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Is All Sugar Created Equal?


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are all sugars the same, is all sugar the same
There are so many varieties of sugar. But is all sugar the same? istock.com/tashka2000

You’ve probably heard it countless times, especially in low-carb circles: sugar is sugar is sugar. This is true in principle – the glucose, fructose, and sucrose found in table sugar or high fructose corn syrup (HFCS) are the same molecules as the glucose, fructose, and sucrose in honey, fruit, and starchy vegetables.

But when it comes to the way your body uses these sugars, these foods are hardly comparable. In this article, I’ll show you why all sugar is not created equal, and why you should care.

Does sugar from fruit and starchy vegetables have the same impact on your health as a candy bar?

Fructose and High Fructose Corn Syrup Are Not the Same Thing

In my previous post in this series, I compared HFCS with white sugar and concluded that these two sweeteners are more or less metabolically equivalent. In the comments section, a few people brought up research showing that fructose is metabolized very differently from glucose; in fact, it’s metabolized more like alcohol.

I’ll address that research in a second, but first, understand this: high fructose corn syrup is not the same thing as fructose. Fructose is a simple sugar molecule with a specific chemical structure, while HFCS is a mixture of fructose and glucose in a roughly 1:1 ratio.

Now, there are certainly some scary studies about the metabolic effects of pure fructose. In animal models, fructose administration can cause dyslipidemia, non-alcoholic fatty liver disease, insulin resistance, and even type 2 diabetes. (1)

But these harmful effects result from animals being fed large amounts of pure, isolated fructose. In this form, fructose does act much like a toxin in the body, and it would be a terrible idea to start sweetening your food with pure fructose. But because fructose isn’t found in isolation in nature or even in our food supply, these studies are largely irrelevant to practical nutrition.

Already, we’re beginning to see that all sugar is not created equal, and that form and “packaging” makes a huge difference in metabolic effect. In this case, pure fructose does not affect the body the same way as fructose in sugar or HFCS. Now, what about fructose in fruit?

Fruit: More Than Just a Hit of Sugar

Although conventional wisdom holds that fruit is unquestionably a health food, the push to avoid sugar and excess carbohydrates has in many cases left people hesitant, even afraid to eat fruit. While it’s typically acknowledged that eating an apple is better than eating a bag of candy, fruit is still often seen as a source of sugar that should be consumed in strict moderation, and the phrase “sugar is sugar” is a common refrain, especially in Paleo or low-carb communities. The problem with this viewpoint is that added sweeteners and fruit have completely different metabolic effects.

First of all, the fiber and water found in whole fruit increase satiety, which makes it less likely that you’ll go into caloric excess. Studies going back more than forty years have shown that naturally occurring sugars in fruits are beneficial to health and do not promote weight gain, and we can see these effects in traditional cultures such as the Kuna, who obtain a significant percentage of their calories from fruit while remaining lean. (2, 3)

And despite some claims to the contrary, there’s no evidence that we should avoid whole fruit simply because it contains fructose. (4) Far from being a health hazard, like pure fructose or added sweeteners, studies overall suggest that eating whole, fresh fruit may actually decrease the risk of obesity and diabetes. (5) Additionally, randomized controlled trials have shown that eating fruit reduces oxidative stress markers and blood glucose in diabetics. (6) Further, limiting fruit intake has no effect on blood sugar, weight loss, or waist circumference. (7)

For most people, 3-5 servings of fruit per day is perfectly fine, although certain people with insulin resistance, diabetes, or metabolic syndrome may see improvements by restricting fruit intake to one to two servings a day, and by choosing fruits that are lower in sugar. Additionally, some benefits of fruit restriction for digestive issues come more from avoiding high FODMAP fruits as opposed to fruits altogether.

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Solid Sugar vs. Liquid Sugar

Another angle to consider is the issue of sweeteners in beverages versus sweeteners in solid foods. Countless studies have demonstrated that drinking your sugar has uniquely harmful effects, primarily because most people fail to reduce their caloric intake to compensate for the extra calories they’re consuming in sweetened drinks. (8)

For example, a study of 323 adults found that subjects who increased the number of calories they obtained from sugar-sweetened beverages didn’t decrease their caloric consumption from other sources. (9)

Another study showed that total calorie intake among sixteen patients was greater on the days that sugar-sweetened beverages were given at lunch than on the days they weren’t. So even when the sweetener used is the same (usually sugar or HFCS), consuming it in a beverage will have different health effects than consuming it in a food.

