We’re all aware that too much sugar is bad for us but recent media attention has revealed it’s not just our waistlines we should be worried about. Research has shown sugar increases our risk of chronic diseases including diabetes, Alzheimer’s, heart disease and cancer. One European study concluded that the consumption of just one sugar-sweetened drink a day increased the risk of type 2 diabetes by 22%.
Sugars are found naturally of course in foods such as fruits and vegetables, wholegrains or as lactose in milk. The main concern however is around added sugars usually in the form of sucrose (table sugar), syrups and high-fructose corn syrup. It is estimated that a third of added sugar consumption comes from sugar sweetened drinks, a sixth comes from foods such as chocolates, ice creams, and biscuits, but half comes from everyday foods such as ketchup, salad dressings, and bread.
New guidelines from the World Health Organisation recommend we all aim to cut our intake of added sugars (including sugar present in honey, syrups and fruit juices) to 6tsp a daily. That’s about 25g for an adult every day. To put this in context a typical can of fizzy drink contains about nine teaspoons of sugar.
Here are a few more reasons why should cut down on sugar:
- Sugar stresses our adrenal glands stimulating the release of adrenaline and cortisol, disrupting blood sugar levels and leading to increase in adipose tissue (fat)
- Sugar suppresses the function of our immune system
- Sugar disregulates the production of leptin, a hormone essential for appetite control
- Sugar causes oxidative stress in the body.
- Sugar appears to promote growth of cancer cells.
- Sugar promotes fat storage and weight gain.
- Over time excess sugar can result in insulin resistance, Type II diabetes and related health complications like nerve damage.
The Many Names Of Sugar
Don’t be fooled by labelling – all the following names indicate the product contains added sugar
|Agave nectar||Barbados sugar|
|Barley malt||Beet sugar|
|Blackstrap molasses||Brown sugar|
|Carob syrup||Caster sugar|
|Confectioner’s sugar||Corn syrup|
|Corn sweetener||Corn syrup solids|
|Crystalline fructose||Date sugar|
|D-mannose||Evaporated cane juice|
|Ethyl maltol||Fruit juice|
|Fruit juice concentrate||Galactose|
|Golden sugar||Golden syrup|
|Granulated sugar||Grape sugar|
|Grape juice concentrate||HFCS High-fructose corn syrup|
|Muscovado sugar||Organic raw sugar|
|Raw sugar||Refiner’s syrup|
The Problem with Fructose
One particular form that has received plenty of bad press is fructose. We know that for some people with digestive issues fructose is bad news. Excess fructose can cause bloating and diarrhoea which is why high fructose foods are listed as High FODMAP foods. While it does have a lower glycemic level than glucose it unfortunately has an adverse effect on our appetite. It appears to lead to higher levels of ghrelin, a hormone which increases appetite. As it is not regulated by insulin, a hormone that helps keep blood glucose levels stable and does not influence leptin production either, a hormone that lets you know when you are full you may be more likely to overeat.
One of the main concerns surrounding fructose is how it is processed by the body Fructose is almost exclusively metabolised by the liver. When we eat a lot of it, much of it is converted into fat. This leads to an increase in triglycerides, which increases the risk of heart disease. Fat build-up in the liver can also lead to inflammation and scarring. Fructose can be converted into energy, but in doing so it can also produce damaging free radicals that attack our body contributing to ageing.
The liver’s metabolism of fructose also produces uric acid, a predictor of cardiovascular disease and of course linked to gout. For more information on fructose see Dr. Lustig’s video presentation, Sugar: The Bitter Truth and look at Don Matesz: Paleo Basics: Fact vs. Fiction for an alternative view.
The presence of fructose in HFCS appears to be key behind its myriad of negative health effects. The fructose content not only contributes to liver disease but lowers HDL levels while increasing small, dense (and more dangerous) LDL particles.
But that’s not to say you should avoid whole fresh fruit – especially the lower glycemic fruits such as berries, avocado, cherries and citrus fruits. They are packed with antioxidants, fibre, vitamins and minerals. However if you already have insulin resistance or metabolic syndrome you may wish to limit your intake of fruit. I also recommend you avoid processed fruit juices and smoothies. Be mindful too that dried fruits like prunes, raisins, apricots and dates are high in sugar including fructose.
One of the main problems with refined sugar (and sweeteners in general) is a tendency to promote overeating, which can lead to weight gain and inhibit weight loss. So if you’re trying to lose weight minimize or avoid foods that are sweetened, even with natural sweeteners. Don’t resort to artificial sweeteners. Recent studies indicate that they potentially disrupt appetite regulation and metabolic response, which is counter to any goals of weight loss. New research also suggests they adversely affect our gut flora as well
Here’s the lowdown on some of the common sweeteners
Honey is a popular sweetener amongst the paleo community and has long been an important food in the human diet. It is still high in fructose (on average around 53%) which is actually similar to HFCS so if you have gut symptoms it may not be the best choice. Honey in its pure, raw form does contain a range of enzymes and other proteins, trace minerals, flavonoids and other polyphenols.
