“Naturally sweetened with agave,” the sales attendant stated proudly, as I eyed the expensive tequila. Her tone and the knowing look on her face resonated with the implication that agave is a better sweetener than sugar.
What the sales attendant and most people don’t realize is that agave is actually worse than sugar. Why? Read below to better understand why all added sugars – table sugar, raw sugar, honey – are bad for you if not consumed in moderation. Then learn why agave and high fructose corn syrup, both which contain a large amount of “liquid” fructose, are especially detrimental to your health and good looks.
What Are Sugars?
Sugars are a sweet-tasting type of carbohydrate used as food or to flavor food. The most basic type are monosaccharides, or simple sugars, and this group includes glucose and fructose.
Glucose is the primary source of energy for your body, and most of the food you eat is converted to glucose. Fructose is the sugar found naturally in fruit. Both can be extracted and turned into concentrated sweeteners, but overconsumption of either can lead to multiple detrimental health effects.
All of the products we know as “sugar,” including table sugar, honey, high-fructose corn syrup, and agave nectar or syrup, are made up of some combination of fructose and glucose (known as a disaccharide).
Most sugars are comprised of roughly half glucose and half fructose. Even high fructose corn syrup (HFCS), a highly-processed sweetener derived from corn, is pretty evenly split (note, different variations of HFCS are available but 55% fructose, 45% glucose is commonly used in products like soft drinks).
Agave syrup is one of few exceptions where one type of sugar dominates – in this case fructose. Agave syrup, despite being marketed as “all natural organic blue agave”, is also highly-processed and chemically refined. At 88% fructose and 12% glucose, it has the highest fructose level of any commercial sweetener other than pure liquid fructose. As you will learn later, this is an important distinction because our body processes fructose differently than glucose.
And speaking of the perception of healthier, is raw sugar any better for you than regular sugar? What about organic sugar?
Sugars are made from either sugar cane or sugar beets. Refined white sugar is pure sucrose which is produced either from sugar cane or sugar beets and is refined to a white crystal. Brown sugar is refined white sugar with a bit of molasses added back. Evaporated cane juice is made from sugar cane and is slightly less refined so it retains more color and flavor from the sugar cane. Turbinado or raw sugar is made from dehydrated sugar cane juice and is processed to retain more color and aroma than white sugar. Organic sugar indicates that the sugar cane was grown organically.
The bottomline is that your body metabolizes each of these as simple sugars, so generally speaking one is not better or more nutritious than the others.
Why Are Sugars Bad for Your Health?
Regardless of what form you’re consuming, sugars are high in calories but low in nutrients and fiber. Beverages like soft drinks, make it very easy to consume a large number of calories very quickly, leading to weight gain over time. Sugary foods often “crowd out” more healthful foods, resulting in many of us being overfed yet undernourished.
But, beyond the empty calories and weight gain, sugar can cause more problems for your body than you might know. Among other things, sugars can:
Suppress the Immune System – Consuming just two cans of soda can, for a few hours, reduce the ability of white blood cells to attack bacteria.
Promote Inflammation – By increasing levels of cytokines in the bloodstream, excess sugars can promote inflammation. Inflammation is linked to heart attacks, strokes, memory loss and aging.
Promote Aging – Glucose and fructose link amino acids in collagen and elastin that support the dermis, producing advanced glycation end products or “AGEs” that literally age you.
Cause Insulin Resistance – Consuming sugar causes a rise in blood sugar, which the body counteracts by pumping out more insulin. When you consume too much sugar, your body has to continuously produce more insulin, and over time, it can become insulin resistant. If this condition persists, it can lead to the development of Type 2 diabetes.
How Does Fructose Differ from Glucose?
Fructose – a type of simple sugar that is naturally found in fruits and in added sugars – is metabolized by our bodies differently than glucose. While the glucose from sugar and starches is metabolized by every cell in the body, fructose is metabolized primarily by the liver.
