It’s no secret that sugar is one of the most overused foods in the Western world.

In 1900, the average American consumed about five pounds of sugar a year. By year 2000, that number had jumped to 150 pounds a year.

And since 2008, Americans’ sugar consumption rocketed another 23 percent higher — accompanied by rising rates of obesity, heart disease, dementia, and cancer.

Compelling evidence has produced a clear medical consensus that excess dietary sugar is a leading driver of those degenerative diseases.

Cane sugar vs. high fructose corn syrup (HFCS)
The word "sugar" conjures images of the white cane sugar commonly used in coffee or baked goods.

Sucrose is the chemical name of the only sugar in sugar cane. This "disaccharide" sugar is formed by a bond between two "monosaccharide" sugars, glucose and fructose.

As Dr. Weston Price discovered in his journeys around the world, people who snack on raw cane sugar stalks don’t get cavities.

That’s probably because the sucrose in the cane doesn’t stick to their teeth, cane syrup contains lots of minerals (which helps retard tooth decay), and chewing a fibrous cane stalk is a lot like brushing your teeth.

So-called “raw” and “brown” sugars are often touted as healthier than white cane sugar, but the difference is insignificant. There simply aren’t enough minerals in those less-refined sugars to make a difference.

Fructose occurs naturally in fruits — although most contain more sucrose than fructose — and it’s a perfectly safe source of energy when it’s part of a fruit or any whole food.

But in excess quantities, fructose promotes insulin resistance, elevated triglycerides, weight gain, abdominal fat, and non-alcoholic fatty liver disease (NAFLD).

Most of the fructose in the average American's diet comes from high fructose corn syrup, or HFCS, which, chemically speaking, is very similar to cane sugar.

HFCS averages 55% fructose and 45% glucose (give or take 5-10%) versus a consistent 50-50 ratio of glucose to fructose in cane sugar.

But because it’s made via industrial processes, HFCS can contain traces of chemicals other than glucose and fructose — ones that pose potential health problems (see Corn-Sweetened Sodas High in Pro-Aging Agent).

And, insidiously, HFCS impairs your liver’s ability to break down this manufactured sugar, by negatively affecting a key messenger chemical called PPAR-alpha, which regulates fat (lipid) metabolism.

Researchers hypothesis that the effects of HFCS on PPAR-alpha explains why it's tied to both metabolic syndrome and to excessively high levels of cholesterol and triglycerides.

Finally, HFCS promotes the formation of advanced glycation end products, or AGEs — which result when sugar molecules attach to protein molecules.

AGEs promote inflammation and generate free radicals, which can cause your blood vessels to become stiff, and damage the collagen in your skin and other connective tissues.

With all these health implications, you’d be right to avoid sugar and HFCS and instead opt for healthier sweeteners.

But in some cases, you’re mostly jumping from a frying pan to a fire.

“Healthy” imposters
When people look healthier sweeteners, they often reach for agave, crystalline fructose, or sugar alcohols such as xylitol, maltitol, sorbitol, and erythritol.

Let's start with agave and crystalline fructose. Is either option any healthier — or at least less harmful — than white cane sugar and HFCS?

The answer, in short, is no.

This overhyped sweetener may be natural, but it’s worse than the alternatives.

Agave is about 97% fructose, compared with the far lower fructose content of HFCS (42 to 55%).

And while agave doesn’t raise blood sugar directly, its abundant fructose promotes insulin resistance — even though the body doesn’t use insulin to process fructose.

Even within the natural health world, the shine once enjoyed by agave has come off — simply because it’s even less healthy than the alternative nutritive (calorie-containing) sweeteners, whether natural or synthetic.

Crystalline fructose
As the Sugar Association trade group explains, “Crystalline fructose is produced by allowing the fructose to crystallize from a fructose-enriched corn syrup.”

So, in short, crystalline fructose is just a kissing’ cousin to HFCS. Take a pass.

Sugar alcohols: A mixed bag
If the name of an ingredient ends in “tol”, you know you’re dealing with a sugar alcohol.

The most commonly used sugar alcohols are xylitol, sorbitol, maltitol, and erythritol.

Small amounts occur naturally in fruits and other plants — but the sugar alcohols added to foods and beverages are synthesized from things like plant cellulose (xylitol), corn syrup (sorbitol), cornstarch (maltitol), and glucose (erythritol), via industrial-scale chemical processes. 

