbed in 41 percent, against 84 percent for pear juice and 20 to 24 percent for grape juice. — healthy children about 1, 3 and 5 years old, one age-specific serving of pear, apple, white grape or purple grape juice, breath hydrogen test (n = 104) Evidence B source
  Incomplete carbohydrate absorption: pear 84%, apple 41%, white grape 20%, purple grape 24% (p < 0.05)
• In a double-blind crossover study of 28 healthy infants and toddlers, carbohydrate malabsorption occurred after apple juice in 54 percent, against 19 percent after white grape juice. — 18 healthy infants (mean 6.3 months) and 10 toddlers (mean 18.0 months), 4 or 8 ounces of apple or white grape juice (n = 28) Evidence B source
  Malabsorption 54% after apple juice vs 19% after white grape juice (P < .001)

Safety, limits and interactions

• Apple juice cut atenolol exposure to 42 percent of the water level with 20 fl oz (600 ml) and to 18 percent with 41 fl oz (1200 ml) in 12 healthy volunteers. — 12 healthy Korean volunteers, 50 mg atenolol with 10 fl oz (300 ml) water, 20 fl oz (600 ml) or 41 fl oz (1200 ml) apple juice (n = 12) Evidence C source
  AUC geometric mean ratio apple juice:water 0.42 (95% CI 0.30-0.59) at 20 fl oz (600 ml); 0.18 (0.13-0.25) at 41 fl oz (1200 ml)
• Taking the HIV combination pill elvitegravir/cobicistat after apple juice lowered elvitegravir peak and total exposure by 67 and 61 percent versus a protein drink. — healthy Japanese male volunteers, single dose EVG/COBI/FTC/TAF after protein drink, milk or apple juice Evidence B source
  EVG Cmax down 67%, AUCinf down 61% vs nutritional protein-rich drink
• In 21 adults who form calcium oxalate stones, urinary oxalate was 18 percent lower on a diet with 12 fl oz (360 ml) milk than on one with 18 fl oz (540 ml) apple juice, without a change in stone risk index. — 21 normocalciuric adults with a history of calcium oxalate stones, 2 study diets (n = 21) Evidence B source
  24-h urinary oxalate 514 vs 423 micromol (juice vs milk), P<.0001; Tiselius risk index unchanged
• FDA set a 10 parts per billion action level for inorganic arsenic in apple juice in its final guidance of June 2023. — apple juice sold in the US Evidence E source
  Action level 10 ppb inorganic arsenic (non-binding guidance)
• In a double-blind randomized study of 60 children recovering from acute diarrhea, juices high in fructose relative to glucose and in sorbitol caused incomplete absorption and a return of diarrhea. — children with acute diarrhea, fed commonly consumed fruit juices right after improvement (n = 60) Evidence B source
  Incomplete carbohydrate absorption and recurrence of diarrhea with high fructose/glucose and sorbitol juices
• The same AAP statement warns that the high sugar content of juice adds calories and raises the risk of dental caries, and that juice lacks protein and fiber. — infants, children and adolescents Evidence E source
  Higher calorie intake and caries risk; lack of fiber
• In 14 healthy adults, a single intake of apple juice taken with the antihistamine fexofenadine cut drug exposure by 49 to 59 percent compared with water. — 14 healthy Japanese adults, single 60 mg dose of fexofenadine with water or apple juice (n = 14) Evidence B source
  AUC0-24 of (R)- and (S)-fexofenadine down 49% and 59% vs water

What people believe that the data does not support

• The EU refused the claim that apple juice helps maintain a healthy cardiovascular system. No apple juice health claim is authorized in the EU register. — EU food labeling Evidence E source
  Claim status Non-authorized
• The 2026 ESPGHAN and NASPGHAN guideline for childhood functional constipation found no evidence for extra fluid or fiber beyond recommended daily amounts and advises a balanced diet with age-appropriate water. — children aged 0-18 years with functional constipation (n = 102 RCTs reviewed for the guideline) Evidence E source
  Good practice statement: healthy balanced diet with age-appropriate water and fiber; no evidence for more
• The American Academy of Pediatrics notes that fruit juice was historically sometimes recommended for children with constipation, in its 2017 statement on juice. — infants, children and adolescents Evidence E source
  Historical use for constipation noted; no efficacy estimate

Who this works differently for

• In the UK ALSPAC cohort followed to age 24, early apple juice exposure was linked with lower adult fat mass in women but not men. — Avon Longitudinal Study of Parents and Children, birth to 24 years, exposure before age two Evidence C source
  Lower adult adiposity in females, no association in males; size not in abstract