Fructose is about 20% sweeter than glucose. But, high fructose corn syrup is even sweeter – about 75% sweeter than ordinary table sugar. So, the more fructose in a food or beverage, the sweeter the substance will be.
Although fruits naturally contain fructose, these fruit sugars are metabolized more slowly as a result of the fiber that is often found in these foods. Added sugars like high-fructose corn syrup and agave syrup that contain a significant proportion of fructose don’t have this natural advantage.
Fructose found in soft drinks and processed foods is most often in the form of high-fructose corn syrup. While HFCS includes a fructose and glucose molecule, these bonds are not tightly held together (unlike sucrose). As a result, it takes very little effort for the body to metabolize this simple sugar.
Why are Fructose & High Fructose Corn Syrup Bad?
Given that fructose is metabolized differently and has a different effect on the body than glucose, the following health issues are associated with its consumption:
Promotes Unhealthy Blood Fats. Because fructose is primarily metabolized in the liver, it promotes the production of fat and triglycerides, fatty materials in the blood that raise the risk for heart disease, high blood pressure and diabetes. Fructose gets metabolized by the liver very quickly. This is even more so when fructose is delivered in liquid form (e.g., beverages sweetened with HFCS). When there is more sugar than the liver can process, it converts the sugar to fat, which may help explain why fructose leads to higher levels of triglycerides.
Promotes Development of Abdominal Fat. Studies have shown that fructose can cause individuals to see an increase in visceral fat, the more harmful type of abdominal fatty tissue that wraps around organs and is associated with higher risk for diabetes and heart disease. Within just three weeks of consuming sugar-sweetened beverages, healthy male subjects showed an increase in belly fat and inflammation.
Turns Off Your Appetite Control System. Fructose does not stimulate insulin, which in turn does not suppress the hunger hormone called ghrelin and the satiety hormone leptin. So, if you drink 250 calories of a sweetened beverage, you’re not likely to consume fewer calories at meal time. In fact, you’re more than likely to consume more.
Leads to Gout, Inflammation & High Blood Pressure. Fructose has been shown to elevate uric acid and increased uric acid levels lead to low-level inflammation. Fructose may also lead to gout, a painful inflammation due to buildup of uric acid in the joints. Uric acid’s effect on a hormone that increases vasoconstriction, promotes the development of high blood pressure.
Sabotages Learning & Memory. A recent UCLA study, published in the May issue of the Journal of Physiology, indicates that HFCS can slow the brain, affecting both learning and memory functions and making us “stupid.”
Promotes Acne & Unhealthy Skin. Other experts contend that HFCS contributes to acne, and they maintain that their patients see an improvement in skin clarity, texture, and pore size once they eliminate it from their diet.
In a recent 60 Minutes segment, Dr. Sanjay Gupta reported on new research showing that beyond weight gain, sugar can take a serious toll on your health, worsening conditions ranging from heart disease to cancer. He interviewed Dr. Robert Lustig, a leading expert in childhood obesity at the University of California, San Francisco. He makes a persuasive case that sugar is a “toxin” or a “poison”.
What Are Added Sugars?
According to the USDA’s Dietary Guidelines for Americans, “The majority of sugars in typical American diets are sugars added to foods during processing, preparation, or at the table.
These “added sugars” sweeten the flavor of foods and beverages and improve their palatability. They also are added to foods for preservation purposes and to provide functional attributes, such as viscosity, texture, body, and browning capacity.”
This tells us that we can expect added sugars – in the form of HFCS, white sugar, brown sugar, corn syrup, raw sugar, malt syrup, honey, molasses, and so on – in nearly every premade or packaged food we purchase.
And though many people, particularly those involved in marketing these products, argue that honey, molasses, HFCS, agave syrup, and the like should also count as “natural,” the truth is that they are concentrated sources of sugar, often highly processed, as in the case of agave syrup and HFCS, and about as far from their natural form as they can get.
