Battle of the sugars: Do natural sugars reign supreme? (and which one is best?)

The negative impact of added sugar on health is becoming more and more apparent as time passes. With this, interest is increasing in the differences between natural sugars and refined sugar. Natural sugars, found in fruits, vegetables, and dairy products, are often perceived as healthier alternatives to refined sugar due to their association with whole foods and additional nutrients. On the other hand, refined sugar, commonly added to processed foods and beverages, is criticised for its lack of nutritional value and potential adverse health effects. This article aims to explore the scientific evidence surrounding natural sugars and refined sugar and investigate whether one option is truly healthier than the other.

Refined sugar

For most people, refined sugar is an essential part of life. It is added to many foods during production as a sweetener, preservative, bulking agent, texturiser, moisturiser, stabiliser, and browning and decorative agent (1). Added sugars increase a food’s calorie content and are not essential for good health and nutrition (2). But because sugarcane and beet sugar are highly processed, these sweeteners don’t contain many nutrients, vitamins, minerals, or bioactive components such as antioxidants.

The glycaemic index (GI) of a carbohydrate-rich food estimates how quickly carbohydrates break down and are absorbed into the bloodstream. The more quickly this happens, the more rapid the blood glucose and insulin responses, and the higher GI rating the food is given. Conversely, lower GI foods have a slower and smaller effect on blood glucose levels and insulin response because they are slowly digested which is generally more favourable for health. Refined sugar is considered a high-GI food with a glycaemic index of 65 (7). Low GI diets lower the likelihood of developing certain chronic diseases.

Dietary sugar in excess raises the risk of metabolic conditions including obesity and diabetes as well as cardiovascular disorders (3). Different epidemiological studies and trials have associated a high consumption of added sugars with weight gain, poor dental health, cancer, metabolic syndrome, heart disease, and Type 2 diabetes mellitus (4,5). 

Unrefined “natural” sugar

Natural sugars, or “unrefined sugars”, refer to sugars that occur naturally in foods, such as fructose in fruits and lactose in dairy products. These sugars are inherently present in whole foods, along with a wide range of essential vitamins, minerals, fibre, and antioxidants. One of the key advantages of natural sugars is their association with whole foods, which provide additional nutrients and health benefits beyond just energy. For this article, we will be looking into sugars from natural sources that can be potentially used to replace refined sugar as an added sugar in food and drinks. These unrefined sugars often include a variety of bioactive compounds, minerals, fibres, antioxidants, polyphenols, and phytochemicals that can put them at a nutritional advantage over refined sugar (6)

Agave

Agave syrup has recently surged in popularity within the market for healthy, organic, functional, and diabetic foods. This trend is attributed to its natural origin, alleged nutraceutical properties, low glycaemic index (GI: 10–19), and that it is extremely sweet and is only needed in small amounts. As AS has a high fructose concentration which makes it sweeter than refined sugar, so not as much is required to reach a comparable level of sweetness (8). For this reason, it has been marketed as a calorie-reduced sweetener.

However, the high fructose concentration in agave syrup raises concerns about its potential adverse effects on human health, rendering it comparable to high-fructose corn syrup. Despite AS being promoted for its low GI properties, it contains a high fructose content ranging from 70% to 90%. Scientific evidence suggests that even at relatively low doses, fructose consumption may contribute to the development of chronic diseases such as dysbiosis, respiratory conditions, metabolic syndrome, non-alcoholic fatty liver disease, and elevated triglyceride levels, thereby escalating the risk of cardiovascular diseases (9). More positively, AS also possesses a small amount of natural compounds with possible nutritional, prebiotic, and bioactive properties (9). It contains bioactive compounds, including fructans, polyphenols, flavonoids, tannins, saponins, and micronutrients such as minerals. Some fructans in some people have been shown to be beneficial to the human gut microbiota (10).

Given the uncertainties surrounding the long-term effects of ingesting fructose-high products on human health, it is recommended that any energy-dense foods or drinks in moderation; including AS.

Coconut sugar

Coconut palm sugar is a natural product made from freshly collected sap from the coconut tree (not the fruit) (11). It is evaporated into a crystalline product and is similar to brown sugar in texture and flavour. It has a lower sucrose content and is considered a lower glycemic sweetener (compared to refined sugar) with a GI of 35 - 42 (12).

