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Does our body process agave differently than sugar?
This is a great question. Hands down, of the two choices - table sugar or agave nectar - sugar would be your better choice. Both are sugars but agave is predominantly fructose - about 82% fructose - where sucrose is 50% fructose and 50% glucose.
Sugar in any amount is challenging, and you should be limiting your consumption, whether it is table sugar, honey, agave, brown sugar, or maple syrup. The problem with agave is that the fructose is taken up and metabolized differently than sugar. It is taken up into the body differently but most importantly it is processed immediately in the liver and does not stimulate insulin release and other hormones. (Sucrose is also processed in the liver, but not immediately.) As such, fructose raises triglycerides, has a negative effect on cholesterol levels, and is linked with a higher risk of hypertension and diabetes.
Interestingly, because of the way it is processed, fructose does not suppress ghrelin, the body's hormone that stimulates appetite. As such, you might consume agave nectar and take in the same amount of calories as sugar, but still be hungry.
Don't be fooled by the fact that it is labeled "natural," because that really means nothing. Many of those syrups are just as processed as table sugar is. All sugars are calorie dense and you want to use them and anything containing sugars sparingly, including sugar.
In the end, use sweeteners carefully and your best bets are table sugar, maple syrup, or honey. Cook and bake with them sparingly.
Thanks for writing,
Timothy S. Harlan, MD, FACP