When cutting calories from their diet, especially during the holiday season, conscientious eaters often start by eliminating sugar. But adding honey to tea or substituting "raw" sugar for white won't make a difference. A teaspoon of table sugar has 14 calories, no matter its color, as does honey, molasses and other "natural" sweeteners.

And artificial and plant-based sweeteners may pose additional health risks, as they've been linked to cancer and other serious health problems in previous animal studies. Packets of plant-derived Stevia, sold in health food stores as a dietary supplement, aren't even approved by the U.S. Food and Drug Administration for sale as a food additive. High fructose corn syrup, an artificial sweetener used in products like soda and ice cream, has been increasingly blamed for rising levels of diabetes and obesity.

All the caveats have left consumers confused about sugar, and it's frequently difficult to find straightforward answers. That's partly due to the controversy surrounding sugar consumption, and while scientific research is still inconclusive on many of these questions, there are some very basic guidelines that consumers can follow to stay healthy.

Souring on sugar

In the past few years, sugars have been blamed for worsening rates of diabetes and obesity, and companies in the business of sweetening the North American diet have countered.

The Corn Refiners Association, an industry group, recently launched an advertising campaign extolling the virtues of high fructose corn syrup. Some beverage and food companies have scrambled to swap high fructose corn syrup for cane sugar and other natural sweeteners. And this year, food manufacturers launched "all-natural" zero-calorie sweeteners extracted from the stevia plant.

In 2007, total retail sales of sugar and sweeteners reached $3.1 billion US, according to an estimate by the market research company Packaged Facts.

These companies are trying to capture market share even as sugar consumption becomes a public health concern, and billions of dollars are at stake. In 2007, total retail sales of sugar and sweeteners reached $3.1 billion US, according to an estimate by the market research company Packaged Facts.

Consumers, though they spend consistently, are often overwhelmed with conflicting information about sugar and sweetener consumption, including warnings about calories, cancer and weight gain.


One popular misperception is that unprocessed sugar is healthier than processed versions.

"When it comes to sugar and cane sugar and any other word they're using, sugar is sugar," says Amy Virus, a registered dietitian at Temple University's Center for Obesity Research and Education.

Virus is referring to the caloric content of not only table sugar, but also honey, molasses, cane sugar and even high fructose corn syrup, which is derived through a chemical process from corn starch. All of these sweeteners have the same number of calories in one teaspoon.

Persuasive marketers using phrases like "all natural" have helped make products with high sugar and fructose levels appealing, says Michael Jacobson, executive director of the Center for Science in the Public Interest, a Washington, D.C.-based nonprofit advocacy organization.

"Marketers know that people will pay a little extra for that all natural product," he says. "It's totally dishonest of companies to brag about not having high fructose corn syrup when they contain sugar."

In 2007, Americans consumed 44 pounds of refined cane and beet sugar and 40 pounds of high fructose corn syrup per capita.

Both Jacobson and Virus say that what matters most is quantity. Americans now eat less table sugar than they did in 1970, but the advent of corn syrup as an additive in everything from ice cream to ketchup means we consume more sugars than ever before. In 2007, Americans consumed 44 pounds of refined cane and beet sugar and 40 pounds of high fructose corn syrup per capita.

The simultaneous increase of diabetes and obesity has not escaped the attention of public health experts and scientists, but scientific research has yet to provide conclusive evidence that sucrose and fructose, found in table sugar and corn syrup, respectively, are directly responsible for the trend.

Dr. Peter Havel, a professor in the departments of molecular biosciences and nutrition at University of California, Davis, has studied the impact of fructose intake and found that it increases some markers that are considered risk factors for cardiovascular disease and diabetes in overweight and obese patients.

Alternatives to Sugar Dr. Elizabeth Parks, an associate professor at the University of Texas Southwestern Medical Center and in the Center for Human Nutrition, has also studied the role of fructose and found that the body often turns excess quantities of fructose into fat.

But Parks is hesitant to draw any conclusions about fructose's links to obesity.

"It appears to me that it's too many calories of everything," she says.

Parks recommends satisfying sweet-tooth cravings with something healthier than a sugary drink or soda, which can have more than the day's calorie allowance. She also warns against demonizing fructose, a natural sugar found in fruit and which is healthy in small doses.

Going natural

For those who cannot give up sodas and sweets, there are several artificial and natural zero-calorie sweeteners available. The FDA has approved five artificial sweeteners for use in the U.S., including saccharin, aspartame and sucralose. However, they are not without medical caveats; some scientific studies using animals have raised questions about aspartame and saccharine and links to cancer.

Stevia, a South American plant whose extract is up to 300 times sweeter than sugar, has become a popular calorie-free alternative and is sold as a dietary supplement in health food stores. The FDA has yet to approve it, or newly launched versions of it, for sale in food products and previous animal studies have demonstrated a link between stevia and genetic mutations and diminished fertility. More recent studies sponsored by Coca Cola and food manufacturer Cargill have deemed it safe for human consumption. Cargill currently sells a zero-calorie, stevia-based tabletop sweetener named Truvia in grocery stores.

Elizabeth Parks sympathizes with consumers who struggle to stay abreast of the current research and make educated decisions about sugars and sweeteners and their health, but says shifting opinion is part of the scientific process.

"[Consumers] shouldn't be surprised that they might get one advice this year and then that advice is refined," she says. "We're getting better at understanding how the intricacies of the diet may affect [people]."