Is Agave Nectar OK for People with Diabetes?

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Agave nectar (or syrup) from the agave plant is commonly used by people with diabetes and others that are interested in health and nutrition as an alternative sweetener. Many people use it because they believe it has a lower glycemic index, which means it raises blood sugars at a slower pace. And being that it is is 90% fructose, it does have a lower glycemic index compared to most sweeteners, such as sugar, but its use comes with some caution.

When fructose is metabolized, most of it goes to liver, instead of the blood stream, where it could raise blood sugar. Because of this, fructose can elevate triglycerides, a type of fat in your blood that is associated with an increased risk of diabetes, metabolic syndrome and heart disease. So if you already have high triglycerides or other risks of heart disease (which many people with type 2 diabetes do), it is probably wise to choose a different alternative sweetener. Also, if you are someone that likes to avoid high fructose corn syrup, you probably want to avoid agave syrup too, since it is almost 100% fructose. 

When using sweeteners one must always remember that additional calories can cause weight gain, which is an independent risk factor for diabetes, and heart disease. One teaspoon of agave nectar contains 5 grams of carbohydrate and 20 calories. If you use 1 tablespoon (the equivalent of three teaspoons), you are consuming 60 calories and 15 grams of carbohydrate - the same amount of carbohydrate in one serving of fruit or one piece of bread, without the additional benefits of fiber and vitamins and minerals.

If you have diabetes and are looking to lose weight, it is best to remove all calories from sugar, including sugary beverages and condiments, like agave, table sugar, maple syrup and use sugar substitutes instead. While I am always an advocate of eating whole, natural foods, studies have shown that reducing intake of sugars (which lowers calorie intake and promotes weight loss) can improve blood sugar and weight control.

What is Agave? 

The agave plant is indigenous to Mexico and comes in many varieties. The blue agave plant is what tequila is made from. The least manipulated commercial form of agave nectar is made from extracts of the Salmiana agave plant, and processed with enzymes derived from the mold Aspergillus niger (a process "generally recognized as safe" by the FDA). 

Agave nectar can be purchased in health food stores and grocery stores. Agave nectar is usually clear or translucent golden brown. It mixes well into beverages like hot or cold tea. When substituting as a sweetener in recipes, it usually works well to look at how much sugar is called for and use about 25% less worth of nectar. Then, reduce the liquid in the recipe by about a third and reduce the oven temperature by 25 degrees.

What is the Bottom Line?

Agave nectar isn't necessarily a better alternative to table sugar and other sweeteners. When it comes to weight, all sugars should be taken into consideration. Weight loss can improve your blood sugars and lower your chance of heart disease.

If you must use sweeteners, you may want to try alternative sweeteners that contain zero calories. If you must use agave or other types of sweeteners, practice portion control. The American Heart Association recommends that men limit their daily intake of added sugars to 150 calories, and women limit their daily intake of added sugars to about 100 calories per day.

Updated May 10, 2016: Barbie Cervoni MS, RD, CDE

Sources:

Basciano H, Federico L, Adeli K. Fructose, Insulin Resistance and Metabolic Dislipidemia. Nutrition & Metabolism, 2005,2:5. 

Mayes, PA. Intermediary Metabolism of Fructose. American Journal of Clinical Nutrition. 1993,58(5S):754S-765S.

The American Heart Association. Sugar 101. Accessed on-line. May 10, 2016: http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Sugar-101_UCM_306024_Article.jsp#.VzlkHfkrKOO

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