Classically, the biggest villains to the health food store were that terrible trio of white substances: refined sugar, salt and bleached flour. Today, however, some health food stores are changing their policies on one of these culprits: sugar.

Those consumers who are smart enough to read labels may have become increasingly aware of sugar's reintroduction into many "healthy" products that used to shun it. And making this sweet dilemma more difficult is the fact that there apparently are a lot of new names for sugar.

Sugar by Any Other Name

Perhaps because it sounds like it fits in with a New Age mentality, a lot of manufacturers are using the word "crystals" in describing their sweetening agents nowadays. But sugar they are. To list just a few, there are: cane juice crystals, dehydrated cane juice crystals, unrefined cane juice crystals, raw cane crystals, washed cane juice crystals, Florida crystals (a trademarked name), unbleached evaporated sugar cane juice crystals, crystallized cane juice, and unbleached crystallized evaporated cane juice. There are also products with such names as organic dehydrated cane juice, unbleached sugar cane, evaporated cane juice, and evaporated cane juice sugar.

Part of the way these new sugars are being sold to consumers is by touting the fact that less refined sugars require less fossil fuel to produce, and that the "transportation chain" and the refining process are shorter. Critics argue that health food stores, in an effort to appeal to the sweet-teeth of regular, health-conscious clients (as well as "cross over" customers from the supermarkets) are trying to bump up the sweetness of ice creams, candies, cookies and cakes. Trade magazine articles (and, no doubt, some aware consumers) have been questioning whether the health food industry has sold out by letting sugar back on their shelves.

Rather than adding to the tempest that's being stirred up in this already sweet teapot, Organica decided to talk to some specialists in nutrition to find out what—if any—differences there are between the various sweeteners that are available on your health food store shelves. How much sugar is too much? Are there alternatives?

Ultimately, of course, it's up to you, the consumer, to decide what you put in your mouth. They say knowledge is power. Here's the skinny on sucrose:

Opinion #1, Vimlan VanDien

"One hundred grams of dried cane juice is pretty much the same thing as 100 grams of other sweeteners, no matter what you call it," says Vimlan VanDien, a nutritionist at the respected Bastyr University, in Seattle, Washington. "When people call these sugars something other than sugar, it's deceptive in a way—if the market is uninformed. Because dehydrated cane juice is sugar. It simply sounds like a whole food."

VanDien feels that calling these sweeteners something other than what they are is a way that some consumers can sugarcoat their consciences too.

"To a certain extent," she explains, "when people buy products with so-called alternative sweeteners, it gives them an excuse to eat sugar. They'll say, ‘Oh, it's organic, so it's O.K.' Or, ‘It's a whole food.' But it's not whole food. If you wanted the whole food, you'd go out in the field and eat the sugar cane, and get all the fiber and nutrients it has."

VanDien does applaud the concept of organic dehydrated cane juice, which some manufacturers have advertised. "If it's organic," she notes, "it would at least not have the pesticides and residues of regular sugar. But if it's not organic, you're getting pesticides too."

The nutritionist's advice for consumers is, " ...look at the package to see if it tells how many grams of sugar are in the product." That is one sure guide to controlling your sugar intake.

VanDien's assessment of sweeteners is pretty rigorous. She thinks virtually every commonly used sweetener is as bad as sugar when it makes up a significant part of the diet, as it does for too many Americans.

"Whether you're talking about cane sugar, honey, barley malt or Sucanat (a tradenamed product), they're all primarily simple sugars, simple carbohydrates," VanDien explains. "People should be concerned that, if they're eating 150 pounds of sugar a year and you change that to 150 pounds of barley malt, you'll have the same problems with your immune system and blood sugar levels you would have if you are eating the sugar."

How the Body Uses Sugar

When you eat a "simple carbohydrate" such as sugar, it is broken down by your saliva, and by enzymes in the pancreas. It is further broken down into glucose in the small intestine, which in turn is absorbed into the bloodstream. Finally, it is carried to the liver, where it is either used as energy, or (if not used), stored as fat.

VanDien doesn't agree with the manufacturers who say a sweetener can be nutritious. "Some people will say, ‘Yes, but sugar is carbs, and carbs are nutrients. So, some sweeteners are nutritious.' But I'd say to that that while you may be getting some nutrient, there's no such thing as a nutrient-dense sweetener. And along with it, you're getting empty calories. Sugar, for too many people," says the nutritionist, "is replacing nutrient dense foods. And most people in this country don't need empty calories. They need nutrient dense foods."