Coconut sugar has a good nutritional profile with small amounts of vitamins, minerals, and antioxidants. In particular, it is substantially higher in magnesium, potassium, iron, zinc, essential amino acids, and vitamins B1, B2, B3, and B6 than refined sugar (13). It also contains vitamins C and E, phosphorus, and phytonutrients like antioxidants, flavonoids, anthocyanidins, and polyphenols (14). Coconut sugar is considered by several researchers to be one of the greatest natural sweeteners for its potential health advantages (15). However, still, substantial knowledge is lacking to confirm its health advantages in humans.

Maple syrup

Maple syrup is produced by boiling the sap of maple trees. This process concentrates the sugars as well as other beneficial compounds such as minerals, organic acids, vitamins, phenolic compounds, and phytohormones, that are in the sap. Compared to other sweeteners, maple syrup is particularly rich in phenolic compounds and in the phytohormone abscisic acid and its derivatives (16). Of the many natural sweeteners, maple syrup is recognised as a much superior alternative to refined sugar, particularly for the potential anti-mutagenic, anti-radical, antioxidant, and anti-cancer of its phenolic compounds (17). It is also proposed to be beneficial to glucose homeostasis, in part due to its lower GI of 54. (16,18). Maple syrup contains a compound that slows down its blood sugar absorption, which may be good for people with diabetes. Maple syrup brings about lower glucose and insulin responses than some other sugars which make it a healthier substitute for other dietary refined sugars (17).

There are different grades of maple syrup according to their colour and flavour. Darker ie. higher-graded syrups may have more nutritional benefits than lighter products due to their high concentration of health-promoting compounds.

You can read more about the maple syrup grading system here:

https://puremaplesyrup.co/blogs/news/which-grade-of-maple-syrup-is-the-healthiest

Date sugar

Date fruits are a rich source of multiple vitamins, minerals, polyphenols, fibre, and contain more than twenty different amino acids (20).  Accordingly, date sugar has been proposed as a preferable alternative to refined sugar as it would provide supply more nutrients and possible health benefits. Date sugar is also considered to have a lower glycaemic load than refined sugar. However, it appears that the GI of date fruit varieties can range substantially, from around 43 - 75, depending on the stage of date maturation (19). While we could not find the GI value of date sugar in any academic sources, various online sources put it at 55.

Date fruits’ bioactive components have been demonstrated to promote several health-beneficial effects. Studies have shown them to have antitumor, anticancer, antioxidant, anti-mutagenic, anti-inflammatory, gastroprotective, hepatoprotective, and nephroprotective effects, and have demonstrated antibacterial activity (21). While the above research is on the fruit as a whole, date sugar is also less processed than refined sugar and, therefore retains some of the fibre, minerals, and antioxidants mentioned. It also has the benefit of being easily used to replace refined sugar in food production.

However, studies surrounding the use of date sugar and its health effects are limited. A key limitation is that there can be variable amounts of macro- and micro-nutrients and phenolic content both within a particular date plant variety and among different varieties. (22,23).

This, combined with the limited amount of research on date sugar, makes drawing any conclusions difficult at this stage.

Honey

Honey has been utilised as a natural sweetener since ancient times and in researching this article it appears to be the most well-studies of the natural sweeteners. Today approximately 300 types of honey have been recognised, the composition and glycemic index of which is highly variable depending on their botanical and geographical origin (24,25). One study found a GI range of 45 – 69 depending on the type of honey (26). This adds complexity to research findings and drawing conclusions which will be covered below.

It is mainly composed of a mixture of different sugars but also to a lesser extent contains water, proteins, enzymes, organic acids, vitamins, minerals, and phenolic compounds (27). These ingredients have been linked to antioxidant, antimicrobial, anti-inflammatory, antiproliferative, anticancer, and antimetastatic effects (25). The majority of these beneficial effects have been attributed to the antioxidant effects of its content of phenolic compounds (28). Like maple syrup, dark honey tends to have a higher content of phenolic compounds (29).

Potential health benefits of honey

Compared to the other natural sugars outlined, honey has been the most extensively studied. However, unfortunately, many of the key study areas have found conflicting results.