There is a big difference between raw honey and processed honey. Raw honey has a much lower glycemic index (around 30) compared to processed honey (around 75). It is reasonably high in fructose (around 40%). Much of the antioxidants, enzymes and antimicrobial benefits associated with raw and Manuka honey are also destroyed during processing. Honey has been shown to have various benefits. For example human studies have found that supplementing with 3-5 tbsp of honey per day increases serum antioxidant levels, including vitamin C and glutathione reductase. Honey also has antimicrobial activity, and Manuka honey may even be an effective treatment in some cases of h. pylori infection. If you are going to use honey then I suggest only in small amounts and use raw or Manuka honey, which will have the most enzymes and nutrients present.
Maple Syrup & Molasses
These liquid sweeteners have similar composition. They contain more sucrose, with some free glucose and fructose. Being lower in fructose than other sweeteners may make them more easily tolerated for those with gut issues. Maple syrup is boiled and refined sap from maple trees. It has a GI of 54. While it does contain some manganese, iron and calcium nutritionally speaking it is not really significantly different from white sugar. Yes maple syrup has been studied for its antioxidant properties but as yet there is little research to show its clinical significance for human health.
Molasses is made during the production of sugar. It contains a reasonable amount of iron, vitamin B6, potassium, zinc calcium and magnesium as well as antioxidants. For example 1tbsp contains around 10% of your daily requirements for calcium, 15% for iron, and 8% for magnesium. This doesn’t give you licence to use large amounts of it though. If you do choose to use these sweeteners select those with minimum processing to contain more minerals and phytonutrients.
In the last few years agave nectar’s reputation as a healthy sweetener has been questionned. It does have a low glycemic index but it is very high in fructose – containing up to 70% fructose – this is actually higher than HFCS. In view of the potential health concerns surrounding fructose it is not recommended.
Xylitol and Erythritol
Known as sugar alcohols (polyols) xylitol and eythritol are popular low GI sweeteners. The GI of xylitol is 13 while erythritol is 0. Sugar alcohols are a type of low-digestible carbohydrate. Xylitol is the most popular and most extensively researched. Naturally present in fruit and vegetables it is normally derived commercially from birch or corn. Unlike artificial sweeteners, sugar alcohols aren’t completely calorie-free, because we are able to digest and absorb them to some extent.
Polyols convert to glucose more slowly than sucrose in your body and do not require much insulin to metabolize. The most well-known health benefit of xylitol is its effect on dental health: there is plenty of evidence for xylitol’s ability to prevent tooth decay. This why it is often added to sugar free chewing gum. Xylitol also contains 40% less calories than table sugar. It also not provoke an insulin response making it suitable for diabetics.
Erythritol is almost completely absorbed, but is not digested, so it provides almost no calories. It also does not raise blood sugar. It is about 60 – 80% as sweet as sucrose (sugar) and occurs naturally in pears, wine, watermelon and grapes. It is the easiest sugar alcohol to digest – more than 90% of erythritol is absorbed in the small intestine, so minimal amounts reach the colon where other sugar alcohols like xylitol end up causing digestive symptoms.
Because sugar alcohols are high FODMAPs and are largely indigestible, they can cause diarrhea by pulling excess water into the large intestine. Some people also find they can cause gas and bloating. Erythritol is probably the best-tolerated sugar alcohol, if you do find they cause symptoms. But still be cautious about consuming huge amounts if you do suffer with digestive upsets. Being prebiotic they can however have a beneficial effect on our gut flora. Even a single dose ox xylitol can produce beneficial changes with a shift from gram-negative to gram-positive bacteria, with fewer Bacteroides and increased levels of Bifidobacteria. So you may find that with regular consumption of xylitol there is a reduction in digestive symptoms
For baking they can be used in a similar way to table sugar and being sweetener you can probably use less as well making them an ideal replacement where some bulk is required in recipes.
A relatively new natural sweetener is coconut sugar. It is a natural sugar made from sap, which is the sugary circulating fluid of the coconut plant.
It does have a relatively low glycemic index (35) and it also contains traces of certain nutrients including Iron, Zinc, Calcium and Potassium. It contains inulin a type of fibre, which may slow glucose absorption. Calorie wise it is similar to table sugar so don’t be fooled into thinking it is a low calorie alternative. However it may be a useful alternative in small quantities for baking.
