Are other natural sweeteners better than sugar?

You may have heard that “natural” sweeteners like honey, maple syrup or agave syrup are a healthier alternative to table sugar.

But when it comes to how our body metabolizes it, there isn’t a big difference between natural sweeteners and table sugar, internal medicine doctor Dr. Carrie Alexander of Novant Health Westbury Park Primary Care said — and it’s ideal to limit both.

Read on to learn why — and how to spot sneaky sources of sugar.

Are natural sweeteners any better for us than plain white table sugar, or is that fake news?

In the few studies that have been done so far, we see that natural sweeteners have a similar metabolic effect to table sugar.

When we eat sugar, our body senses it and then causes us to release insulin from our pancreas. That insulin works within your bloodstream to help your cells utilize the sugar molecules. If you routinely have too much sugar, your blood sugar can spike too much and cause negative effects. We’ll talk about them later in the article.

So far, research shows that the body processes honey, maple syrup and agave syrup very similarly to table sugar. They both spike your blood sugar very similarly.

Are there any extra benefits to using natural sweeteners?

Some of these natural sweeteners may have additional bioactive compounds. For example, a lot of people are believers that their allergies are better if they have local honey. So far, research hasn’t backed that up, but it may be that there are additional benefits in some of these agents that research hasn’t discovered yet.

At this point, though, I don’t think we can say that there is any additional benefit to using the natural sweetener over table sugar.

Solve a sweetener-related marital dispute for me: We make pancakes for our kids on Saturdays, and I buy the pure maple syrup because it seems healthier. My husband thinks we should buy the cheaper Hungry Jack syrup. Who’s right?

When my children were young, I bought maple syrup for them as well.

Hungry Jack is made with high fructose corn syrup (HFCS), which is totally different from a natural sugar. HFCS is made from corn, and the reason that so many things on the market are made of HFCS is because that sweetener is cheaper to produce than natural sugar.

The sugar spike is about the same between HCFS and other sugars, but some studies show there may be more inflammation related to HCFS than to other sugars. Inflammation can be linked to heart disease, blockages in arteries, and lots of other health issues. Researchers also think HFCS can alter the gut biome, which can lead to obesity. I’m not a big fan of HFCS.

So if I had to choose between maple syrup or Hungry Jack, I’m going to spend extra money on maple syrup — and I’ll also try to limit how much maple syrup my kids were taking in. (Note: Some pancake syrups don’t contain HFCS and display that prominently on their labeling.)

It sounds like your rule of thumb is, “Limit sweetened foods. But if you’re going to have something sweetened, avoid HFCS.”

Yes, that’s what I try to do. If I’m buying a barbecue sauce, jelly or syrup, I try to look for the one made with sugar and not HFCS. But in general, I’m trying to avoid anything with added sugar.

If we eat too much sugar, we start secreting high levels of insulin to try to combat those really high blood sugar levels. If we eat this way often, over time our cells can become insulin-resistant, like, “I don’t need any more sugar — I have plenty.” So they’re not responding to the insulin, and the blood sugar is staying higher longer. This can lead to chronically elevated blood sugar, which can lead to diabetes.

Or the sugar may build up in the liver and be turned into fat, which can cause metabolic dysfunction-associated steatotic liver disease (MASLD). That can potentially lead to cirrhosis, which can lead to liver cancer.

So we see a lot of bad effects of taking in too much sugar.

Are there certain groups of people who need to be more cautious about sugar?

The American Heart Association guidelines say men should have no more than 36 grams of added sugar per day and women no more than 25 grams, roughly equal to 9 teaspoons of sugar for men and 6 teaspoons of sugar for women. The federal dietary guidelines recommend no more than 50 grams per day.

People who have heart disease, diabetes, or have a family history of diabetes need to be most careful. (That’s why the American Heart Association guidelines are stricter — they’re focused on preventing heart disease.) But everyone needs to be careful with added sugar.

Do you have tips for cutting back on added sugar?

With what we eat in the United States, it’s very hard to live by the recommendations for added sugar without a significant overhaul to most people’s diets.

For example, if you put one tablespoon of regular jelly on your toast, you’re getting 12 grams of sugar, just from jelly — and that's just the start of your day. But here are some suggestions:

• Stop drinking anything that has calories (except a glass of low-fat milk — that’s OK). Contrary to popular belief, juice is not healthy; it’s sugar without fiber. And we all love to go get a fancy coffee somewhere, but many of them are full of sugar. If you like orange juice, cut the orange up and eat it instead. And if you have a cup of tea or coffee, try to drink it black. For guidance on what your children should drink, consult their pediatrician.

• Pay attention to hidden sources of sugar: You see all kinds of breads that look healthy, but the only way to know is to read the ingredients. You’re looking for whole wheat flour, which has more fiber and is better for stabilizing your blood sugar than white flour or enriched wheat flour. If it tastes like cardboard, it’s probably the right bread for you.

Similarly, granola sounds super healthy — but if you read the nutrition label, you’ll see that it’s full of sugar, as is most of the cereal aisle. Try steel-cut oats instead.

Many crackers have sugar and so do condiments like marinara, teriyaki sauce, salad dressing and ketchup. By reading labels, you can sometimes find options without added sugar or HFCS.

• Fruit is fine. A lot of patients say, “I can't eat a banana because it's full of sugar.” But fruit has fiber and naturally occurring sugar mixed together. The fiber slows down the sugar spike, so you don't have big release of insulin.

• Watch serving sizes. If you have a muffin tin at home, think of how big that muffin is, versus how big muffins in the bakery are. The muffin in the muffin tin has been the same size since the 1970s, but the muffins you get at a bakery have gotten bigger. That’s an example to show how much more we're taking in these days. Our serving sizes have gotten out of control — so learn what appropriate servings are, even for healthy foods like fruit.

The “quick and dirty” rules I say to patients are: Only eat things that look like God made them. Avoid bags and boxes. The more that you eat that is unprocessed, the better, since the more processed the food, the faster your blood sugar goes up.

But if you’re going to eat some of these foods, Novant Health registered dietitians advise their patients to try their best to avoid going above 10 grams (10g) of added sugar.

Can you walk me through a day of lower-added-sugar, less-processed eating?

Sure. For breakfast, you could have a couple of eggs with a piece of fruit, or some plain Greek yogurt that doesn’t have additives. You could add your own fruit or a little honey to it if you miss sweetener.

For lunch, I suggest whole grains that are higher in fiber and have less effect on your blood sugar, like farro or quinoa, paired with a protein like meat or beans that will keep you full. Have vegetables with whatever you make.

For snacks, you can have an apple, banana, a cup of yogurt or a handful of nuts — something that’s less processed.

For dinner, I recommend keeping your entree to one-fourth of the plate, and fruits and vegetables to three-fourths of your plate. That way, you’re maximizing your fiber intake and minimizing some of the more-processed foods.

And recipe selection matters: Instead of substituting in a sweetener that you think is “better” for you, pick recipes that don’t have a lot of sugar to begin with.