Lipid profile – One meta-analysis found that there exist studies validating that honey improved participants’ LDL-cholesterol, triglycerides, and HDL-cholesterol (30). However, more recent studies in the same review found that honey did not significantly improve participants’ lipid profiles. Therefore, the effects of honey consumption on lipid profiles are still a matter of debate.

Weight loss – Again, the effect of honey on weight loss is conflicted. One review noted that the majority of studies are in animals and that it successfully reduced the animals’ body weight, and body fat composition (31). While in humans, honey did not reduce the weight of the study participants, there was no evidence that honey increased their body weight (31).

Diabetes – One review found that honey may provide benefits in managing diabetes mellitus such as better control of the hyperglycaemic state, limiting other metabolic disorders, and decreasing the negative effects on organs that may produce diabetic complications. However, there also exists research with contrary findings (32).

It is recommended that children under 1 year old should not consume honey due to the high risk of developing botulism (29).

A note on study strength

It should be noted that many of the studies on honey involve small samples, a lack of standardised protocol, and differences in types of honey, doses used, duration of interventions, and participant characteristics. This makes it extremely difficult to compare results and draw conclusions and recommendations. Despite the promising positive effects of honey on human health, more high-quality, standardised, randomised controlled clinical trials are necessary to establish a real cause-and-effect relationship between honey intake and health benefits

Added sugars

The term “added sugars” refers to any sugars added to foods during processing or preparation (and excludes naturally occurring sugars present in intact fruit, vegetables, or dairy products or juiced or pureed fruit and vegetables) (33). All of the sugars detailed above are classified as added sugars. Added sugars are most predominant in processed and prepared foods, such as sugar-sweetened beverages, desserts, sweet snacks, breakfast cereals, and yoghurt however, most processed foods contain amounts of added sugar. Added sugars are not required by the human body in order to function and it is advised that every person over 2 years old limit added sugars in the diet to less than 10% of total calories (or for a 2,000 calories diet, no more than 200 calories from added sugar) (34).

The American Heart Association has recommended even less; no more than 100 calories per day for women and no more than 150 calories per day for men.

In summary

While natural sweeteners MAY be a healthier alternative than refined sugar, no added sugars are even better!

Personally, I will be favouring natural sugars when I need a calorific sweetener. moving forward. Until more research becomes available there is not one natural sugar that stands out to me as ‘the best’, but I will be staying away from agave syrup for the time being, and probably opting for a good quality honey or coconut sugar depending on my needs.

Unrefined natural sweeteners each offer unique nutritional profiles and potential health benefits but research is still very much lacking, and no one sugar reigns supreme. Agave syrup boasts a low GI index but raises concerns due to its high fructose content. Coconut sugar and date sugar offer additional vitamins, minerals, and antioxidants compared to refined sugar, but research on their health effects is still emerging. Maple syrup is rich in phenolic compounds, which may have antioxidant and anti-cancer properties. Honey, the most extensively studied of the natural sweeteners, has shown conflicting results in research regarding its impact on lipid profile, weight loss, and diabetes management.

However, despite their potential advantages, it’s important to remember that while natural sugars may provide a few potential health benefits, they are primarily sweeteners and not a rich source of nutrients. All added sugars, whether natural or refined, contribute to overall sugar intake and should be used mindfully as part of a balanced diet. The best approach to sugar consumption is to prioritise whole, minimally processed foods and limit added sugars in the diet to maintain overall health and well-being. As research continues to uncover the complexities of sugar and its impact on health, individuals can make informed choices about their sugar intake, aiming for balance and moderation in their dietary habits.

*Disclaimer*

The information presented in this article is for educational purposes only and is based on our interpretation of the current research. No content on this site should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

References

1. Jomaa L, Hamamji S, Kharroubi S, Diab-El-Harakeh M, Al Zahraa Chokor F, Nasreddine L. Dietary intakes, sources, and determinants of free sugars amongst Lebanese children and adolescents: findings from two national surveys. Eur J Nutr. 2021;60(5):2655-2669. http://doi.org/10.1007/s00394-020-02444-5

2. Fidler Mis N, Braegger C, Bronsky J, et al. Sugar in Infants, Children and Adolescents: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2017;65(6):681-696. http://doi.org/10.1097/MPG.0000000000001733

