Written by Courtney Human RD(SA)

This month I decided to dive into our sweeter desires. There are countless sugar additives on the market whether, artificial sweeteners, honey, sugar varieties as well as Xylitol just to name a few. Navigating amongst these choices can be daunting especially when considering which one is ‘healthier’, ‘more natural’ or ‘less calories.’ Well guess what? As a dietitian I add artificial sweetener to my coffee, honey to my oats and brown sugar to my bran cereal so if you are looking for a clear-cut answer, stop reading now, as this is not a simple topic either.

First and foremost, although the focus of this blog is on which sweet additive to choose maybe the focus should be on why we are adding it at all. Is it simply a habit we have formed, because of a taste preference or do we think we are adding a specific nutrient value to our meal. I had a journal club discussion and a colleague of mine made a comment on sweet treats she brought home from Japan tasting so bland which made her realise that our sweet tolerance in South Africa is sky high. And even though sugar tax laws came into play lowering the amount of added sugar in products these were replaced with artificial sweeteners to maintain the sweet taste. Hence, regardless of the source of sweetness this high sweet tolerance increases the risk of cravings for other refined sugary foods which contribute heavily to obesity in our country. Besides obesity excessive sugar intake has also been linked to high blood pressure, heart disease, dementia and Alzheimer’s.

Politics aside I’m going to start with the most common dilemma of sugar VS honey. If you are someone wanting to lose weight and have changed to honey as a lower calorie option, I may be the bearer of bad news. But let’s start with the positives as according to research, honey has a nutritional composition dependant on the nectar it originates from with darker and raw varieties having more antioxidants and enzymes than lighter and pasteurized varieties – this was news to me. In its purest form it contains trace amounts of potassium, calcium, zinc, and vitamins C, B1, B2, B3, B5 and B6 as well as antioxidants, enzymes, and amino acids. On the contrary commercially sold honey may have added flavours, sugar, and colouring to increase shelf life and visual appeal. Overall, honey has a lower GI (glycaemic index) meaning that it does not raise blood sugar levels as quickly. Recent studies also show honey as a cough suppressant, allergy reliever and topical wound healer with bees adding enzymes aiding in digestion. However, the negatives are honey can’t be given to infants younger than 12 months and for weight watchers honey is more concentrated thus higher in calories than sugar. One tablespoon of honey contains 64 calories versus 49 calories in sugar, although honey is sweeter so less may be needed.

Sugar comes from sugar cane or sugar beet which although is still natural undergoes more processing to be the final snow-white product. Brown sugar is just white sugar with molasses which adds the brown colour and flavour with slightly more minerals and moisture. Palm sugar (jaggery) is made from the juices of palm trees or sugarcane and is gaining popularity as a replacement for white sugar for its minuscule amounts of vitamins, minerals, and antioxidants. But no matter the colour of type of sugar besides being lower in cost and calories as well as having a longer shelf life, in excess it can still lead to quicker sugar spikes, cavities, increased chronic disease risk, negative changes in gut bacteria and indigestion. To avoid these negatives of sugar our family also jumped onto the Xylitol trend thinking this was a lower calorie ‘sugar’ option, but this is approximately the same calories per teaspoon and was specifically designed for Diabetic patients to not affect their blood sugar levels not for weight loss.

Overall, all of the above mentioned have similar nutritional values. Sugar and honey are composed of glucose, fructose, and/or sucrose in varying amounts and both fructose and glucose are broken down quickly by the body leading to spikes in blood sugar levels. The reason sugar is higher GI than honey is due to a higher fructose content, and the absence of trace minerals. When considering caloric content alone, all added sugar or honey provide approximately 4 calories per gram. Research aside they also contain insignificant amounts of vitamins and minerals when compared to lower-calorie nutrient dense sources. Side note, honey or palm sugar lose their nutrient content when heated too. Therefore, if your primary concern is calorie management, it’s best to use sugar or honey sparingly or the natural sweetness from fruit or zero calorie artificial sweeteners. Additionally, replacing sugar with jaggery or honey may not offer the nutritional advantage you believed it would.

Bottom line: It is possible to consume too much of both honey and sugar and the risks of overconsumption are the same for both hence both should be used in moderation or not at all. Moderation according to the USDA and HHS guidelines is eating less than 10% of your total daily calories in added sugars. More practically, the American Heart Association (AHA) suggest that women consume no more than approximately 6 teaspoons and men no more than 9 per day. It is important to note these amounts consider all sugars or honey already added to processed and pre-packaged foods.

Most people take the easy way out and simply replace added sugar with artificial sweeteners which have no nutritional value or calories. Though the Food and Drug Administrators (FDA) deem sweeteners safe to use, this is not recommended as recent research reveals they can still increase sugar cravings, cause disruption to gut bacteria and indirectly affect insulin sensitivity. The artificial sweetener winning the popularity contest for all the wrong reasons is aspartame which the World Health Organization (WHO) declared a potential carcinogen on July 14, 2023. In layman’s terms a carcinogen is a cancer-causing substance. With this announcement even I ditched the sweetener in my daily cappa until looking deeper into the scientific evidence. This announcement was made after relooking at existing evidence which lacks consistency, hence ‘possibly carcinogenic’.The amount of artificial sweetener you would need to consume daily to reach this carcinogenic threshold you would most likely have explosive diarrhoea before anything else. Moreover, extensive evidence shows alcohol and obesity are two of the highest ranked carcinogens which need way more attention in our country than artificial sweeteners do. At Midline Dieticians the emphasis is still on limiting sweetened beverages and fruit juice while increasing water intake. So basically, from our perspective, meeting your daily water intake before reaching for the diet coke but reaching for the diet coke before alcohol. We need to look a little deeper, so yes, as a registered dietitian I still add Canderel to my daily cappa.

In conclusion, added sugar or honey alongside artificial sweeteners run the risk of substituting nutrient-dense foods which in excess lead to poor health outcomes by delivering calories without other necessary elements such as vitamins, minerals, or other important nutrients. The key message of sugar consumption is to limit added sweetness in our diet and focus on minimally processed foods to lower our sweet tolerance as a whole. Believe it or not there is room for honey, sugar and artificial sweeteners in a balanced dietitian approved lifestyle but if moderation is not possible than rather don’t risk it for the biscuit.