Real Honey vs. Fake Honey

I’ve already written about the unique metabolic effects of honey, and there have been studies comparing the effects of honey and “artificial honey” on blood lipids, insulin response, and blood sugar. Although artificial honey is a mixture of glucose and fructose in the same ratio as was found in natural honey, its metabolic effects are completely different.

In one study, supplementation with real honey decreased triglycerides and LDL cholesterol, increased HDL cholesterol, and even decreased plasma homocysteine. (10) On the contrary, the artificial “honey” raised triglycerides and LDL cholesterol. Other similar studies have found that natural honey results in more stable postprandial blood sugar and insulin response when compared with artificial honey. (11, 12)

There are further examples that I won’t get into, but I hope I’ve demonstrated that the phrase “sugar is sugar” is simply not accurate when it comes to nutrition and “real” food. The source of sugar does make a difference, and we as a community need to be careful about generalizing study results where they may not apply, and demonizing foods that don’t deserve to be demonized.

If you missed any of the previous articles in this series on sweeteners, be sure to check them out below, and stay tuned for the final post where I’ll tie everything up and give you some practical tips on where sweeteners should fit in a healthy diet. If you’re looking for a great brand for natural raw honey, I recommend Beekeeper’s Naturals.

Previous articles in this series:

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Join the conversation

  1. To answer these questions all that’s necessary is a blood glucose meter and occasional AIC tests ( 30 dollars without a requisition,via life extension foundation). Then, you’ll never have to wonder or have faith in anyone’s opinion again. Due to extreme digestive issues ( very long story) I cannot digest much besides fruit. I’ve had to deal with all the information that basically says sugar is the enemy. Of course “ sugar is sugar”. If you eat less of it because it takes time to eat an apple and you can drink down a ton of sugar in a soft drink or fruit juice, then fruit is better, along with it’s great nutrients and fiber. But the fiber in fruit is not bound with the sugar well, which is why it raises blood sugar almost as fast ( for me) as juice. Living on fruit if you have insulin resistance is very hard. But with burst exercise ( do cardio for 5-10 minutes after each little fruit meal) and my trusty glucose meter at least I’m able to eat!! And, many people have gotten healthy juicing and/ or eating raw food duets with lots of fruit. It is a sugar diet. It works because doing something like juicing takes all the metabolic burden of digestion away, so this amazing machine can heal itself. May we all find healing.

  2. I have a question about a certain type of sugar, crystalized sugar. Apparently called rock candy in English according to wikipedia. Where I come from it is used in certain types of cookies and I love the taste of it.
    I have read that this type of sugar is regarded as part of traditional chinese medicine. Does it have therapeutic properties ?
    I am just really curious, but cannot find anything about it

  3. If anyone here has done any research they would know that the reason diabetes is so prevalent is due to the mitochondria and pancreas destroying polyunsaturated fats and not sugar. Otherwise my blood sugar of 95 with 500+g of fruit sugar a day would not be possible.

    Have a nice day.

    • Hi Mike,

      I find you observation interesting. I agree with you that diabetes is caused by something else other than eating huge amounts of sugar or carbohydrates.

      So, does is follow from your statement that if one eats lots of fats, then one should not worry about diabetes?

      Please let me know if you have a blog or twitter account, where I can follow your comments and insights.


  4. I am grateful to the scientists out there who are continually researching and investigating what’s in our food and providing us with informed options on what we then choose to eat. However, it feels like we have put too much faith in the scientists to prove once and for all what is healthy for our bodies.
    What if we relied less on research, and more on what our bodies are telling us what is good for us and what supports us? Our bodies tell us at every opportunity whether it ‘likes’ that food we just ate or not. What we eat needs to be about what feels good in our body immediately and long after we’ve eaten the food, not about what tastes good. And you can have both!
    Our body can and does tell us (when we choose to listen and be totally honest with ourselves) how much sugar we need and from what source. One day we might need an apple, another day it might be blueberries. It won’t ever tell us we need to eat a candy bar though!
    Just listen, feel what’s going on, and we can then use our scientists to confirm what we already feel.

    • I try to keep my carbs down. I feel better when I do but I have noticed something interesting. When I have cane sugar I feel a crash and always regret it but when I eat coconut sugar I don’t get the big crash. Coconut sugar must break down completely different in my body.

