It may be advisable for people living with diabetes to avoid table sugar and instead use sweeteners. However, agave syrup is not a suitable replacement, due to its high-fructose content that provides more calories than table sugar.

Table sugar consists of sucrose, which is harmful to those who have diabetes. Fructose, however, is a different sugar that has links to liver damage, which might have damaging effects on blood glucose control. Controlling blood sugar levels is vital for managing diabetes.

People with diabetes should avoid added sugars where possible. Although agave syrup is vegan-friendly and natural, it is not a good alternative sweetener for people with diabetes.

In this article, we look at the evidence for and against using agave syrup as an alternative sweetener.

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Agave syrup is not a healthful alternative to added sugar.

Agave is the name for a group of succulent plants that grow in warm climates, particularly the southwestern United States and Mexico.

Some people use blue agave as a sweetener. However, it is high in carbohydrates. The agave plant also produces nectar containing large amounts of a sugar called fructose.

Parts of the alternative health community have turned to agave as a potential alternative to table sugar and other sweeteners. Support for agave stems from its role as a vegan-friendly sweetener and its low glycemic index (GI), between 10 and 19 depending on the product.

The higher the GI of a food is, the faster the increase in blood glucose after eating it. Agave has a lower GI than most other sweeteners, which means that it is less likely to cause blood sugar spikes.

GI, however, is not the only way to assess the impact of a particular food for people with diabetes.

A 2014 study gave four groups of participants four different diets to follow: The researchers divided groups following high-carb and low-carb diets into a further group eating only carbs with a high GI ranking and another eating only low-GI carbs.

Those following high-GI diets saw a drop in insulin sensitivity and an increase in LDL cholesterol in the group that ate more carbohydrates when compared to the low-GI group.

In the low-carb group, however, the GI ranking of the foods did not make a difference to insulin sensitivity, blood pressure, or many of the risk factors for diabetes and cardiovascular disease apart from reducing triglycerides by a small amount.

Triglycerides are fats that store excess calories. They can be harmful in combination with high cholesterol levels.

For people already following a diabetes-friendly diet plan, the study found that low-GI foods produced no improvements in cardiovascular risk factors in the blood. The findings suggest that limiting overall carb intake supports a safe diabetes diet.

Agave contains higher levels of fructose than table sugar and most other sweeteners. The body releases less insulin in response to fructose. This means that blood sugar may remain higher after eating agave than other sugars.

A 2014 study on mice suggests that agave syrup might be a healthful alternative to table sugar. Mice who consumed agave nectar had lower blood glucose levels compared with mice that consumed table sugar. They also gained less weight.

However, not all data gathered from research on mice applies to humans. The study also only compared agave to table sugar, which is harmful to people with diabetes. Agave may be marginally better than table sugar for people who have the condition, but it is not necessarily a healthful addition to the diet.

More importantly, agave is still a sugar. As with table sugar, high-fructose corn syrup, and other sugars, people with diabetes should avoid it.

People who are following a healthful diet to manage diabetes should reduce their sugar intake rather than switching from one type of sugar for another.

A high-calorie alternative to table sugar

For people with diabetes who want to try agave syrup instead of table sugar, there is another reason to avoid changing over.

Agave is a higher-calorie sweetener than table sugar. It contains 21 calories per teaspoon, compared with table sugar’s 16 calories per teaspoon.

Supporters of agave highlight its enhanced sweetness when compared to table sugar, potentially allowing people to use smaller quantities to achieve the same flavor. However, this potential benefit is small when considering agave syrup’s negative health impact.

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Some people believe that agave syrup is better for you than table sugar, but it contains more calories and fructose.

Agave poses other risks to people with diabetes outside of its high fructose content.

A number of studies have looked at high-fructose sweeteners. Fructose usually produces worse effects than another type of sugar called sucrose, common in table sugar.

The liver breaks down glucose, so taking in too much can lead to liver damage. People with diabetes already face an increased risk of liver disease and non-alcoholic fatty liver disease (NAFLD), making agave a high-risk sweetener for those with the condition.

In 2017, a study of mice linked fructose to liver damage, including fatty liver disease and liver cell death. The study also found a link between fructose consumption and inflammation. Inflammation is behind a wide range of illnesses.

Another 2017 study also linked eating fructose to fatty liver disease. The study emphasizes that the incidence of fatty liver disease with no links to alcohol consumption has increased over the past decade.

According to a 2013 review of animal studies, high levels of fructose consumption might influence metabolic problems. This means that fructose may contribute to weight gain, unhealthy levels of fat around the waist, and oxidative stress.

A 2015 study cautions that fructose might promote the development of high blood pressure, insulin resistance, and other cardiovascular risk factors.

However, the study cautions that this relationship only applies when people base 20 percent or more of caloric intake on foods that contain fructose.

This suggests that fructose-based sweeteners may be acceptable in moderation but also that people with diabetes should generally avoid them.

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Honey is a possible alternative to agave syrup.

People with diabetes should avoid all added sweeteners, as well as sugar-rich, processed foods.

Lifestyle and dietary changes are effective methods for managing diabetes. Even though giving up or drastically reducing sugar intake might require discipline, it offers many health benefits, especially for those closely controlling blood glucose.

Those looking to eat a sweet treat should choose their sweeteners carefully. Since artificial sweeteners contain no, or few, calories, doctors once thought that they might be a safe alternative to traditional sugar. More recent research goes against this recommendation.

A 2015 study found that artificial sweeteners alter the bacteria that live in the gut, triggering insulin resistance.

While honey and maple syrup may be safer natural alternatives for people with diabetes, both still break down in the body and increase blood sugar.

Whole fruits are ideal for adding sweetness to foods, as they provide sugars alongside fiber, antioxidants, and other nutrients that can benefit health.

Try mixing fresh or dried berries into oatmeal, add unsweetened applesauce to plain Greek yogurt, or blending frozen bananas with cocoa powder to replace ice cream.

Learn more about whether honey is safe for diabetes here.

Agave is not a healthful replacement for table sugar.

While it is less harmful and more natural, people who are closely managing blood glucose should avoid agave. The high fructose content can reduce insulin sensitivity and may worsen liver health. Agave is also a higher-calorie sweetener than table sugar.

People with diabetes should avoid adding sweeteners to food and use fruit as an alternatives for extra sweetness.