What is still unknown

• Observational data link drinking apple juice five or more times a week with higher odds of asthma in US children aged 2 to 9, but causality is not established. — 1961 US children aged 2-9 years, NHANES 2003-2006 (n = 1961) Evidence C source
  OR 2.43 for asthma, apple juice >=5 times/week vs <=1 time/month, P=0.035 (odds, not risk)
• Across 8 USDA samples of shelf-stable apple juice with added vitamin C, vitamin C ranged from 21 to 90 mg per 3.5 oz (100 g) while fructose ranged only from 5.3 to 6.8 g. — USDA Foundation Foods samples, apple juice with added vitamin C, from concentrate, shelf stable (FDC 2003590) (n = 8) Evidence E source
  Vitamin C 21.1-89.6 mg/100 g (median 44.5); fructose 5.3-6.76 g (median 5.64); potassium 87.8-112 mg (median 94)
• A 2024 meta-analysis of foods, drinks and diets for chronic constipation in adults found 23 studies with 1714 participants, none on apple juice. The only juice tested was prune juice, in a single study. — intervention trials (RCTs, non-randomized, uncontrolled) of foods, drinks and diets in adults with chronic constipation, searched to July 2023 (n = 23 studies (17 RCTs), 1714 participants) Evidence A source
  No apple juice studies found; prune juice n = 1 study

The bottom line

Apart from water, what is in the glass is mostly sugar. UK composition tables give clear apple juice 9.7 g of sugars per 3.5 oz (100 g), 5.5 g of it fructose, with 37 calories, as one average with no range. A US juice box weighs 7.4 oz (209 g) in survey coding. In 40 healthy adults, 12 oz of apple juice produced four times more breath hydrogen than white grape juice, a sign that some fructose went unabsorbed, with no more gut symptoms. In 30 men with impaired fasting glucose, 17 fl oz (500 ml) of ordinary apple juice gave about three times the glucose response of a juice treated with enzymes to lower its glucose, a version made for the trial. For children, two small trials on iron point different ways. In 21 children aged 4 to 7, iron absorption from a muffin fortified with ferrous fumarate was 5.5 percent with apple juice that had no added vitamin C and 8.2 percent with orange juice. In 21 children aged 3 to 6 eating an ordinary meal, the gap of 7.17 against 7.78 percent did not reach significance. Observational data link apple juice five or more times a week with 2.43 times the odds of asthma in 1961 US children aged 2 to 9, from one cross-sectional survey with asthma taken from interviews. The authors say only longitudinal studies can test cause. In a UK cohort followed from birth to 24, early apple juice was linked with lower adult fat mass in women and not in men, with no size in the abstract and strong social confounding that the authors flag themselves. The EU turned down the claim that apple juice helps keep the cardiovascular system healthy, and no apple juice health claim is authorized there, which means the evidence fell short when it was assessed. Who should be careful. If you take fexofenadine or atenolol, the trials above compared juice with water, so ask whoever prescribed the drug what to swallow it with. In healthy Japanese men, taking the HIV pill elvitegravir with cobicistat after apple juice lowered peak and total elvitegravir exposure by 67 and 61 percent against a protein drink, and the abstract does not say how many men took part. In 21 adults with a history of calcium oxalate stones, urinary oxalate was 514 micromol a day on a diet with 18 fl oz (540 ml) apple juice and 423 on one with 12 fl oz (360 ml) milk. The stone risk index did not change, and the study credits the gap to the calcium in milk. In 2023 the FDA set a non-binding action level of 10 parts per billion for inorganic arsenic in apple juice. For young children the facts we have are the iron and asthma findings above. We have no card on apple juice in pregnancy or breastfeeding.