  5. Unfortunately, knowing whether HFCS is more like sucrose or more like fructose is not possible. While the industry states it is 55-45 fructose-sucrose, independent testing has shown it to have a large variability, up to 65% fructose[1]

    If Richard Johnson’s hypothesis is right, and the fructose->uric acid pathway is a causal pathway to metabolic syndrome, diabetes, and obesity[2], then that extra amount is not just an unimportant mis-statement, but rather, a dangerous lie. Given the high fructose content in many of the “natural” sweeteners like honey and maple syrup, it would also recommend seriously limiting the use of those.

    1. http://onlinelibrary.wiley.com/doi/10.1038/oby.2010.255/full

    2. https://www.youtube.com/watch?v=blzZKUFN4x0

    • Beth, try eating coconut sugar and see/feel how that is in your body. Do you feel stimulated, racy, confused, bloated, headachy, dull, sad, flat, tired after eating it? Your body will tell you if you’re prepared to listen. Science is awesome, but your body is even more amazing and Always truthful – the body cannot lie.

    • Coconut Sugar has a significant sucrose and fructose content. It should affect blood sugar levels the same.
      From my readings of ALL the sweetener articles Chris Kresser wrote, my choice is Erythritol, Honey, Xylitol, and Stevia. That is, after detoxing from all sweet things for a couple weeks in order to rid the body and brain from the addiction to sweet things, so that when I choose to have something sweet, I can eat those sweeteners in moderate amounts.

  6. Chris,

    This is good information, but your examples don’t seem to speak specifically to the impact of the ‘sugar’ being ingested. When you say that the benefit to consuming sugar via fruit is better than consuming sugar via an articial means, your commentary focuses on how eating the fruit lowers your overall calorie intake, not to how the sugar from the fruit impacts your health ( or doesn’t).

    I remain confused about the impact of sugar in fruit vs the impact of sugar consumed artificially. I think a couple of notable ‘fruititarinas’-Steve Jobs and Horst Redenbacher (Aveda) both had significant liver damage that has NOT been directly tied to their diet but is certainly suspect given your reference to the non-alcohol fatty liver disease that has been a proven result of excessive intake of artificial sugars.

    Thanks for the attempts to simplify a nuanced problem but I’m not sure I have the answer yet.

    • Note that Steve Jobs and other fruitarians juice/d A LOT and consume fruit as juice rather than as the whole fruit, and also just consume fruit all day long, rather than in the context of a Paleo/ancestral approach.

  7. Well as a Type 1 diabetic, I can tell you no diabetic should eat 1 or 2 fruit servings per day if they want normal blood sugars. I’ve had diabetes for 50 years and I believe I’m a live and not blind today because I started eating a low carb high fat diet 10 years ago. Dr. Bernstein’s Diabetes Solution explains that even an average blood sugar of 120 mg/dl can cause disease.

    To me bread and bagels are not much more than baked blood sugar. Anyone with diabetes and even metabolic syndrome should know that eating something that their body cannot properly handle will do damage.

  8. When you say “drinking your sugar” will this apply to making smoothies only of pure fruit, with NO added sugar? Ive been trying to investigate the pros and cons of fruit smoothes, some claim that the fine liquid helps digestion of the nutrients, others claim that there will be greater sugar absorption and ‘destruction of the fiber’. What does the science say about this?

    • For extreme poor digestion cases, juicing is used to easily digest nutrients. In most cases, the main benefit is to quickly obtain nutrients, or in the case of vegetables, to be able to obtain a much larger quantity of nutrients without the time to eat them.

      The digestion of solids usually takes over 3 hours to enter the bloodstream. Anything juiced passes the digestive system and enters the bloodstream in less than 1/2 an hour. All nutrients… and all sugars.

      The fast increase of blood sugar from juicing fruits, not to mention fructose, starts the insulin-fatty acid chain reaction that happens with any sugar.

      Best to eat fruits, juice vegetables, and not too many of those that have a lot of sugar like carrots and beets.

    • Try using a 10 dollar blood glucose meter and getting your AIC tested every few months. It takes all the mystery out of it. You’ll know immediately the effects of that smoothie.

  9. I agree that the paleo crowd is not correct in considering fruit as the same as all other sugars. When I was a fairly strict raw foodist in San Diego, I knew lots of people that ate large amounts of fruit, none of whom had metabolic syndrome or blood sugar problems.
    This is an interesting website /book I just came across: http://www.healingdiabeteswithfruit.com/
    which discusses diabetic cases that have been healed largely by eating fruit. Dr. Gabriel Cousins also heals diabetes but does restrict fruits I believe while getting blood sugar under control. His documentary movie – “Simply Raw: Reversing Diabetes in 30 Days” is worth a watch too, though they ate mostly nuts, seeds and veggies

  10. More info on the ample fruit diets e.g. raw vegan, high raw etc, and their effects on fatty liver please. Do age and weight play a large role in those cases? Or what factors might modify a fatty liver response to an ample fruit diet?

