The market is flooded with thousands of varieties of sweeteners. This article could easily read: The good, the bad, and the ugly. The good is almost never present in anything processed or with a shelf life. Even this exception to the world of sweeteners has its own set of caveats. Such as not for those with insulin resistance and probably best if kept away from rich sources of polyunsaturated fats, such as most nuts and seeds and certainly away from seed oils. This lone, potentially, healthy sweetener has been shown to have a less-insulin driving effect and may have antioxidative and anti-inflammatory effects. Raw honey is the only sweetener with any scientific evidence that it may be able to play a role in a healthy diet.

As we move downward from here, let’s take a look at some very popular sources of sugar that are often touted as beneficial or well tolerated without any significant challenges to the body’s insulin production. Agave would be very high on this list. However, when you really get down to it, there isn’t any good evidence that agave has merit. In fact, its lower glycemic index is only accurate when it is the only food being consumed. This is in large part to its fructose content which is unusually high. That is really the major fault with agave: fructose. By now, most of us know something about fructose. Either we have heard about high fructose corn syrup or we have seen one of Dr. Robert Lustig’s talks presented at Stanford on its toxicity, even in moderate amounts by US consumption standards.

Agave has more fructose than corn syrup, even high fructose corn syrup. Fructose metabolism poses major challenges for human physiology, most notably the liver and our mitochondria.

Brown rice syrup has gained recent popularity as more people become aware of the dangers with fructose, it is easy to understand why the food industry is now favoring this glucose-only sweetener. In fact, one enteral formula manufacturer has started to use rice syrup for its primary source of carbohydrates. While this may be a step in the right direction, eliminating fructose, let’s be clear: it is still sugar. In fact, rice syrup has an exceptionally high Glycemic Index.

This is something that we should all be concerned with, especially if it is incorporated into a meal replacement or sole source of nutrition.

Fruit juice concentrates may be the worst of the worst. It is alarming to see how many supposedly "natural" and/or "organic" products use fruit juice concentrates and make the label claim "no added sugar". Fruit juice has so many issues associated with it that it really deserves an article of its own. Until then, avoid those products that contain these as they have all the fructose and often contain advanced glycosylated end-products (AGEs) formed in their concentrating process (heat and fructose are a bad combination). There is also an enteral formula that uses fruit juice concentrates as its primary source of carbohydrates, which in this case is mostly sugar.

We feel strongly that whole foods should provide us, in all stages of health, with the vast majority of our carbohydrates and all other nutrients. Using sugar, in all of its forms, is just a cheap way to add calories to any product. Functional Formularies believes that everyone should have the right to a truly no added sugar option. We hope that you do too!

John Bagnulo MPH, PhD. - Director of Nutrition