Sugar alcohols have become popular sugar substitutes for several reasons:

  • They look like cane sugar on a table.
  • By weight, they have about half the calories of cane sugar.
  • They taste 50 to 100 percent sweeter than table sugar, meaning smaller amounts.

Sugar alcohols don’t cause blood sugar spikes, in large part because they’re only absorbed incompletely, and the body doesn’t use insulin to metabolize them.

But sugar alcohols exert a laxative effect in some people, due to inadequate digestion, potentially causing diarrhea, gas, bloating, and cramping.

Let's examine the four most commonly used sugar alcohols:

Xylitol contains only about 40% as many calories as cane sugar, but is about equally sweet. It’s the most widely used sugar alcohol, thanks largely to its ability to help prevent tooth decay.

Erythritol is fully absorbed in the small intestine, so it rarely causes the laxative or digestive problems associated with some other sugar alcohols. It has the fewest calories compared with cane sugar, containing only about 5% as many.

Much of the erythritol used in conventional food products is produced from corn starch extracted from genetically modified corn.

Importantly, erythritol can aggravate irritable bowel syndrome (IBS) and related conditions, including small intestinal bacterial overgrowth.

Sorbitol is about 60% as sweet as cane sugar, and has about 40% fewer calories. Unlike xylitol, which appears to help retard tooth decay, decay bacteria can feed on sorbitol.

Maltitol is made from the natural sugar maltose, and closely resembles cane sugar in terms of mouth feel and taste. It’s about 90% as sweet as sugar, with only about half as many calories. Maltitol is well absorbed and will elevate blood sugar, albeit much less than cane sugar does.

Long story short?

If you don’t want artificial sweeteners (you shouldn’t!), and don’t like the taste of stevia (see below), small quantities of sugar alcohols can provide alternatives to cane sugar, HFCS, and other actual sugars.

Real sweetness
The evidence — and humankind’s long experience with both — place stevia and honey on the healthy-sweetener pedestal.

The big difference between the two is that honey has about four-fifths as many calories as cane sugar or HFCS, while stevia is calorie-free.

And when it comes to choosing a stevia product, the devil's in the details.

Stevia is a traditional South American culinary and medicinal herb that's naturally sweet, with a touch of bitterness. 

For decades, it's been widely used in Japan and China as a sweetener, with no adverse reactions reported.

However, it wasn’t approved as a sweetener by the FDA until about 2007, before when you had to buy stevia as a dietary supplement.

Clearly, the healthiest choice is whole stevia — available as a powder or liquid extract — because the stevioside compound found in it can actually improve insulin sensitivity.

So-called “green leaf” stevia is simply dried, powdered leaf — which is how stevia has been consumed in South America for centuries. It’s 30-40 times sweeter than cane sugar.

Stevia extracts may or may not contain significant amounts of the beneficial stevioside compound. 

Synthetic stevia products like PurVia get their sweetness from the isolated stevia compound called rebaudioside A, which is 200 to 400 times sweeter than cane sugar, but doesn’t have any of the health benefits of the stevioside in whole stevia.

Rebaudioside A is sold under the trade names Rebiana (isolated rebaudioside A), PurVia (isolated rebaudioside A), and Truvia (a blend of Rebiana, erythritol, and natural flavors).

Even more so than HFCS, production of these sweeteners — largely by Coca-Cola/Cargill and Pepsi — are highly industrial processes involving many steps of chemical manipulation.

Raw, unpasteurized honey offers a wholly unique blend of vitamins, minerals, and myriad constituents with apparent health benefits — including a possible boost to your immune system.

Sadly, the honey in the best-selling supermarket brands has been heavily processed, and stripped down to little more than pure sugars.

According to a USDA beekeeping handbook, most American honey contains these approximate proportions of sugars and water:

  • Fructose – 38%
  • Glucose – 31%
  • Water – 17%
  • Maltose – 7%
  • Sucrose – 1%
  • Other sugars – 1%
  • Undetermined constituents – 5%

in 2013, researchers reported that the average ratio of fructose to glucose in most German honeys was 56% fructose to 44% glucose, and that the ratio ranged from 64%/36% to 50%/50%.

Thanks to its water content, honey has about 20% fewer calories than cane sugar (305 vs. 390 calories per 100 grams).

Whether it’s raw or processed, honey will raise your blood sugar and insulin levels, so use it sparingly.

The sweet bottom line
If reducing sugar intake is your goal, do it gradually, to give your taste buds time to adjust.

And if there are things you simply cannot manage “straight” — such as your morning coffee or tea — opt for stevia, honey, or a sugar alcohol, in that order of preference.


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