VanDien also has strong views about product manufacturers who tout some of the "new," less refined sugars as containing important minerals and vitamins that are leached out of more refined sugar (which is essentially pure sucrose). "Manufacturers who say their sugars have vitamins in them—that's hogwash," says VanDien. "If you're looking for B vitamins in foods, eat grains. Don't eat sugars. When you're eating a carbohydrate, like sugar, it needs B vitamins to be converted to energy. Since sugar doesn't have B vitamins in it, your body has to supply those vitamins to convert those carbs," she says. "So, you're using your body's stores of B vitamins."

VanDien notes that there are, "...some trace elements of vitamins and minerals in honey, brown sugar, barley malt and the like." But she questions whether their mineral content is enough to make any difference. She also points to the "plethora of diseases—diabetes and heart disease being the two most obvious—that accompany obesity.

She stresses that people with hypoglycemia and diabetes would be well advised to watch not just their sugar intake, but would also want to avoid eating a lot of "alternative" sweeteners such as honey or barley malt. "If you have those health problems, you should also be watching your intake of total carbs, not just your simple sugars," she says. "Diabetics should manage their total carbohydrate load. For hypoglycemia, doctors sometimes give some sugar to bring the level back up, but then the pancreas releases insulin to clear it out. So, there's a yo-yo effect. The latest advice is to eat balanced meals regularly. More snacks. A little carbs, a little protein, a little fat."

What about fruit juice and artificially sweetened products? VanDien isn't much more fond of concentrated fruit juice sweeteners. "Some of them are nothing more than refined white grape juice, with no fiber, and no complex carbohydrates. You might as well be eating sugar," VanDien says. "Generally, when you see fruit juice sweetened, it's not necessarily better than sugar."

Naturally, the nutritionist thinks people should shun artificial sweeteners, some of which are "potentially carcinogenic." But while VanDien faults sugar for not being "nutrient dense," she also says that "almost anything, in moderation, is not bad. I think balance and moderation are the key words.

"However, too many people in this country eat too much sugar. There's a big difference between eating a scoop or two of ice cream, and eating a whole pint. Because, in large quantities, sugar suppresses the immune system. Go to a fast food place and get a "Big Gulp" drink. At 100 grams of sugar, you'll start to depress your white blood cell activity. Normally, foods in a health food store won't have that much sugar in them."

Asked for a good "alternative" to using sugar and the other sweeteners that aren't much better than sugar in her estimation, VanDien said, "Stevia (see sidebar) might be a good substitute. It's non-caloric."

Opinion #2, Dr. Nan Fuchs

Twenty five years ago, Dr. Nan Fuchs (pronounced fewks) wanted to be healthier. She obtained an M.S. and Ph.D.. in nutrition. And by her own accounts, she has "tried to stay as unbiased as possible" about nutrition.

Today, she has a California-based consulting practice called The Nutrition Detective. Fuchs treats people "who are either sick, or simply want to be healthier." She is also nutrition advisor to the national Women's Health Letter, and is the author of two books, The Nutrition Detective and Overcoming the Legacy of Overeating.

Dr. Fuchs says she originally got interested in sugar because she personally had had a problem metabolizing it in the past. Not surprisingly, she's outspoken on the reintroduction of sugar into many health food stores.

"It's a question of economics," says Fuchs. "Health food stores and manufacturers are capturing dollars from products that are not necessarily the best quality or the healthiest. Some of the companies that use things such as evaporated cane juice say they've studied it and find that people metabolize their sugars more slowly than refined sugar. But I find people who have the same problems with evaporated cane juice as they do with regular sugar. And I deal with people all over the country. I find that people who react to sucrose, or refined sugar, are reacting in the same way to evaporated cane juice," says Fuchs.

Fuchs also agrees with VanDien that the amounts of trace minerals and vitamins in the more "unrefined" sugars are negligible, and that they don't have the B vitamins the body needs. "There are many people who are predisposed to have a problem with sugar—alcoholics, the children of alcoholics, drug abusers. There are people who physiologically and genetically can't metabolize sugar," says Fuchs. "But you must always remember that nutrition is an individual thing. It depends on the person."

What to do if sugar adversely affects you? "If sugar affects your mood, makes you jittery, suppresses your immune system and you have a weak immune system, then you should avoid sugar," says Fuchs. "I say go off cane sugar, sucrose, honey for a couple of weeks, and then eat some and see if it produces those same symptoms—such as problems associated with blood sugar levels spiking and dropping, and that sense of fatigue. But we would probably all benefit by eating less of anything that's high in sucrose, and that includes refined sugar, brown sugar, honey and evaporated cane juice."

Fuchs does feel that some alternative sweeteners are clearly better than sugar, or the so-called lesser refined sugars. "Sugar is 93 percent sucrose. That's different than barley malt, which is maltose and glucose, and different than maple syrup, or fruit juice concentrate. You can't say those are the same things as sugar when their chemical compositions are different."

