A common question asked by diabetics is whether they should substitute honey for table sugar in their diet. This is generally motivated by the belief that a “natural” product like honey will be better for their health than a refined product such as table sugar.
In general, I am of the belief that better management of diabetes comes not from eating a single food or focusing on a particular food group, but instead from the combined effect of numerous lifestyle and dietary changes such as weight-loss, a higher intake of fruits, vegetables, and whole grains, and increased physical exercise. Having said that, their is certainly a case to be made that substituting table sugar for honey can lead to better glycemic control and an improvement in some cardiovascular risk factors. We will discuss these more in detail below.
Short term effects of honey on blood sugar levels
The easiest way to compare the likely impact on blood sugar levels is to compare the glycemic index values of table sugar and honey. Table sugar (sucrose) has a glycemic index of 62 compared to an average of 54 for honey. This means that compared to table sugar, an equivalent amount of carbohydrates from honey will result, on average, in a 13% lower increase in blood glucose levels. Furthermore, most people find honey to be slightly sweeter than sucrose and therefore can use less of it to sweeten foods (however keep in mind that a teaspoon of honey weighs more than a teaspoon of table sugar because it is denser).
Honey consists of approximately 80% carbohydrate (in the form of various sugars) and 20% water. Like many fruits, honey contains a significant amount of fructose. Although the sugar content varies widely depending on the region the honey was sourced from, fructose and glucose occur in around a 1:1.5 ratio and make up the majority of the sugar content of honey while small amounts of maltose, galactose, sucrose, and around 20 other sugars are also present.
The presence of fructose and glucose together is important because the two seem to work synergistically to improve glucose control. Fructose increases the activity of the enzymes glucokinase and glycogen synthase. Glucokinase is involved in the uptake of glucose by the liver while glycogen synthase is involved in the conversion of glucose to glycogen, which is the long term storage molecule for glucose. Therefore, foods containing fructose help improve glucose uptake and storage, resulting in lower blood glucose levels.
A 2000 study, published in the Journal of Clinical Endocrinology & Metabolism, compared the glycemic response of 11 healthy adults to 75g of glucose, with or without the addition of a small amount of fructose (7.5g). The researchers found that the glucose response, as measured by the area under the 3-hour blood glucose curve, decreased by an average of 19% with the addition of fructose.
Longer term effects of honey
Several studies have looked at the longer term effects of honey consumption on overall health. In general, honey appears to decrease fasting glucose levels and improve various markers of cardiovascular disease. Cardiovascular disease is a big issue for diabetics as the risk of developing heart disease or suffering a stroke is around three times higher than in non-diabetics. Heart attacks and other cardiovascular diseases are responsible for two-thirds of all deaths in the diabetic population.
A 2008 study by researchers at the Heart and Vascular Research Center in Mashhad, Iran, compared the effects of sucrose and honey in a group of 55 overweight volunteers. The participants were randomized to receive either 70 g of sucrose or honey daily for the 30 day study period. The researchers found significant reductions in fasting blood glucose (4.2%), total cholesterol (3%), LDL cholesterol (5.8%), triglycerides (11%), and C-reactive protein (3.2%). In contrast, the above measurements remained unchanged or even worsened slightly in the sucrose group. Furthermore, the body-weight of the volunteers in the honey group actually reduced slightly despite the additional calories from honey and the fact that no other diet or lifestyle changes were made.
The researchers concluded that: “Consumption of natural honey in overweight and obese subjects reduced cardiovascular risk factors, particularly in subjects with elevated risk factors, and it did not increase body weight in overweight or obese subjects.”
Honey exhibits mild anti-inflammatory and anti-oxidant properties which might explain some of the improvements in cardiovascular health observed in the study. Honey also contains trace amounts of the minerals: calcium, iron, magnesium, phosphorus, potassium, zinc, copper, manganese and selenium, many of which play a role in glucose and insulin metabolism as well as the health of the pancreas.
Overall, it appears that substituting honey for table sugar may result in some modest benefits for diabetics however keep in mind that honey still contains a large amount of calories – a tablespoon of honey actually contains more calories than a tablespoon of table sugar due to its higher density. The majority of type-2 diabetics are overweight or obese and in these people weight-loss is generally the best way to improve glycemic control. With that in mind, if you want to try honey rather than sucrose as a sweetening agent, try and limit your consumption of honey to less than a serving a day (approx 20g or 60 calories).
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