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This amazing guest post was written by Dr. Sarah Brewer, a licensed Medical Doctor, a Registered Nutritionist, a Registered Nutritional Therapist! Check out her website here!

We all know we should aim to minimize our intake of sugar, but sometimes a little sweetness is essential in desserts and other recipes. Which are the best and worst sweeteners from a health point of view?

Why Too Much Sugar Is Bad For You

sugar cubes

As well as promoting tooth decay, excess sugar provides so-called ‘empty’ calories which can lead to weight gain. The ‘empty’ refers to the fact that table sugar (sucrose) does not provide any other nutritional benefits such as vitamins, minerals or fiber – it simply contains pure energy, and most of us already get more than enough calories from our diet.

During digestion, sucrose is broken down into two different sugars, glucose plus fructose. The glucose is absorbed straight into the bloodstream to cause a rapid spike in blood sugar levels, and the speed at which this happens is referred to as the Glycemic Load (GL).

Foods with a high GL cause rapid spikes in blood glucose levels which, in turn, trigger the release of insulin hormone from the pancreas. Insulin acts as the key for glucose to enter muscle and fat cells so that glucose levels subsequently fall. 

The fructose sugar is metabolized in your liver and, while it can be converted into glucose, usually it’s converted into fat instead, and excess intakes contribute to fatty liver changes and inflammation.

This effect is similar to that of alcohol and, in fact, researchers now also believe that fructose sugar also affects the brain in a similar what to alcohol, contributing to the pleasurable effects of sweetness and the ‘addictiveness’ of sweet foods.   

Beware the Glycemic Load

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Sugary foods tend to have a high GL so that glucose levels peak, trigger the release of insulin, and then plummet. This can lead to reduced concentration, drowsiness and tiredness a few hours after eating a sugary meal. As a result, you’re tempted to eat more sugar to restore your energy levels and to satisfy your sugar cravings.

As well as encouraging a snacking habit, a high sugar diet may also increase the risk of developing type 2 diabetes. This can happen for genetic reasons if your pancreas struggles to keep churning out insulin in response to a high sugar diet.

Mostly, however, excess sugar leads to weight gain and obesity, which is associated with insulin resistance. When fat cells become resistant to the effects of insulin, more glucose stays within the circulation, so your blood glucose levels rise.

Some of the excess circulating glucose is converted into fat in the liver, further contributing to fatty liver changes (rather like those poor overfed geese and ducks which are the source of paté de fois gras) and some attacks proteins in the circulation to hasten to harden and furring up of the arteries.

A series of metabolic abnormalities also develop from raised glucose levels, so you are also likely to develop a raised blood pressure, triglycerides and develop cholesterol imbalances and inflammation – all of which increase your risk of heart disease and stroke.   

For all these reasons, following a diet that contains less sugar, and selecting foods with a lower glycemic load is better for your long-term health. Researchers have found, for example, that just replacing one sugary drink per day with water or unsweetened tea or coffee can lower your risk of developing type 2 diabetes by as much as 25%. 

The Good, The Bad, and the Ugly

Check labels when buying products to see how much sugar they contain. The Nutrition Facts Panel contains a listing for ‘Sugars’ which includes the total amount that is naturally present (e.g., lactose in milk, fructose, and sucrose in fruit) as well as sugars added during manufactures such as corn syrup, juice concentrates or honey.

Checking the ingredients list to see where these sugars come from is often enlightening. There are over 60 different common names for sugar such as sucrose, high-fructose corn syrup, barley malt, maltose, rice syrup, agave nectar, caramel, dehydrated cane juice, molasses, Muscovado, saccharose, treacle and so on.

Glucose

The worst form of sugar from a health point of view is pure glucose (dextrose), which is rapidly absorbed into the circulation to cause a sugar spike – especially if it’s stirred into a drink such as tea or coffee. The only people who may need to carry glucose/dextrose with them are those with type 1 diabetes who use insulin or other powerful glucose-lowering medication which can cause a hypo (dangerously low blood glucose level).

Sucrose

White table sugar (sucrose) is made from sugar cane or sugar beets. It is a pure white product that is digested to release both glucose and fructose with nothing else – not even a few vitamins or minerals to provide at least some benefit. Best avoided. 

Brown Sugar

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Brown sugar sounds healthier than white but, despite providing a smattering of vitamins and minerals, these are too few to offer any meaningful nutritional benefit. This often masquerades under names such as dehydrated cane juice, or as raw, Turbinado, Muscovado, Demerara or Barbados sugar. Best avoided. 

Agave Nectar

This sounds as if it should be healthy as it’s made from cactus juice and is more accurately called Agave syrup. Unfortunately, during processing, it loses any vitamins and minerals naturally present in the cactus juice and, from a nutritional point of view, is little better than high fructose corn syrup.