Of course, naturally occurring sugars in fruit and dairy don’t and shouldn’t count as added sugars. They offer other benefits in the form of nutrients, antioxidants, and fiber, which help offset the effects of the sugar they contain.
How Much Added Sugars are We Consuming?
Added sugars contribute an average of 16% of the total calories in the average American diet, and the majority of these are found in soda, energy and sports drinks (36% of added sugar intake), grain-based desserts (13%), sugar-sweetened fruit drinks (10%), dairy based desserts (6%), and candy (6%).
Put another way, the average American consumes 22 to 28 teaspoons of added sugars a day – mostly in the form of high fructose corn syrup or ordinary table sugar. That’s roughly an extra 350 to 448 calories per day!
The worst offenders are sugary beverages. Soda, energy and sports drinks contribute 112 calories a day to the American diet, the #4 source of calories for adults and #3 source for children and adolescents.
How Much Added Sugars are in Foods?
Take a look at the sugar content of many popular food items:
|Cheesecake Factory Black-Out Cake||1,330||38 tsp.|
|Cinnabon Classic||880||15 tsp.|
|Pinkberry Original (large)||370||14.5 tsp.|
|Coca-Cola (12 fl. Oz.)||140||10 tsp.|
|Starbucks White Chocolate Mocha (grande)||470||9 tsp.|
|M&Ms Milk Chocolate (1.7 oz.)||230||8 tsp.|
|Nutella (2 tbs.)||200||5 tsp.|
|Honey (1 tbs.)||60||4.5 tsp.|
|Kellogg’s Special K Protein Bar||170||4 tsp.|
|3 Oreo Cookies||170||3.5 tsp.|
|Kashi GoLean Crunch (1 cup)||190||3.5 tsp.|
Once you start reading labels, you’ll notice that sugar pops up in foods that you wouldn’t normally associate with being sweet like bread, peanut butter, salad dressing and condiments.
Sugar Stacks is a great website that visually shows how much sugar is contained in beverages, desserts, candies, cookies, sauces, breakfast foods, vegetables and fruits. For example, a tablespoon of catsup, contains 4g of sugar. Check it out!
How Much Added Sugars Should We Be Consuming?
The World Health Organization recommends sugar intake of no more than 10% of total daily calories. For most people, that’s about 50 grams of sugar, roughly 11 teaspoons or the amount in one 20 ounce bottle of soda. Those who are overweight or have other risk factors for heart disease or diabetes should probably cut it down by half, to 5% of total daily calories.
The American Heart Association has even stricter recommendations – 100 calories a day for women (6 ½ teaspoons); 150 calories a day for men (9 ½ teaspoons).
Based on the sugar content of the above listed foods, clearly most children and adults are getting way over their limit of added sugars on a regular basis.
What About Artificial Sweeteners?
Artificial sweeteners are calorie-free substances that stimulate the same sweetness receptors on the tongue as sugars, and those receptors send signals to the brain that something tastes sweet. They make up an industry that makes $1.5 billion annually.
Common artificial sweeteners include:
Sugar alcohols are ingredients listed as erythritol, glycerol, malitol, mannitol, sorbitol, and xylitol –sweeteners that are not completely absorbed by the body’s digestive tract and so do not provide as many calories as sugar. The incomplete absorption can, however, lead to issues with bloating, gas and diarrhea.
Sucralose (brand name Splenda) is an FDA-approved zero-calorie sweetener that is 600 times sweeter than sugar. Sucralose replaces sugar molecules with chlorine, causing most of the substance to pass through the body undigested. Though the chemical is advertised as being “made from sugar,” it is highly processed and neither natural nor a sugar. There have been questions about its safety because while repeated-dose studies have shown it to be safe, no long-term studies conducted about its safety have been conducted.