Sources

1. apj-daily-r4-09 · randomized crossover trial
   The incremental area under the curve (iAUC120) of glucose levels (primary parameter) was significantly lower after verum (mean ± SD: 63.6 ± 46.7 min × mmol/l) compared to control (mean ± SD: 198 ± 80.9 min × mmol/l)
   Eur J Clin Nutr, 2019 · checked 2026-09-29
2. apj-daily-r4-15 · food composition dataset
   CoFID 2021 14-331 Apple juice, clear, ambient and chilled: Energy (kcal) 37 | Total sugars (g) 9.7 | Fructose (g) 5.5 | Glucose (g) 2.4 | Sucrose (g) 1.8 | Vitamin C (mg) 26 | Potassium (mg) 89
   CoFID 2021, Public Health England (OGL v3.0), code 14-331 · checked 2026-09-29
3. ev-ajc-13 · food composition dataset
   Apple juice, with added vitamin C, from concentrate, shelf stable | Fructose 5.699 g per 100 g (range 5.3-6.76, n=8) | Glucose 3.208 g per 100 g (range 2.83-3.68, n=8)
   USDA FoodData Central, Foundation Foods (release 2026-04-30), FDC 2003590, Apple juice, with added vitamin C, from concentrate, shelf stable · checked 2026-10-06
4. apj-daily-r4-17 · reference dataset
   FNDDS 64104010 Apple juice, 100% (fdc_id 2709320): 1 fl oz (no ice) 31 g | 1 fun size box (4.23 fl oz) 131 g | 1 juice box/pouch (6.75 fl oz) 209 g | 1 bottle (10 fl oz) 310 g | Quantity not specified 248 g
   USDA FNDDS (FoodData Central survey foods), code 64104010, FDC 2709320 · checked 2026-09-29
5. apj-daily-r4-01 · randomized crossover pharmacokinetic trial
   One-time ingestion of apple juice significantly decreased the area under the plasma concentration-time curve (AUC0-24) for (R)- and (S)-fexofenadine by 49 and 59 %, respectively
   Eur J Clin Pharmacol, 2014 · checked 2026-09-29
6. apj-daily-r4-04 · randomized crossover absorption trial
   Iron absorption increased from 5.5% +/- 0.7% to 8.2% +/- 1.2%, P < 0.001 from the muffins given with orange juice compared with muffins given with apple juice.
   J Pediatr Gastroenterol Nutr, 2010 · checked 2026-09-29
7. apj-daily-r4-05 · randomized crossover absorption trial
   Median iron absorption from the meal ingested with apple juice was 7.17% (mean +/- SD, 9.48% +/- 9.68%). Median iron absorption from the meal ingested with orange juice was 7.78% (9.80% +/- 6.66%; P =.44).
   Arch Pediatr Adolesc Med, 2003 · checked 2026-09-29
8. apj-daily-r4-08 · randomized crossover trial
   Consumption of apple juice resulted in a greater mean breath hydrogen area under the curve at 23.3 ppm/hour (95% CI 13.0 to 33.6) compared with white grape juice at 5.8 ppm/hour (95% CI -4.6 to 16.1) (P<0.001).
   J Acad Nutr Diet, 2017 · checked 2026-09-29
9. apj-daily-r4-06 · randomized crossover dietary trial
   On the other hand, LDL-cholesterol concentrations increased by 6.9% with clear juice compared to whole apples and pomace.
   Eur J Nutr, 2013 · checked 2026-09-29
10. apj-daily-r4-07 · randomized crossover dietary trial
    Apples are rich in polyphenols and pectin, two potentially bioactive constituents; however, these constituents segregate differently during processing into juice products and clear juice is free of pectin and other cell wall components.
    Eur J Nutr, 2013 · checked 2026-09-29
11. ev-ajc-04 · RCT
    Neither pomace interventions influenced BM frequency.
    Br J Nutr, 2023 · checked 2026-10-06
12. ev-ajc-07 · controlled clinical trial
    Extra fluids and cloudy apple juice did not influence stool frequency and consistency compared with the basal period. In contrast, clear apple juice significantly promoted diarrhoea.
    Arch Dis Child, 1995 · checked 2026-10-06
13. ev-ajc-02 · meta-analysis
    Fruits resulted in higher stool frequency than psyllium (MD: +0.36 bowel movements [BM]/week, [0.25-0.48], n = 232), kiwifruits in particular (MD: +0.36 BM/week, [0.24-0.48], n = 192); there was no difference for prunes compared with psyllium.
    Aliment Pharmacol Ther, 2024 · checked 2026-10-06
14. ev-ajc-03 · RCT
    A placebo-controlled, randomized study involving 20 volunteers of age 20-29 with symptoms related to chronic constipation showed that the consumption of juice enriched with highly polymerized inulin significantly (p≤ 0.05) increased the frequency of bowel movements and facilitated defecation.
    Food Funct, 2020 · checked 2026-10-06
15. ev-ajc-05 · RCT
    Incomplete carbohydrate absorption (BH2 peak above 20 ppm) occurred more frequently after pear juice consumption (84%) than after apple juice (41%) or grape juice (white 20%, purple 24%) [p < 0.05].
