Here are some scary facts: In 2012 almost 10% of the US population had diabetes, and that number is growing. Over 35% of the population is classified as pre-diabetic. Diabetes was the 7th leading cause of death in the US in 2010.
With these staggering numbers, and the very strong correlation between sugar consumption and diabetes, it’s no wonder that Americans are increasingly choosing sugar substitutes. Cane sugar, xylitol, aspartame, sucralose, Stevia, HFCS, coconut sugar, and maple syrup oh my! It’s daunting trying to make heads or tails of all the sweet ingredients in today’s products. In Part 1 you will find info on sugar and caloric sugar alternatives, but first some background and terminology.
Glucose. Glucose is a monosaccharide, meaning it is made of a single sugar molecule. The human body preferentially and readily metabolizes glucose to use as an essential fuel for all cells in the body. Absorption of glucose causes blood sugar (glucose) to rise. A hormone called insulin regulates the uptake of glucose from the blood into human cells. When the amount of glucose in the blood stays very high over time, insulin resistance develops. Insulin resistance means that cells have stopped responding to insulin the way they are supposed to. The body initially compensates by producing more and more insulin, but eventually this fails and diabetes results. In a non-diabetic person, glucose is used efficiently and is stored when needed in muscles in a form called glycogen.
Fructose. Fructose is also a monosaccharide, but it is non-essential in the human body. It is absorbed readily from the digestive system. Fructose raises blood sugar without causing an increase in production of insulin, thereby bypassing the body’s main regulatory method. This is why over-consumption of fructose has been linked to insulin resistance and diabetes. In addition, fructose metabolism favors production of fat more than glycogen, the storage form of sugar that muscles use. Fruit, vegetables, high fructose corn syrup, maple syrup, and agave syrup are examples of fructose sources.
Sucrose. Sucrose is a disaccharide formed from linking on fructose and one glucose molecule.
Sugar, Masqueraders, and Natural Sugar Alternatives
Table sugar, that ubiquitous white crystalline powder that we all know and love, is pure sucrose. It is readily hydrolyzed (broken down) into fructose and glucose and causes a rapid rise in blood glucose. That is why it is not a good choice for diabetics. The majority of sugar in the US is either beet sugar or cane sugar. Cane sugar is sold in many forms, which are listed below.
Now that sugar is being villainized in the public eye, marketers have become savvy about labeling sugar as anything other than sugar. Here is a list of ingredients that are really just sugar:
- brown sugar – cane sugar with molasses added back for varying degrees of darkness
- confectioner’s sugar (powdered sugar) – cane sugar ground very fine and combined with cornstarch to prevent caking
- raw sugar – an unregulated product that is refined sugar with some amount of refining products added back
- turbinado sugar – similar to raw sugar
- invert sugar – sucrose processed to break it into separate glucose and fructose molecules, won’t crystallize
- dextrose – synonymous with glucose
- high fructose corn syrup – see below
High Fructose Corn Syrup. A byproduct of corn syrup, high fructose corn syrup (HFCS) is 42-90% fructose. HFCS has become a very cheap additive for food industry since the US government liberally subsidizes corn farming. As a result, more and more products are replacing sugar with HFCS. It has been increasingly linked to obesity, diabetes, and metabolic syndrome.
A recent study found that rats being fed water sweetened with HFCS gained more weight and exhibited negative metabolic outcomes versus rats fed water sweetened with sucrose and given the exact same number of calories. The researchers are quoted as saying, “Our findings lend support to the theory that the excessive consumption of high-fructose corn syrup found in many beverages may be an important factor in the obesity epidemic.” The mechanism for this is largely unknown, but theories suggest that fructose metabolism is more likely to result in the production of fat than glucose. Another possibly contributing factor is that all fructose molecules in HFCS are free or unbound, making them more readily absorbable.
Honey. Honey has been used as a sweetener since ancient Egypt, and contains approximately equal parts fructose and glucose. In its raw, unpasteurized form, honey is rich in enzymes and antimicrobial substances that are so potent that it can be preserved almost indefinitely. Raw honey is a very effective antibacterial agent. It also may benefit people with seasonal allergies, eczema, and other allergic-type conditions. However, most honey available in grocery stores has been heat-treated to remove these beneficial properties.
Agave Syrup. This sugar substitute has become very popular, especially in the paleo community, because it has a lower glycemic index than other sweeteners. Glycemic index refers to how much a given food raises your blood sugar level. The higher the glycemic index, the more the food raises your blood sugar. So, if agave has a lower glycemic index is it better than other sweeteners? Probably not. Agave is very high in fructose – perhaps even higher than high fructose corn syrup. In this regard, it may favor fat production and promote insulin resistance. One advantage of agave is that it is 25% sweeter than sugar, so you may need to use less to achieve the same amount of sweetness.
Maple Syrup. Maple syrup is made from boiling down the sap from maple trees. It has a rich caramel flavor, and can be quite easily substituted into most recipes. Compared to agave, honey, and HFCS, maple syrup contains much less fructose and more sucrose, which may be an advantage, as long as it is used in moderation. Maple syrup is also rich in minerals and the B vitamin thiamin.
So, what’s the take home message?
Sugar and caloric sugar substitutes can all contribute to the development of diabetes and obesity, so should be consumed only in small amounts. Some sweeteners, including high-fructose corn syrup and agave nectar are very high in fructose, which may contribute more to the development of these conditions than other sweeteners.
Your naturopathic doctor at Today can help give you more individualized guidance on which sweeteners are safest for you!
In Sugar: The Good, The Bad, and The Ugly Part 2, find information about non-caloric sweeteners!