Fuchs believes that fruit juice concentrates used to sweeten some products are better than refined sugar, and that brown rice syrup is a better choice, while being half as sweet as sugar. She also notes that health food stores which offer these alternative sweeteners in products also often couple them with whole grains, which give the consumer some essential B vitamins. "A Twinkie is refined sugar and white flour," says the doctor, "so you're getting no nutrients."

Another sideline benefit of eating products that are fruit juice sweetened, in Fuchs' mind, is that the consumer doesn't get "triggered" into eating more and more of fruit juice sweetened products, as they might when eating appetite-stimulating sugar. "If you eat toast and fruit juice sweetened preserves it doesn't satisfy your craving for sucrose, but it should satisfy your need for something sweet," she says.

If people want a substitute for sugar, Fuchs recommends a product called Fruit Source, sold in syrup or granulated form. "It tastes a lot like brown sugar," she notes, "and works in cookies and baking."

Health Problems Associated with Sugar

Fuchs says that "sugar adds to imbalances" in the human body. "It may contribute to gas, intestinal flora, fatigue and PMS," she explains. "Sugar depresses the immune system. It depletes vitamins and minerals; it may even contribute to osteoporosis in older women, because sugar causes calcium and magnesium to be depleted."

When Dr. Fuchs counsels someone who is craving sugar (displaying the symptoms of somebody who is "sugar addicted"), she first determines that they're not suffering from a Candida overdose, or an allergy. She then switches the patient to fruit juice sweetened products, "to get them off the trigger food." Fuchs has the client stay off the suspected trigger food for a couple of weeks, and then reintroduces the food to see if they have a reaction.

"Of course, it takes some work to stay off sugar. There are a lot of hidden sugars: in salad dressing, tomato sauce, many products," she adds. "Part of the problem is, 100 years ago there wasn't that much sugar around in foods. Now, it's in lots of products."

"I'm not saying all sugar is bad. But too much sugar is bad. Just like too much wheat and too much caffeine is bad," says Fuchs. "A healthful diet is about balance."

Fuchs says simply: if you're eating too much sugar or any other sweetener, cut back. "Some people eat strawberries, or grapefruit, and pour sugar on them. Their palates have been molded into saying, ‘This isn't sweet enough.' But a strawberry should be sweet enough, unless it isn't ripe. A fruit-juice-only jam should be sweet enough. Applesauce shouldn't need sugar added to it," she says. "It's a simple fact that people need to get back to appreciating the taste of fruits and other foods."

VanDien agrees wholeheartedly, and her advice for getting people back to being able to taste the natural sweetness in foods is simple. "I tell people, if you were going to make a cake, and you want to sweeten it, you can do so by putting whole apples in it—that would be a good way to use a sweetener. Dried fruits is another way to get fiber."

"Basically," says VanDien, "we need to reeducate our palates so that we can taste the sweetness in a carrot."

ALTERNATIVE SWEETENERS "A" LIST

Here are some of the sweeteners you may encounter in products:

Amasake: One of the least refined of the "natural" sugars, fermented and filtered, made from brown rice.

Barley malt: Mostly maltose. A dark, sweet, thick liquid. Sometimes used in malted milks.

Brown rice syrup: Cultured (usually naturally fermented) rice, broken down by enzymes, strained and cooked to a syrup-like consistency. Is also available in powder form.

Corn syrup: Cheap to produce, it's basically glucose with water. Dark corn syrup has food coloring in it.

Date sugar: Made from pulverized (generally not refined) dates, it contains sucrose, glucose and fructose. It's low in grams of sugar per teaspoon, low in calories.

Florida Crystals: A trademarked brand, slightly less refined than white refined sugar.

Fruit juice concentrate: "Reduced" (broken down) peaches, pears, pineapple, white grapes and other fruits are used. Concentrates can be highly refined. If a product has slightly refined or unrefined fruit juice, it will obviously be more nutrient dense.

Honey: A mix of sugars. Usually about 30-40% glucose, 40-60% fructose. Honey does contain some nutrients, but not many. It's very high in calories. Honey may sometimes be "stretched" with additives, and some imported honeys are reportedly "contaminated." It's best to buy local honey.

Molasses: The dark brown syrup left after sugar processing has milled out and crystallized the sugar for refining. After filtering, molasses may have sulfur added to kill bacteria, and stabilize it. Blackstrap molasses contains iron and traces of vitamins and minerals.

Stevia: Made from the leaves of a Paraguayan herb, and usually found in powder form, it is 300 times sweeter than sugar. A little goes a very long way (obviously). It's non-caloric, which is generally considered a plus. (See Stevia sidebar.)