Agave enjoyed a huge boom around 2010, when everyone seemed to be shouting from the rooftops about what a great natural sweetener it was, especially ideal for people with diabetes. NOT.

We looked into it, both then and more recently, and what we found was pretty interesting.

Of course, a lot of people are down on the chemical content of those familiar little packets of artificial sweeteners -- Equal, Sweet N' Low and Splenda -- so they’re turning to plant-based alternatives, like agave and stevia.

 

What is Agave Syrup/Nectar?

Agave PlantAgave nectar is made from various types of agave plants, which are found in southern Mexico. The consistency and even the taste are comparable to honey. Interesting fact: If you ferment the blue agave plant, it actually turns into tequila (wow!). Otherwise, agave can be used to create a sweet syrup or "nectar" (the latter term certainly sounds more benign and natural!)

Angela Ginn, a Certified Diabetes Educator (CDE) and National Spokesperson for The Academy of Nutrition and Dietetics, explains: “Agave is a nutritive sweetener that contains carbohydrate, vitamins and minerals such as iron, calcium, potassium and magnesium and calories. The difference in the color of various types is due to the filtration of salts and minerals in production.”

For a long time, many health food advocates believed agave was a perfect solution for PWDs (people with diabetes) because it's made of up to 90% fructose rather than sucrose, so it's much lower on the glycemic index (GI) and thus doesn't pack the same immediate punch to blood glucose levels as table sugar.

But that, as we learned, may be misleading. While it’s generally true that the lower a food’s GI score, the slower it raises blood sugar, it’s also well-documented that basing a food’s healthfulness on the glycemic index is misguided -- given that ice cream ranks lower than watermelon.

 

Healthy and Natural - Raw Agave?

Beware that agave syrup is hardly a “free food.” A teaspoon comes with 20 calories and 5 grams of carbs — slow-releasing carbs, yes, but they're still there. In comparison, one teaspoon of regular sugar is 16 calories and 4 carbs. And the calories, for anyone watching their weight, can still add up if you're not careful.

On top of that, agave’s praise for being a “natural” sweetener appears to be misleading too. It turns out the distilled nectar is highly processed using chemicals and GMO enzymes. In fact, some consumer advocates were horrified to learn that the process often uses an enzyme derived from mold (Aspergillus Niger). Crazy!

And what about so-called “raw agave”? Turns out it is simply processed at a lower temperature in order to retain some of the nutrients lost at high temperatures.  

According to Joanne Rinker, the American Association of Diabetes Educators’ (AADE) pick for diabetes educator of the year in 2013: “Raw agave nectar has a more mild, neutral taste. It is produced at temperatures below 115°F to protect the natural enzymes and retains a healthy pre-biotic substance called inulin, which provides the food for healthy pro-biotic bacteria to eat.  That may be the only real difference or benefit.” 

 

What’s the Glycemic Index of Agave Nectar?

The big selling point of agave is of course its low Glycemic Index measure. Just how low?

Nutrition and Dietetics expert Ginn tells us the GI measure of agave nectar is 32, which is rather low on the 0-100 scale -- therefore it may well have a lesser effect in spiking your blood glucose.

“However, agave contains fructose and glucose similar to High Fructose Corn Syrup (HFCS). The common concern from consumers is that HFCS may be associated with obesity and insulin resistance in adults,” she adds.

Joanne Rinker - diabetes educator

When people choose processed foods that contain fructose, like agave, it is metabolized very differently, and specific to diabetes, it can lead to insulin resistance. So, although the GI (Glycemic Index) may be low, the impact is potentially harmful!
Joanne Rinker, 2013 AADE Diabetes Educator of the Year

 

 

 

 

 

 

 

Fructose, High Fructose Corn Syrup, and Diabetes

Let’s talk about fructose for a moment... That's the natural sugar in fruit, right?

Yes, but according to research, fructose found in fruit is perfectly fine, while fructose found in processed foods, like agave syrup, can have some seriously negative health effects.

Dr. Ingrid Kohlstadt, a Johns Hopkins professor and fellow of the American College of Nutrition, recently told the Chicago Tribune: "Fructose interferes with healthy metabolism when taken at higher doses. Many people have fructose intolerance like lactose intolerance. They get acne or worse diabetes symptoms even though blood glucose is OK."

Many agave brands contain 70-95% fructose, whereas even HFCS itself contains just about 55%, while a piece of whole fresh fruit contains just 5-6%.

Most of us have heard the warnings about High Fructose Corn Syrup, and seen the corn industry's slimy commercials purporting that it is "safe." Is fructose from the agave plant really much different than from corn syrup? Especially in such large (concentrated) quantities?

Everyone is so afraid of HFCS, but the reality is that the real high fructose syrup is agave.
- Mary Toscano, Certified Nutrition Educator and author of “Sweet Fire: Sugar, Diabetes & Your Health”

Mary Toscano nutrition expert

 

 

 

 

 

She explains that large doses of fructose are harsh on the liver, which when forced to metabolize it, develops a syndrome called fatty liver, which contributes to chronic liver disease called cirrhosis.  Basically, the fructose is converted into triglycerides which get stored as white adipose tissue (fat) -- the kind of fat that the body CANNOT use for energy. All bad.

There's a lot of research on the negative effects of fructose, including evidence that fructose-sweetened beverages can cause weight gain and insulin resistance — certainly things we PWDs want to avoid!

 

The Research on Agave Says…

Surprisingly, there is very little research on agave, or on the use of sweeteners in general. This fact was corroborated by all the experts we queried.

