I’m encouraged that most people I know are trying to make healthy food choices for themselves and their families.

Unfortunately, because the food industry is motivated to sell products, even people with the best intentions can be misinformed. One clear example is with added sweeteners. I’ve heard friends say that they select agave nectar, honey, or stevia rather than table sugar because these are “natural and healthy” alternatives. I’d prefer that they make choices based on preferred taste after learning more about these products.

Food can be naturally sweet or it can be sweetened by either “natural” or “artificial” additives. Sugars, particularly glucose, fructose and sucrose (table sugar—composed of half glucose and half fructose) are the compounds that sweeten foods. Cells function using glucose as energy and we get this source through foods.

As with any food, moderation is always important and our bodies work hard to moderate glucose levels by producing insulin. Table sugar has become victimized as processed and highly caloric. Sugar grows naturally as cane and the final product is processed and contains approximately 16 calories per teaspoon. Both people with diabetes and people trying to reduce their weight are advised to limit refined table sugar.

Which alternative to select is not quite as simple as it might seem.

Artificial sweeteners, such as Aspartame (Equal and NutraSweet) and Saccharin (SugarTwin and Sweet’N Low), are synthetic compounds that neither add calories to the diet nor increase blood glucose levels , so they might be healthier options to table sugar for people with diabetes. Although these sweeteners are without calories, there is evidence that people that consume a lot of artificial sweeteners in the form of diet soda and other processed foods still gain weight. The reason for weight gain is still unclear, but it may be because people are encouraged to increase calorie count in other forms to balance the “calorie savings” from diet soft drinks. Artificial sweeteners are common in processed foods that don’t contain nutritional benefits, so overall calorie count is usually higher in people that select this form of sugar substitute.

Another benefit of artificial sweeteners is that they do not cause dental cavities. Furthermore, there is no scientific evidence that any artificial sweetener approved by the FDA causes serious health problems, including cancer. They are synthetic compounds but without health risk.

That leads us to people convinced that “natural” sweeteners are better for them. Unfortunately, most of these “natural” sweeteners are highly processed. Stevia is often used as a natural substitute to the artificial sweeteners because it, too, has no calories and does not increase blood glucose level. However, stevia is a highly processed product originally from a plant (just as table sugar is a processed plant product). So, although stevia has no calories, it cannot be considered “natural.” The FDA has approved stevia in moderate doses but still with reservations. It is not recommended for women who are pregnant or breast feeding and should be limited to no more than two servings per day.

“Natural” sweeteners that are promoted as healthier sugar substitutes are often more processed and refined than expected (except raw honey which is not processed.) Furthermore, these compounds are not very different from sucrose (table sugar.) These include date sugar, grape juice concentrate, honey, maple sugar and syrup, molasses and agave nectar. Food manufacturers are not dishonest when they report that their foods contain added “natural” sugar.

But consumers should not be misled by the term “natural.”

The methods to process agave nectar are similar to creating high-fructose corn syrup and the outcome is a product with the same proportion (approximately 70%) of fructose as HFCS. These additives offer no nutrient or health benefit beyond table sugar. They are nutritionally similar, are broken down into glucose and fructose in the body, raise blood glucose level, and contribute to dental cavities. Natural sweeteners contribute to caloric intake at the same rate as refined table sugar. People with diabetes and people trying to lose weight will not benefit from these sugar substitutions. This is true of agave nectar. This especially popular sugar substitute does cause blood sugar spikes.

These natural sweeteners are safe on their own but selecting them rather than sugar provides no health benefit. People may actually increase their sugar and caloric intake by mistakenly adding these products to their diets thinking they are healthy choices. As with any added sugar, natural sweeteners such as honey and agave nectar can contribute to weight gain, tooth decay, and poor nutrition. (I’m not certain how to classify Sucralose (Splenda). It is a no-calorie, artificial product but it is derived from the naturally-occurring sucrose.)

In summary, there is nothing wrong with the choice to not use refined sugar. However, choosing a substitute needs to be considered with a lot of thought. “Natural” does not mean better. Diabetics are better off selecting artificial sweeteners to any natural ones. Selecting agave nectar might be a preference for taste but is no less refined, natural, or calorie free than refined table sugar. Stevia has no calories but cannot be considered natural.

The best choices are always whole foods. Berries, mangos and other fruits offer plenty of natural flavor and can be selected as sweet snacks. Unlike any added sweetener, these whole foods add nutrients to the diet. Processed foods, even those marketed as diet or natural, will add calories without the same nutrition that whole foods offer. A product marketed as “natural” or “organic” isn’t necessarily healthy. Added sugar is added sugar, of any kind. Why not avoid sugars, processed foods, cakes and cookies except to celebrate a special occasion?

Life is sweet enough—as demonstrated by the strawberries in the farmers markets this week—without additives.

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Assist. Ed: Jade Belzberg/Ed: Sara Crolick