3. Alkhaldi AK, Alshiddi H, Aljubair M, Alzahrani S, Alkhaldi A, Al-khalifa KS, Gaffar B. Sex differences in oral health and the consumption of sugary diets in a Saudi Arabian population. Patient Prefer Adherence. 2021;15:1121-1131https://doi.org/10.2147/PPA.S308008

4. Kaartinen NE, Similä ME, Kanerva N, Valsta LM, Harald K, Männistö S. Naturally occurring and added sugar in relation to macronutrient intake and food consumption: results from a population-based study in adults. J Nutr Sci. 2017;6:e7. https://doi.org/10.1017/jns.2017.3

5. Manickvasagan A, Kumar CS, Al-Attabi ZH. Effect of sugar replacement with date paste and date syrup on texture and sensory quality of kesari (traditional Indian dessert). JAMS;2017;22:67–74. https://doi.org/10.24200/jams.vol22iss1pp67-74

6. Arshad S, Rehman T, Saif S, et al. Replacement of refined sugar by natural sweeteners: focus on potential health benefits. Heliyon. 2022;8(9):e10711. https://doi.org/10.1016/j.heliyon.2022.e10711

7. Mohammed F, Sibley P, Abdulwali N, Guillaume D. Nutritional, pharmacological, and sensory properties of maple syrup: A comprehensive review. Heliyon. 2023;9(9):e19216. https://doi.org/10.1016/j.heliyon.2023.e19216

8. Saraiva A, Carrascosa C, Ramos F, Raheem D, Raposo A. Agave syrup: Chemical analysis and nutritional profile, applications in the food industry and health impacts. IJERPH. 2022; 19(12):7022. https://doi.org/10.3390/ijerph19127022

9. Ozuna C, Franco-Robles E. Agave syrup: An alternative to conventional sweeteners? A review of its current technological applications and health effects. LWT. 2022;162;

113434. https://doi.org/10.1016/j.lwt.2022.113434.

10. Man S, Liu T, Yao Y, Lu Y, Ma L, Lu F. Friend or foe? The roles of inulin-type fructans. Carbohydrate Polymers. 2021;15;252:117155. https://doi.org/10.1016/j.carbpol.2020.117155

11. Asghar MT, Yusof YA, Mokhtar MN, Yaacob ME, Ghazali HM, Chang LS. A review of nutritional facts, production, availability and future aspects of coconut palm sugar. JFNS. 2021;11(3):1-8.

12. Trinidad TP, Mallillin AC, Sagum RS, Encabo RR. Glycemic index of commonly consumed carbohydrate foods in the Philippines. J of Fun foods. 2010;2(4):271-274. https://doi.org/10.1016/j.jff.2010.10.002

13. Hebbar KB, Arivalagan M, Manikantan MR., Mathew AC, Thamban C, Thomas GV, Chowdappa P. Coconut inflorescence sap and its value addition as sugar – collection techniques, yield, properties and market perspective. Current Science. 2015;109(8):1411–1417. http://www.jstor.org/stable/24905994

14. Hebbar KB, Arivalagan M, Pavithra KC, Roy TK, Gopal M, Shivashankara KS, Chowdappa P. Nutritional profiling of coconut (Cocos nucifera L.) inflorescence sap collected using novel coco-sap chiller method and its value added products. J. Food Meas. Charact. 2020;14:2703–2712. https://doi.org/10.1007/s11694-020-00516-y. 

15. Hebbar KB, Ramesh SV, Ghosh DK, Beegum PP, Pandiselvam R, Manikantan MR, Mathew AC. Coconut sugar - A potential storehouse of nutritive metabolites, novel bio-products and prospects. Sugar Tech. 2022;24:841–856. https://doi.org/10.1007/s12355-021-01101-3

16. St-Pierre P, Pilon G, Dumais V, Dion C, Dubois MJ, Dubé P, Desjardins Y, Marette A. Comparative analysis of maple syrup to other natural sweeteners and evaluation of their metabolic responses in healthy rats. J. Funct. Foods. 2014;11:460–471. https://doi.org/10.1016/j.jff.2014.10.001