If you do a search, what you’ll come up with are several NIH (National Institutes of Health) and ADA (American Diabetes Association) studies on the negative effects of fructose: how it induces dyslipidemia (high triglycerides) and insulin resistance and stimulates something called hepatic de novo lipogenesis, or DNL (disruption of the enzymatic pathway for synthesis of fatty acids). And you’ll also find some scientific evidence that low-glycemic foods are generally better for you.

The government’s 2015-2020 Dietary Guidelines for Americans and associated Dietary Guidelines Advisory Committee Report mainly focus on the nutrition and health implications of all added sugars (including agave and other calorie-containing sweeteners) and nonnutritive sweeteners. But this is for the general public, not specific to diabetes.

In short, there just isn’t any research specific to agave syrup. But according to Rinker, “the overall message (from the health and medical community) is that the GI is low and the fructose is high, at 90% vs. 50% for sugar.” And we’ve already established that high fructose is bad.

 

Cooking and Baking with Agave

Some PWDs report that they do enjoy and benefit from agave. Jeff Cohen, a type 2, shared in an online forum: "I've had great success with agave. I also like the appealing taste, something most other sweeteners don't provide." He points out that most of the warnings he's seen were for a few particular brands of agave — Volcanic Nectar — accused of adding "fillers" like maltose, which have their own long list of ill effects. Jeff believes that "not all agave should be written off."

Yet many others disagree. Brian Cohen, a type 2 known in the Diabetes Community for his healthy cooking skills and enthusiasm, says he’s definitely not a fan. “My understanding is that agave syrup and nectar are different, agave syrup is closer to table sugar while agave nectar can be nearly 90% fructose.  I suspect that out in the real world, agave syrup would have about the same effect on blood sugars as table sugar… Personally I never buy or use anything with a high fructose content like agave syrup/nectar.”

“I have found that other sweeteners such as stevia, sugar alcohols (my favorites are Xylitol and Erythritol) or even sucralose (Splenda) can sometimes have a different, slightly bitter taste, but I don’t think it noticeably affects dishes,” he adds.

Still, one noted advantage of agave is that it is extremely concentrated, so you can use a fraction of the amount in a recipe as you would with other sweeteners.

The taste is sweeter than sugar, so 1/3 cup of agave would be compared to 1 cup of sugar. When living with diabetes the recommendation is Moderation.
Angela Ginn, Certified Diabetes Educator (CDE) and National Spokesperson for The Academy of Nutrition and Dietetics

Angela Ginn - nutrition expert

 

 

 

 

 

 

The AADE’s Rinker agrees: “What’s most important is how much of any sweetener we are consuming.We should be limiting them to no more than 4-9 tsp per day (less than 10% of total calories). This includes agave, sugar, brown sugar, etc.”

She provides some helpful details on how PWDs should think about agave:

“Agave is 1.5 times sweeter than sugar so the idea is that a person who chooses this may be able to use less to get the desired sweetness then they would with regular sugar.  If this helps a person cut back from 6 tsp to 4 tsp, for example, then this may be a great alternative.  But, if a person assumes that if they choose this sweetener they can have a larger portion then that is not the case, as it will still affect blood sugar.”

“Agave nectar has 5g of carbohydrate and 15 calories per teaspoon and that is actually higher than regular sugar, which is 4g and 16 calories. Agave syrup is processed, it is higher in calories and it still contains carbohydrates and needs to be counted just like any other carbohydrate.  The benefit may be that you can use less for the same desired sweetness.  That may make it ‘better’ than some alternatives, but it would come down to personal preference.“

Sam Tablot - diabetes chefWe also asked celebrity chef Sam Talbot, who lives with type 1 diabetes himself, and he tells us:

"Agave is lower GI but high in fructose, and it does have a unique taste that chefs can desire for flavor. I tend to use different natural sweeteners in my cooking -- coconut sugar, honey etc. -- depending on desired texture and flavor layers."

 

Best Sweeteners for People with Diabetes

So with all that said about agave, what’s the best sweetener choice for people with diabetes?

There is no one definitive  answer.

CDE Joanne Rinker reminds us that the American Diabetes Association lists agave with table sugar, brown sugar, honey, maple syrup and all other sugars. “If a person was really looking for the healthiest option from this list, the answer may be local honey. If that was the sweetener of choice, they would still have to be aware of portion sizes, but they would have the added benefits of antioxidants, phytonutrients and allergy protection,” she says.

If you’re looking for another truly raw and natural option, many health food advocates recommend date sugar, which can also be made into a paste suitable for baking. Different varieties of dates have a Glycemic Index score in the 43 to 55 range, but without the high fructose or chemical processing drawbacks of agave.

Nutritive vs. Nonnutritive Sweeteners (NNS)
According to the Academy of Nutrition & Dietetics:
  • Nutritive sweeteners contain carbohydrates and provide energy. They occur naturally in foods or may be added in food processing or by consumers.
  • NNS are those that sweeten with minimal or no carbohydrates or energy. They are regulated by the FDA as food additives and generally recognized as safe.
  • Seven NNS are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, and sucralose. They have different functional properties that may affect perceived taste or use in different food applications.

Other suggestions are stevia, coconut palm sugar, coconut nectar, and yacon syrup, made from the root of the yacon plant, which grows in the Andes region of South America. Yacon is actually reported to have health benefits to your gut: it’s a prebiotic the aids in the absorption of calcium and other vitamins, and promotes healthy gut flora, which are essential for good digestion.  

Some final words of wisdom from T2 foodie Brian Cohen: “Many of us seek a way of sweetening our baking or cooking without incurring high blood sugars. There are literally dozens of alternatives to table sugar, many which have really small or negligible effects on our blood sugars.  But many of those alternatives may have their own adverse effects, so it is important to try to read up (from credible sources) and make informed choices about which alternative sweeteners to use.”

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.