Stevia & Lo Han Kuo
Stevia is fast becoming a popular low calorie sweetener. It is extracted from the leaves of a plant Stevia rebaudiana and has been used for centuries in South America.
It is incredibly sweet and has virtually no calories. The most potent sweet compounds in the Stevia leaf are called Stevioside and Rebaudioside A and they are both many hundred times sweeter than sugar. Ideally choose a brand that uses the whole plant. Many on the market make use of only certain active ingredients and not the entire plant. Usually it’s the synergistic effect of all the agents in the plant that provide the overall health effect. It can have a slight bitter after taste and is normally used in minute amounts as a sweetener. While there is some debate about its benefits the majority of the evidence indicates that stevia, used in reasonable quantities, is a harmless (and possibly beneficial) natural sweetener. Because stevia contains almost no calories, one potential issue with stevia is that the sweet taste without the influx of sugar might confuse our insulin response. As yet there is no evidence that this is the case. In addition there are studies to indicate that it may help lower elevated blood pressure as well as lower blood sugar levels in diabetics.
There is concern that potentially it could have a negative impact on fertility. Stevia was used traditionally in South America as a contraceptive. So far animal studies generally appear to indicate minimum effects. However if you are struggling to get pregnant then it may be wise to keep your intake to a minimum. So far it does look like stevia could be a very useful sweetener particularly for anyone with blood sugar imbalances or who would prefer to use a non-caloric sweetener.
Lo Han Kuo or Monk Fruit is another natural sweetener similar to Stevia, but harder to find. In China, the Lo Han fruit has been used as a sweetener for centuries, and it’s about 300 times sweeter than sugar. The Chinese call luohanguo the “longevity fruit” because the steep mountain fields in Guangxi Province where it is grown have an unusual number of residents that live to be over 100 years old. The mongrosides in the fruit appear to have antioxidant properties as well as benefits for diabetes and potential anti-cancer properties. Like stevia it has no impact on blood sugar levels either.
Yacon syrup comes from the yacon tuber, an Andean crop that’s commonly used as a food tuber in South America. To make syrup, the tuber is juiced, the pulp removed, and the liquid reduced and concentrated.
It’s a sweet syrup that tastes a bit like molasses while having a low glycemic index. Yacon syrup is a low GI sweetener (between 1 and 5 depending on the source) and therefore prevents glucose spikes in the blood. It’s low GI level is mainly because it contains a large amount of inulin, a fructo-oligosaccharide (FOS) that tastes sweet but is not digested in the small intestine and instead acts as a prebiotic fibre. It does contain a reasonable amount of fructose around 35%.
In one small 2009 study, researchers found that daily yacon syrup reduced belly fat in obese women with insulin resistance. Being high in prebiotic fibre it may have digestive health benefits by supporting a healthy gut flora.
Jaggery is basically unrefined sugar made from sap tapped from trees. You can get it from coconut, date and palmyra trees. Palmyra jaggery is thought to be the most nutritious. It has a sweet caramel flavour making it ideal for baking. One of the benefits is its relatively low GI score of around 40 and in particular its low fructose content compared to other sugars. Palmyra jaggery has around 3% free fructose making it useful for anyone who experiences digestive symptoms. Being much less processed than table sugar it also contains a wealth of vitamins and minerals including iron, B6, calcium, potassium and B12. Calorie wise it is similar to sugar so don’t choose this if you are looking for a low calorie option. However being intensely sweet you can actually use less in recipes than table sugar.
Don’t Shun Fruit
Concern about our intake of sugar has somewhat demonised whole fresh fruit. However remember that added sweeteners and fruit have completely different metabolic effects. Whole fresh fruit provides fibre, vitamins, minerals and antioxidants and provide more satiety than a liquid sugar. A moderate fruit consumption (2-3 portions daily) does not appear to adversely affect diabetes. So if you want natural sweetness munching on a piece of fruit rather than using sweeteners is a good option. If you have blood sugar imbalances or insulin resistance then you may wish to restrict consumption to 1-2 portions daily and focus on low GI fruits. If you suffer with bloating then stick to low FODMAP fruits
Choosing a Healthier Sugar
If you suffer with insulin resistance or diabetes then your best options are probably stevia or the sugar alcohols. For anyone with digestive symptoms then you are best to avoid sweeteners with a high fructose content. This is because large quantities of fructose can be difficult to digest and absorb, and may lead to fermentation. If you have small intestinal bacterial overgrowth (SIBO) fructose is bad news and likely to make gas and bloating much worse.
If you are looking for a healthier sugar then whatever you choose use it sparingly. Consider its total sugar content, impact on blood sugar level, fructose levels as well as any nutritional qualities.