The high fructose content means it has less impact on blood glucose levels than sugar, but there are increasing concerns about eating too much fructose, as mentioned above. The high fructose content does have the advantage that Agave Nectar is sweeter tasting than sugar, so you need less. Best avoided but if you insist on using it, only add a dash.

Coconut Sugar

It is the crystallized sap collected from the flowers of coconut palms. From a nutritional point of view, it is similar to that of brown sugar and mainly consists of sucrose plus small amounts of glucose and fructose. It provides small amounts of B vitamins, iron, and magnesium, and is better than white sugar but don’t have too much.

Maple Syrup

Maple syrup is made from a tree sap and, because it is a diluted form of sugar, offers a less intense sweetness with fewer calories. It contains useful amounts of vitamins and minerals such as manganese, zinc and riboflavin, and even some antioxidant polyphenols similar to those found in tea and red wine.

If you must put something on your porridge to sweeten it, a dash of maple syrup is better than a sprinkling of sugar.

Honey

Honey is often viewed as a health product despite its high sugar content. Produced by honey bees from flower nectars, the sucrose sugar is pre-digested by the bees to release glucose and fructose. Honey contains some vitamin B6 and also has a natural antimicrobial action by releasing hydrogen peroxide.

Honey made from the nectar of medicinal plants, such as the Manuka bush, are even active against some antibiotic-resistant bacteria, and sterile honey is used to treat wounds. However, it is still a high sugar product, and one to consume in moderation. 

Date Sugar

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Made from the sap of the Palmyra or sugar date palm, date sugar is also known as Palmyra jaggery. It provides useful amounts of iron, magnesium, calcium and even vitamin B12.  Better than white or brown sugar, but keep your intake to a minimum – in fact when substituting it for sugar in recipes you can often use half the amount.

Stevia

Stevia is made from the leaves of a South America plant which contains substances that stimulate the sweet-tasting receptors on the tongue. Stevia is up to 30 times sweeter than sugar with zero calories and has no impact on blood glucose levels.

Pure stevia is available as syrup drops or powder, and it is also mixed with granules to produce a product that can be used in a similar way to granulated sugar. Some people notice an aftertaste, while others don’t.

Monk Fruit

Monk fruit sweetener is made from the juice of an Asian fruit which contains antioxidants (mogrosides) that taste sweet but are not metabolized in the same way as sugar in the body. As a result, monk fruit sweetener has no impact on blood glucose levels and no calories. Some research suggests that Monk fruit may boost immunity and have anti-cancer benefits.

Go Easy On Sugar Alcohols

Sugar alcohols such as xylitol, lactitol, sorbitol, and maltitol are derived from sugars and are known as sugar alcohols. Despite their sweet taste, they are not processed in the body like sugars. While sorbitol, lactitol, and xylitol do not raise blood glucose levels, maltitol has the same effect on blood glucose levels as sucrose.

Xylitol is derived from the bark of the birch tree and has 40% fewer calories than sugar and is popular in chewing gum as it actively protects against tooth decay. Sugar alcohol is widely used in diet and low-carb products, but their laxative effect limits their consumption.

Some people are more sensitive to this than others, so that intakes above ten to twenty grams per day can cause flatulence, bloating and diarrhea. So, while they are better than sugar from a health point of view, use them with caution.

Avoid So-Called Artificial Sweeteners 

artificial sweetner

Artificial sweeteners are highly controversial and have attracted many negative claims that they’re addictive, are toxic or cause cancer. The fact remains that they are deemed safe enough for use in food and drink, but it’s wise to limit your intake. They include saccharin, neotame, advantame, aspartame and acesulfame potassium (acesulfame K or Ace-K). These artificial, non-nutritive sweeteners are from several hundred to 20,000 times sweeter than sugar.

Ideally, we should all cut back on our intake of sugars and sweeteners and obtain sweetness from whole fresh fruit and vegetables such as sweet potatoes. The sugars naturally present in these are accompanied by a nutritional powerhouse of vitamins, minerals, polyphenols and other antioxidants as well as plenty of fiber. Cut back slowly, and you will soon retrain your taste buds to appreciate lower levels of sweetness.

Dr. Sarah Brewer is a medical nutritionist, nutritional therapist and the author of over 60 popular health books. Follow her Nutritional Medicine blog at www.DrSarahBrewer.com, her blood pressure advice at www.MyLowerBloodPressure.com and her health product reviews at www.ExpertHealthReviews.com. For nutrition and recipe tweets follow @DrSarahB and for general health and fitness tweets follow @DrSarahBHealthy.

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Dr. Sarah Brewer
M.D.
Dr. Sarah Brewer, MSc (Nutr Med), MA (Cantab), MB, BChir, RNutr, MBANT, CNHC, FRSM, is a medical nutritionist, nutritional therapist and the author of over 60 popular health books.
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