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Ask Dr. Gourmet

Should diabetics use agave nectar as a sweetener?

Can you shed any light on the benefits or misconceptions of agave nectar especially as it relates to Type II diabetics and the glycemic index? Is it just a bunch of hype or can agave nectar (when used properly) be a useful and safe dietary sweetener?

Dr. Gourmet Says...

Agave plant in California. Copyrighted by Marc Ryckaert and used under Creative Commons license. Resized.

I haven't used agave nectar in years. It was somewhat popular in the early eighties when I was involved in managing a chain of healthy fast food restaurants. I didn't use it much in cooking but we served it as an alternative sweetener. In the last few years it has been marketed heavily as an alternative to sugar.

The reason for this is that it is very sweet but has a low Glycemic Index (GI). You can think of GI as a measure of how a particular food is processed by the body. In essence, it measures the rise in blood glucose of a 10 to 50 gram carbohydrate equivalent of a food as compared to the same number of carbohydrate gram equivalents of glucose. There's been some research about GI, especially in diabetics, that shows it may help with controlling blood sugar, but the science is imperfect. For instance, the GI of a Milky Way bar is 62 while that of watermelon is 80 and baked potatoes are 93 (lower GI is purported to be better for you). I am sorry, but it's clear to me that watermelons and potatoes are far better for you than candy bars.

Agave nectar has a reported GI of between 10 and 19, and table sugar has a GI in the 60 range, even though a tablespoon of agave nectar has more calories (60 calories vs. only about 50 for granulated sugar). This is because the processing of agave nectar results in higher levels of fructose. It's the fructose that's sweeter but is slightly more calorie dense than table sugar.

So, can this be better for you and better for diabetics? We really don't know since there's no head to head research using agave nectar in comparison with other sweeteners. But I would be careful using it. While it may have a lower glycemic index, it still has a lot of calories. And all calories are the same in relation to their ultimate use as fuel for the body (whether they come from carbs, protein or fats). While these may be better quality, they are still calories and too many leads to weight gain.

It appears that agave nectar is safe and it may not cause as dramatic a spike in blood sugar as other foods, but there's no real proof that it's healthier and it actually has more calories than sugar. Given this and that the price is extremely high, I won't be using it in Dr. Gourmet recipes any time soon.

Thanks for writing,

Timothy S. Harlan, MD, FACP, CCMS
Dr. Gourmet