  11. Interesting article, what I find in my practice is that some people seem to abuse honey and agave etc, because it is not table sugar they think they can use it liberally. I suppose there are people that eat too much fruit but that is not an issue I have encountered in my practice.

    • I read Suzanne Somers books and she states her husband used to eat 20 pieces of fruit a day. But he thot it was ok. It was fruit! Many adults feel the same…and about juice. Hey, its fruit; can’t be bad! Children will also do this if allowed, eat huge amts of fruit. They’re just subbing fruit for another junk food. Same dental caries, sugar imbalances, hyperactivity, diabesity as eating junk food.
      Adults who eat grains, esp wheat, will be eating way too many grains too so they can limit the fruit. If they go off the grains, boom! Fruit is the next food to abuse. Greens and fat are limited when not limiting grains and fruit, even when junkfood is cut out. When you have a client eating too many greens or other fibrous veggies, let me know. It’ll never happen with no limits on fruit.

    • > … abuse honey and agave etc, because it is
      > not table sugar they think they can use it liberally.

      I opined on honey earlier. On agave, you might tell them that so-called “agave nectar” should actually be called “extra high fructose agave root syrup”. It is usually made the same way as HFCS, and can be up to 90% free fructose.

      Making it also destroys the plant. Your tequila and mezcal drinking clients might be horrified about that.

  12. So then what sweetener is better option I was looking into Stevia sweet leaf any suggestions.

    • Some ppl feel stevia white powders or glycerite is too processed. They use the green powders or the stevia leaves themselves. For me even if it was as bad as hfcs or agave etc (which it’s nowhere near) I don’t have a problem becuz you need an infestimally small amt. And I also just trained my sweet tooth to need very little sweetness in my diet. Water with lemon or pure cranberry juice, whole fruit only, no caffeine drinks needing sweetening, most meals with no sweet taste at all. So when I have the rare almond flour muffin it can have stevia in it or the few drops in my greens smoothie.

      • Thank I am a sweet drinker I consume most of my calories from drinks so to switch to liquid stevia is going to be a huge change that I plan to achieve.. thanks for all the great input .

        • The thing is your body is hooked on the SUGAR not just the sweet taste. So when you switch to stevia, your body is not going to be happy. You’ll want more and more and more. Maybe even sugary/starchy foods.
          At least for a few days to a few weeks (I’ve seen it take a few WEEKS, yes). Then your body will adjust to low sugar intake. But be ready for a battle.
          And there are products out there that propose to make this transition easier/shorter. They don’t really– that I’ve ever seen.
          It’s a matter of simply being in agony for awhile.
          Knowing that tho may give you the fortitude to pull through it.
          There IS relief at the end of tunnel! Just keep slogging through the withdrawal and readjusting of your diet. It’s WORTH IT.

    • You might want to avoid products like Truvia.

      Many products promote the fact that they use stevia, but, you’ll find erythritol in the ingredients. For some reason, they don’t mention that (I wonder why).

      The last time I bought stevia, it was a liquid, in a little dropper bottle from my health food store – the store brand, IIRC. I rarely use sweeteners, myself, just eat my share of fruit to get plenty of sweetness and sugar carbs.

      If I was eating something that required sweetening, I would use stevia, based on the information I have, to date. I can handle pure cranberry juice just fine, so, I seem to have lost my sweet tooth.


  13. re: “natural honey”

    We can argue about the metabolic effects of this sugar, but anyone planning to consume it needs be aware of the rampant dilution, adulteration and outright fraud in the honey market. The chances that’s it’s largely HFCS are surprisingly high.

    I’ve previously summarized this on the Wheat Free Forum under topic “Honey”, linked from my user name here.

    I don’t eat honey. My personal policy on fructose is:
    – zero refined fructose from any source
    – fructose in whole foods only as whole fresh (not dried) fruits, and subject to my net carb targets (and fruits vary wildly in sugar content : blueberries do not equal papaya).

    Either blood sugar (BG and HbA1c) matter, or they don’t. If they do, the glucometer or HbA1c kit overrules the Nutrition Facts the fruits would have if they had an NF panel, which they don’t, so you’re on your own here.