    J Am Coll Nutr, 1997 · checked 2026-10-06
16. ev-ajc-06 · RCT
    In the combined age groups, carbohydrate malabsorption occurred more frequently after apple juice consumption (54%) than after white grape juice (19%; P < .001).
    Pediatrics, 1995 · checked 2026-10-06
17. apj-daily-r4-02 · crossover pharmacokinetic trial
    The geometric mean ratios (95% confidence intervals) of apple juice : water were 0.18 (0.13, 0.25, 1200 ml) and 0.42 (0.30, 0.59, 600 ml) for the AUC(0,t(last)).
    Br J Clin Pharmacol, 2013 · checked 2026-09-29
18. apj-daily-r4-03 · randomized crossover pharmacokinetic trial
    The geometric means for Cmax and AUCinf of EVG following milk ingestion slightly decreased by 21% and 14%, respectively, and those following apple juice ingestion decreased by 67% and 61%, respectively, compared with a nutritional protein-rich drink.
    Clin Pharmacol Drug Dev, 2018 · checked 2026-09-29
19. apj-daily-r4-10 · randomized crossover metabolic trial
    Twenty-four hour urinary oxalate excretion was 18% lower (P<.0001) on the milk diet vs the juice diet: 423 vs 514 micromol, respectively.
    J Am Diet Assoc, 1998 · checked 2026-09-29
20. apj-daily-r4-18 · regulatory guidance
    The final guidance identifies for industry the action level of 10 parts per billion (ppb) for inorganic arsenic in apple juice
    US FDA, Final guidance on action level for inorganic arsenic in apple juice, 2023 · checked 2026-09-29
21. ev-ajc-08 · RCT
    Feedings of juice with high fructose/glucose ratios and sorbitol resulted in incomplete carbohydrate absorption and recurrence of diarrhea during the phase immediately after improvement of the illness.
    J Pediatr, 2001 · checked 2026-10-06
22. ev-ajc-11 · guideline
    High sugar content in juice contributes to increased calorie consumption and the risk of dental caries.
    Pediatrics, 2017 · checked 2026-10-06
23. ev-ajc-12 · RCT
    One-time ingestion of apple juice significantly decreased the area under the plasma concentration-time curve (AUC0-24) for (R)- and (S)-fexofenadine by 49 and 59 %, respectively
    Eur J Clin Pharmacol, 2014 · checked 2026-10-06
24. apj-daily-r4-14 · regulatory decision
    POL-HC-6628 Apple juice Apple juice helps to maintain a healthy cardiovascular system Clarification provided Apple juice : - helps to maintain a healthy cardiovascular system - plays an important antioxidative function on cardiovascular system Non-authorised
    EU Register on nutrition and health claims, claim POL-HC-6628, snapshot 2026-09-21 · checked 2026-09-29
25. ev-ajc-09 · guideline
    There is no evidence to support physical activity, fluid, or fiber intake in the treatment of FC in children beyond the recommended daily amounts.
    J Pediatr Gastroenterol Nutr, 2026, ESPGHAN/NASPGHAN guidelines for treatment of functional constipation in children aged 0-18 years · checked 2026-10-06
26. ev-ajc-10 · guideline
    It was also sometimes recommended for children with constipation.
    Pediatrics, 2017 · checked 2026-10-06
27. apj-daily-r4-13 · prospective cohort
    early exposure to apple juice was associated with lower adult adiposity in females but not males.
    Eur J Clin Nutr, 2024 · checked 2026-09-29
28. apj-daily-r4-12 · cross-sectional survey analysis
    Children consuming AJ ≥5 times/week v. ≤1 time/month, adjusted for the other beverages, were more than twice as likely to have asthma (OR=2·43, P=0·035). ... Longitudinal studies are needed to provide evidence of causal association.
    Public Health Nutr, 2016 · checked 2026-09-29
29. apj-daily-r4-16 · food composition dataset
    USDA Foundation Foods FDC 2003590 Apple juice, with added vitamin C, from concentrate, shelf stable, 8 samples: Vitamin C 21.1-89.6 mg (median 44.5) | Fructose 5.3-6.76 g (median 5.64) | Potassium 87.8-112.0 mg (median 94.0) per 100 g
    USDA FoodData Central, Foundation Foods, release 2026-04-30, FDC 2003590 · checked 2026-09-29
30. ev-ajc-01 · meta-analysis
    We included 23 studies (17 RCTs, 6 uncontrolled; 1714 participants): kiwifruit (n = 7), high-mineral water (n = 4), prunes (n = 2), rye bread (n = 2), mango, fig, cereal, oat bran, yoghurt, water supplementation, prune juice, high-fibre diet, no-fibre diet (n = 1).
    Aliment Pharmacol Ther, 2024 · checked 2026-10-06