Aspartame (brand-names Nutrasweet, Equal, Spoonful) is another FDA-approved zero-calorie artificial sweetener that is 200 times sweeter than sugar. Some people have a genetic condition that prevents them from metabolizing phenylalanine, an amino acid in aspartame. Others complain of side-effects such as headaches, dizziness, vision problems, and seizures. A reported 7,232 complaints were made to the FDA between 1998 and 1995 about these symptoms, despite the product’s purported safety. Additionally, aspartame has been shown to cause cancerous tumors in laboratory rats, but other studies have found no evidence that these health risks will develop in humans.
Is Stevia a Good Option?
An alternative sweetener getting a lot of buzz recently for its purported “health benefits” is stevia. Marketed under names including Truvia, Purevia, and Sweet Leaf, it is a highly sweet herb extracted from the leaf of the South American stevia plant, and it contains virtually no calories.
Yet like table sugar, most of the commercially available stevia, while marketed as “natural,” is refined into a pure white powder. Fresh or dried stevia leaves can be found at health food stores in the herbal supplement section, and they can be crushed into beverages or food for those looking for a truly natural sweetener.
And because nothing is perfect, stevia does have a hint of licorice flavor and a slightly bitter aftertaste. Some are more sensitive to it than others, so trying a small amount in some weak tea is a good way to test your palate.
What Should I Do?
The main thing to remember is that regardless of the sugars used – raw sugar, honey, agave syrup – they should be used in moderation. Most of us are consuming far too much in the way of added sugars and we need to reduce our consumption.
Remember, your target is 100 calories a day of added sugars if you’re a woman and 150 calories a day if you’re a man.
How to do this? If you have a sweet tooth, you’ll need to retrain your taste buds – much like if you’re a saltaholic. Start by reducing or cutting out sugar in foods where it is less noticeable and work from there.
As an FYI, a great way to retrain your taste buds is by going on a juice fast that features vegetable juices. Once you come off the fast, you’ll have a greater appreciation for the taste of sugary foods.
Here’s some other suggestions:
Watch what you’re drinking. Beverages are the number one source of excess sugar and empty calories. Replace sugary beverages and juices with water or unsweetened tea. To add flavor and make the drink more visually appealing, add slices of lemon, orange, cucumber, or mint. Whole strawberries also work well. I’m not a big fan of soft drinks, diet or otherwise, but if you are going to drink them, at least go for the brands that sweeten with Sucralose. Keep your soft drink consumption to 1 serving per day. Instead of drinking juice, eat an orange, apple or grapefruit. The fiber in the fruit will slow the absorption of sugars which naturally occur in the fruit.
Start reading labels. This is especially important on packaged, processed foods, to identify and avoid added sugars. Look for names like corn sweetener, corn syrup, evaporated cane juice, dextrose, glucose, high fructose corn syrup, honey, maltose, malt syrup, molasses, sucrose and syrup. Read descriptions on restaurant menus, and when in doubt, ask! Servers are trained to know the ingredients in the dishes they serve and are usually more than happy to share their knowledge with you. To convert grams of sugar to teaspoons, divide by 4. Multiply grams of sugar by 4 to figure out calories from added sugars. Example: 4 grams of sugar is equivalent to 1 teaspoon of sugar and 16 calories.
Cut down portions. And if you absolutely, positively, must eat sweets, have just a small portion, making sure your indulgences are few and far between. Try eating dessert after some strenuous exercise to maximize insulin response. Treat your body right by easing up on the “treats.” After all, it’s not truly a “treat” if you have it all the time, right?
Substitute sweets with fruit. Instead of eating sugary desserts, opt for fruit and complement it with a small piece of dark chocolate for creamy richness, depth of flavor, mood enhancement, and antioxidant benefits. Keep in mind that you don’t need to worry about the naturally occurring sugars in fruit, milk and plain yogurt.
Keep learning more. If there’s one thing you may have learned today is that agave syrup is no better than table sugar and in fact may be worse than high fructose corn syrup! The lesson here is be wary of slick marketing and the overuse of terms like “natural”. The more you learn and add to your knowledge base, the better able you will be to make informed choices about the foods you eat.
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.