Moderation, how sweet it is.

So the other day when I had gone down the Facebook rabbit hole, the subject of moderation came up again.  I have already ranted about this vague term this post and reminded people over and over again that you need to have some kind of goals and framework individualized for you to figure out what "moderation" means for you.  One particular discussion I had involved the use of artificial sweeteners and many people declaring that "I use [insert this kind of sweetener here] and I think it's perfectly OK in moderation."  So now I ask you, what does that mean?  Using one teaspoon per day?  One teaspoon per meal?  One Tablespoon per day?  Think about it.  I'll wait.

OK we're back.  First of all, let's talk about the likely suspects, what people are referring to when they are crowing about the sweetener they use in "moderation."  Usually these folks are trying to avoid artificial sweeteners, avoid "table sugar, avoid high fructose corn syrup, are trying to lose weight, or have diabetes (type 1 or 2), pre-diabetes, or are just trying to "be healthier."
1) Cane sugar--This is what many people think of when they add sugar to their coffee, add sugar to cooking or baking, or consume when they drink Dr. Pepper.  It is simply sucrose that is extracted from the tropical plant sugarcane.
2) Organic cane sugar--same as above, only the sugar cane is produced without pesticides and is usually not as white as non-organic cane sugar.  If a sugar is going to be Fair Trade certified, it has to adhere to strict pesticide handling standards and better treatment of workers.
3) Brown sugar--usually made by adding molasses back to the "white" product that results from the processing of cane or beet sugar.
4) Raw sugar or Sugar in the Raw or Natural Brown sugar or Whole Cane Sugar--a brown colored sugar produced from the first crystallization of sugar cane.  The molasses is left in and there are more minerals in this type of sugar.
5) Turbinado sugar or Demerara sugar--made by crystallizing raw sugar cane juice and then spinning in a centrifuge.
6) Muscovado/Moscovado sugar--made by crystallizing raw sugar cane juice, heating it to thicken, evaporated in the sun, and then pounded to yield a damp sugar that has a higher mineral content.

7) Honey--a sweet, thick liquid produced by bees from the nectar of flowers.  It can range from a yellow to amber color and the flavor can vary depending on what the bees are eating.  Most of the honey you find at the grocery store is pasteurized and filtered or aethetic purposes, ease of packaging, and to slow down crystallization.
8) Raw Honey--same as above except it hasn't gone through the pasteurization process and usually has a creamier texture as well as flecks of bee pollen in it.

9) Agave Nectar--made from the juice of the agave plant usually found in desert regions and also varies in color and flavor.
10) Maple syrup--made from the sap of sugar maple, red maple or black maple trees. In cold climates maple trees store starch in their trunks and roots before the winter and in spring this starch coverts to sugar and rises in the sap. The sap heated evaporate much of the water and leaves a concentrated syrup.

Choices, choices.  Will any of these help meet our health goals?
1) Avoid elevations in blood glucose levels?

•  For people with Type 2 Diabetes/pre-diabetes/metabolic syndrome who are controlling their blood glucose levels with diet/exercise alone or diet/exercise plus oral medication need to restrict the amount of carbohydrate they eat at a meal, and while that amount is based on the individual, I'm going to use an AVERAGE of 30 grams per meal as an example.  Each of the above examples has ON AVERAGE 15 gm of carbohydrate per Tablespoon.  So let's say you had a breakfast of 2 pieces of toast, a banana, and eggs, and then 2 cups of coffee with two HEAPING teaspoons of honey.  This means you consume ~30 gm of carb from the toast, ~25-30 grams of carb from the banana, none from the eggs, and roughly 15 grams of carb from the two cups of coffee for a grand total of 70-75 grams of carb for one meal.  So, if you are going to use agave or whatever in your coffee--you will have to measure it and count it towards you carb intake and you will likely need to eat less fruit and forgo the toast at that meal too. 
• If you have Type 1 diabetes or have Type 2 diabetes controlled by adjusting your insulin to carb ratio via a pump or injected insulin, you will need to count the honey, etc to towards your total carb intake and bolus accordingly
• I know that some of you are wondering about the glycemic index, likely specifically agave nectar.  Yes it does have a lower glycemic index--but keep in mind that the glycemic index was established using non-diabetics, so if you have diabetes you can test your individual response, and the results might not be in your favor.  Keep in mind that portion size makes a difference and will therefore impact your glycemic load; so yes you still HAVE TO WATCH THE AMOUNT YOU CONSUME.

2) Will using these sweeteners help me lose weight? 

• Once again each of these sweeteners has an average of 60 calories per tablespoon.  So, if you lose control of the honey bear over your big cup of tea (and you know who you are) you might be getting a lot more calories than you think so that won't help with your weight (especially if you drink more than one cup per day).
• In individuals who have insulin resistance losing control of the honey bear will likely result in a overconsumption of carbohydrates for that meals, elevating your insulin levels and making you hungrier sooner.  Losing weight is hard enough, don't make it harder on yourself!

3) Aren't these better for me than high fructose corn syrup? 

• As I said before in a previous post the main problem with HFCS is that it just makes it easier/cheaper to overconsume on carbohydrate/calories.  If you overdo honey, agave, raw sugar you can still wind up with tooth decay, elevated triglycerides, weight gain, elevated blood sugar, etc.  I suppose one advantage might be that if you use something like agave or real maple syrup you will be shelling out more money, so that might give some people an incentive to cut down on your portions.
• The related question is usually "but isn't this a natural sweetener?" Often when people ask me this I know they have tuned out on my carbohydrate explanation so: THE USE OF ALL THOSE SWEETENERS MUST COUNT TOWARD YOUR CARBOHYDRATE INTAKE AT EACH MEAL. (Whew, I feel better).  And of course there is the reminder that natural doesn't mean better.  Cynanide is natural, and if you love to read mystery novels written before 1950 or so you will know that cyanide resembles sugar, but you don't want to put that in your coffee.

• 4) Won't a teaspoon/Tablespoon of local honey taken daily "cure" my seasonal allergies?  Unfortunately there isn't any evidence that honey works to prevent allergies any more than a placebo.  And if it did, it would only work on people who are allergic to pollen specifically.  Keep in mind that in rare cases a person with severe pollen allergies could have an anaphylatic reaction to eating honey, and honey should never be given to children under one year of age. (Link)

5) Aren't these better me than "artificial sweeteners?" 

• One of the better discussions I have found is in the following video, which also discusses the "natural" low calorie sweetener stevia (which he does give a favorable review).  It's a bit long, but worth watching.  I personally prefer to use stevia for the "don't have to think about carbs or calories" quality.
• Some people claim they are allergic/intolerant to certain sweeteners.  If so, you need to follow all of the above steps to control how much honey, etc you're getting. If you have irritable bowel syndrome like yours truly, keep in mind that too much fructose can cause problems.  And fructose is found in high concentrations in, you guessed it, honey and agave.  So don't pig out on the agave-sweetened coconut ice cream unless you want to pay for it.  Not that SkepticRD  knows anything about that.

Take home message--use of caloric sweeteners are only safe if you are aware of your daily carbohydrate/calorie limit.  Otherwise the term "use in moderation" is as empty as it sounds.