The scoop on whether consuming natural or artificial sweeteners really makes a difference

One of the first things to do in a healthy diet is to cut out sugar. But this is easier said than done, so it should be a good thing there are many natural alternatives in the market, such as honey, agave nectar and maple syrup.

But are they really better?

White sugar is a simple carbohydrate which is easily utilised by the body for energy but is stored as fat if it is not needed.

Dietitians say other types of sugar, such as brown sugar and natural sweeteners, are no better than refined white sugar.

With obesity on the rise here, this is something more people should be aware of.

Ministry of Health statistics from the 2010 National Health Survey showed that about 10.8per cent of Singaporean adults were considered obese, up from 4 per cent in 2004.

NATURAL SWEETENERS

Natural alternatives to sugar include agave nectar or syrup, honey, maple syrup and coconut sugar.

A common belief is that these foods are less processed and, therefore, healthier choices than white sugar, but dietitians say this is often not the case. Also, they may have the same number of calories and carbohydrates as white sugar.

Agave nectar, for instance, is processed, though not as much as white sugar, said MsVanessa McNamara, a Singapore-based dietitian who runs her own consultancy, The Travelling Dietitian.

Agave nectar has become popular because it is viewed and marketed as a low glycaemic index (GI) food. Food with a low GI release sugar slowly into the body and does not cause the sharp fluctuations in blood sugar level that sugar does.

The truth, however, is that agave nectar will also affect your blood sugar level, even if not as much, said Ms McNamara.

"Agave is one of those trendy foods that is often overpriced. People need to be aware that it is no better than sugar in that it contains calories and still puts our blood sugar levels up. Even if agave is low GI, it is predominantly fructose."

Agave can contain as much as 90per cent fructose, a type of sugar that is also called fruit sugar. As it is broken down only in the liver, too much of it can result in a build-up of fat in the liver. Refined sugar, or sucrose, is half glucose and half fructose.

Coconut sugar, produced from the sap of the coconut flower, is another trendy sugar as it is also seen as a low GI food.

Ms Jenny Ng, principal dietitian at Mind Your Diet, said a small-scale study involving 10subjects was done a few years ago.

"Although the results showed that it does have a slightly lower GI than table sugar, the result wasn't conclusive (as it was done on a very small scale) and should be further evaluated."

She added: "While it is said to contain certain nutrients such as zinc and potassium, the amount is insignificant and one is better off getting these nutrients from other food sources."

So, if newfangled agave nectar or coconut sugar does not cut it, how about old-fashioned honey?

"Honey does have some anti-bacterial properties, so it is better than sugar in that sense, but it still has the calories and it is going to push up your blood sugar level," said MsMcNamara.

In fact, honey has more calories than sugar, pound for pound.

She said: "People need to stop and think about why they are taking a natural sweetener. Is it because they think it is healthier, more nutritious or tastier?

"Don't take it just because you think it is lower in calories and better for blood glucose levels as it may not be true."

Agreeing, Ms Ng said: "Regardless of the type of sugar, it will eventually be broken down to glucose, which will enter our bloodstream and be used as energy by our cells.

"Essentially, all sugars are the same, with minor differences in terms of the presence of minerals, impurities and colouring."

Ultimately, the choice of consuming sugar or natural sweeteners boils down largely to individual preference and has little to do with health.

"There's nothing wrong with a little bit of sugar in our diets," said Ms McNamara. "There's nothing wrong with alternative sugar or natural sugar and there is a place for artificial sweeteners."

ARTIFICIAL SWEETENERS

These intense sweeteners include aspartame, acesulfame-k, saccharin and sucralose.

Their appeal lies in their calorie content: They have very few or no calories but they are a lot sweeter than white sugar.

For instance, aspartame, which is sold as NutraSweet and Equal, is up to about 200 times sweeter than sugar, while sucralose, which is sold as Splenda, is 600 times sweeter than sugar.

Because they are not carbohydrates like sugar, they do not raise blood sugar levels (sucralose is made from sugar but the sugar molecule is chemically modified to make sucralose, which is not metabolised by the body for energy).

Artificial sweeteners are good alternatives for people with a sweet tooth or diabetes.

"If one is unable to take too much natural sugar for fear of the fluctuations in one's blood sugar level or is health/weight conscious, one can turn to artificial sweeteners," said Ms Ng.

Artificial sweeteners have come under attack for a long time, with critics saying they can cause health problems as serious as cancer.

But these claims are unfounded.

"Although there have been studies stating that artificial sugar is carcinogenic in large quantities, the amount of artificial sugar that an average individual can ingest in one day generally does not exceed that test amount," said Ms Ng.

"Hence, it is still safe to ingest artificial sugar."

The Health Promotion Board (HPB) says sugar substitutes are safe for the general public when consumed in moderate amounts.

"Despite the popular belief that sugar substitutes can cause diseases such as cancer, there is no scientific evidence that any of the ones approved for use in Singapore is linked to cancer," it said on its website.

It did, however, sound a note of caution: Those diagnosed with phenylketonuria - a genetic disorder in which the body cannot process part of a protein called phenylalanine - should avoid aspartame, which contains phenylalanine. High levels of phenylalanine can cause brain damage.

Another group of artificial sweeteners which are low-calorie (rather than no-calorie) are sugar alcohols, such as isomalt, lactitol and xylitol. Also known as polyols, they are carbohydrates with a chemical structure similar to sugar and alcohol.

They are usually found in sugar-free or reduced-sugar beverages and desserts.

They do not contribute to tooth decay and do not affect blood glucose levels as much as sugar.

The American Diabetes Association said these low-calorie sweeteners are useful for reducing calories and carbohydrates when used instead of sugar in coffee, tea and cereal and on fruit.

However, sugar alcohols can have a laxative effect or produce other gastric symptoms in some people, especially in children, it warned.

HIDDEN SUGARS

Generally, sugar should be taken in small amounts as it provides empty calories and has no nutrients.

While sugar substitutes are commonly used for weight management or blood sugar control, this is not necessary. The HPB said those who are overweight or have diabetes mellitus can use table sugar or consume food with added sugar in small amounts.

As the use of sugar substitutes does not condition the taste buds to less sweet foods and beverages, the HPB recommends that you gradually reduce the usage so you get used to less sweet food. Be aware that sugar-free foods may still affect your blood sugar level as they can contain carbohydrates from other sources.

People should also watch out for hidden sugars in food and drinks. Soft drinks, in particular, have a lot of sugar: one can has as much as eight teaspoons of sugar, said Ms Ng.

If you add sugar to your drinks or to your food while cooking, you may be increasing your caloric intake significantly without realising it.