Sweeteners and Sugars: A Guide for Seniors

What Is Fructose (fruit sugar)?

is the naturally occurring sugar in all fruits. It is also called levulose, or fruit sugar.

Honey

is a combination of fructose, glucose, and water. It is produced by bees.

What Is High fructose corn syrup (HFCS)?

and

corn syrup

are made from corn. Sugar and HFCS have almost the same level of sweetness. HFCS is often used in soft drinks, baked goods, and some canned products.

Dextrose

is chemically identical to glucose. It is commonly used for medical purposes such as in IV hydration and parenteral nutrition products.

Invert sugar

is a natural form of sugar that is used to help keep candies and baked items sweet. Honey is an invert sugar.

Sugar alcohols:

What Are Sugar alcohols?

include

mannitol, sorbitol, and xylitol.

These sweeteners are used as an ingredient in many food products that are labeled “sugar-free”, “diabetic”, or “low carb”. These sweeteners are absorbed by the body at a much slower rate than sugar. They also have about one half of the calories of sugar. They should not be confused with sugar substitutes that are calorie free. Sugar alcohols may cause stomach cramps and diarrhea in some people.

Erythritol

is a naturally occurring sugar alcohol found in fruit and fermented foods. It is 60% to 80% as sweet as table sugar but has fewer calories. Also, it does not result in as much of a rise in blood sugar after meals or cause tooth decay. Unlike other sugar alcohols, it does not cause stomach upset. Erythritol is used in many foods marketed to people with diabetes, and it is a main ingredient added to Stevia and monk-fruit sweetener products. A recent study linked consuming erythritol to a mildly increased risk of adverse cardiovascular events such as heart attack, stroke, and death. More research is needed to understand the implications of this study and possible long-term adverse effects of using erythritol and other no- and low-calorie and artificial sweeteners.

Other types of natural sugars:

Agave nectar

is a highly processed type of sugar from the

Agave tequiliana

(tequila) plant. Agave nectar is about 1.5 times sweeter than regular sugar. It has about 60 calories per tablespoon compared to 40 calories for the same amount of table sugar. Agave nectar is not healthier than honey, sugar, HFCS, or any other type of sweetener.

Glucose

is found in fruits in small amounts. It is also a syrup made from cornstarch.

Lactose

(milk sugar) is the

carbohydrate

that is in milk. It is made up of glucose and galactose.

Maltose

(malt sugar) is produced during fermentation. It is found in beer and breads.

Maple sugar

comes from the sap of maple trees. It is made up of sucrose, fructose, and glucose.

Molasses

is taken from the residue of sugar cane processing.

What Are Stevia sweeteners?

are high intensity extracts derived from the stevia plant that are recognized as safe by the FDA. Stevia is 200 to 300 times sweeter than sugar.

What Are Monk fruit sweeteners?

are made from the juice of the monk fruit. They have zero calories per serving and are 150 to 200 times sweeter than sugar.

What Are the Possible Risks and Side Effects?

Table sugar provides calories and no other nutrients. Sweeteners with calories can lead to

tooth decay

.

Large amounts of sugar-containing foods can contribute to excess weight gain in children and adults. Obesity increases the risk for

type 2 diabetes

,

metabolic syndrome

, and

high blood pressure

as well as some types of cancer.

Sugar alcohols such as sorbitol, mannitol, and xylitol may cause stomach cramps and diarrhea when eaten in large amounts.

What Are Recommendations?

Sugar is on the United States Food and Drug Administration’s (FDA) list of safe foods. It contains 16 calories per teaspoon or 16 calories per 4 grams and can be used in moderation.

The American Heart Association (AHA) recommends limiting the amount of added sugars in your diet. The recommendation extends to all types of added sugars.

• Women should get no more than 100 calories per day from added sugar (about 6 teaspoons or 24 grams of sugar).
• Men should get no more than 150 calories per day from added sugar (about 9 teaspoons or 36 grams of sugar).

The United States Department of Agriculture (USDA) Dietary Guidelines for Americans also recommends limiting added sugars to no more than 10% of your calories per day. Some ways to reduce your intake of added sugars include:

• Drink water instead of regular soda, “vitamin-type” water, sports drinks, coffee drinks, and energy drinks.
• Eat less candy and sweet desserts such as ice cream, cookies, and cakes.
• Read food labels for added sugars in packaged condiments and sauces.
• There is currently no daily recommendation for the naturally occurring sugars found in milk and fruit products, but too much of
  
  any
  
  sugar can have negative effects on your health. It is important to have a balanced diet.

The American Diabetes Association nutrition guidelines state that you do not need to avoid all sugar and foods with sugar if you have diabetes. You can eat limited amounts of these foods in place of other carbohydrates.

If you have diabetes:

• Sugars affect blood glucose control the same as other carbohydrates when eaten at meals or snacks. It is still a good idea to limit foods and drinks with added sugar, and to check your blood sugar level carefully.
• Foods that contain sugar alcohols may have fewer calories, but be sure to read the labels for the carbohydrate content of these foods. Also, check your blood sugar level.

Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report.

Diabetes Care.

2019;42(5):731-754. PMID: 31000505

.

Snetselaar LG, de Jesus JM, DeSilva DM, Stoody EE. Dietary guidelines for Americans, 2020-2025: understanding the scientific process, guidelines, and key recommendations.

Nutr Today.

2021;56(6):287-295. PMID: 34987271

.

US Department of Agriculture. Sweeteners: nutritive and nonnutritive sweeteners.

www.nal.usda.gov/human-nutrition-and-food-safety/food-composition/sweeteners

. Accessed April 9, 2025.

Witkowski M, Nemet I, Alamri H, et al. The artificial sweetener erythritol and cardiovascular event risk.

Nat Med.

2023;29(3):710-718. PMID: 36849732

.

Updated by: Stefania Manetti, RDN, CDCES, RYT200, My Vita Sana LLC – Nourish and heal through food, San Jose, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.