17. Saraiva A, Carrascosa C, Ramos F, Raheem D, Lopes M, Raposo A. Maple syrup: Chemical analysis and nutritional profile, health impacts, safety and quality control, and food industry applications. Int J Environ Res Public Health. 2022;19(20):13684. https://doi.org/10.3390/ijerph192013684

18. Mohammed F, Sibley P, Abdulwali N, Guillaume D. Nutritional, pharmacological, and sensory properties of maple syrup: A comprehensive review. Heliyon. 2023;9(9):e19216. https://doi.org/10.1016/j.heliyon.2023.e19216

19. Meenakshi S, Misra A. Effect of dates on blood glucose and other metabolic variables: A narrative review. Diabetes Metab Syndr. 2023;17(2):102705. https://doi.org/10.1016/j.dsx.2023.102705

20. Maqsood S., Adiamo O., Ahmad M., Mudgil P. Bioactive compounds from date fruit and seed as potential nutraceutical and functional food ingredients. Food Chem. 2020;308:125522. https://doi.org/10.1016/j.foodchem.2019.125522

21. Sayas-Barberá E, Paredes C, Salgado-Ramos M, et al. Approaches to enhance sugar content in foods: Is the date palm fruit a natural alternative to sweeteners?. Foods. 2023;13(1):129. https://doi.org/10.3390/foods13010129

22. Allaith A. Antioxidants in date fruits and the extent of the variability of the total phenolic content: Review and analysis. Antioxidants. IntechOpen; 2019. http://dx.doi.org/10.5772/intechopen.83851

23. Habib HM, Ibrahim WH. Nutritional quality of 18 date fruit varieties. Int J Food Sci Nutr. 2011;62(5):544-551. https://doi.org/10.3109/09637486.2011.558073

24. Lay-flurrie K. Honey in wound care: Effects, clinical application and patient benefit. Br J Nurs. 2008;17:S30, S32–6. https://doi.org/10.12968/bjon.2008.17.Sup5.29649

25. James H. Papyrus Harris, donation to the temple of re at Heliopolis. In: Birch S, editor. Breasted ancient records of Egypt part four pSalt 825, Egyptian magical text. 1876. 

26. Atayoğlu AT, Soylu M, Silici S, İnanç N. Glycemic index values of monofloral Turkish honeys and the effect oftheir consumption on glucose metabolism. Turk J Med Sci. 2016;46(2):483-488. https://doi.org/10.3906/sag-1502-102

27. Bansal V, Medhi B, Pandhi P. Honey – A remedy rediscovered and its therapeutic utility. Kathmandu Univ Med J (KUMJ) 2005;3:305–9.

28. Cianciosi D, Forbes-Hernández TY, Afrin S, et al. Phenolic compounds in honey and their associated health benefits: A review. Molecules. 2018;23(9):2322. https://doi.org/10.3390/molecules23092322

29. Palma-Morales M, Huertas JR, Rodríguez-Pérez C. A comprehensive review of the effect of honey on human health. Nutrients. 2023; 15(13):3056. https://doi.org/10.3390/nu15133056

30. Gholami Z, Sohrabi Z, Zare M, Pourrajab B, Nasimi N. The effect of honey on lipid profiles: a systematic review and meta-analysis of controlled clinical trials. British Journal of Nutrition. 2022;127(10):1482-1496. https://doi.org/10.1017/S0007114521002506

31. Ugusman A, Shahrin SAS, Azizan NH, et al. Role of honey in obesity management: A systematic review. Front Nutr. 2022;9:924097. https://doi.org/10.3389/fnut.2022.924097

32. Bobiş O, Dezmirean DS, Moise AR. Honey and diabetes: The importance of natural simple sugars in diet for preventing and treating different type of diabetes. Oxid Med Cell Longev. 2018;2018:4757893. https://doi.org/10.1155/2018/4757893

33. Mela DJ, Woolner EM. Perspective: Total, added, or free? What kind of sugars should we be talking about? Adv Nutr. 2018;9(2):63-69. https://doi.org/10.1093/advances/nmx020

34. Harvard T.H. Chan. The Nutrition Source: Added sugars. School of Public Health. Updated April 2022. Accessed April 19, 2024. https://www.hsph.harvard.edu/nutritionsource/carbohydrates/added-sugar-in-the-diet/