by Amy Medling, founder of PCOS Diva
Refined sugar is one of the most vilified food ingredients in the last 15 years for good reason. Excessive consumption of table sugar has been linked to health issues such as obesity, heart disease, cognitive disease, cancers, and of course Type 2 Diabetes just to name a few.
It goes without saying that people would be better off if they consumed their sugar in the form of fruit or just avoid it all together. This is particularly true for women with PCOS since we already have to go the extra mile when it comes to regulating our insulin levels. For that reason, let’s explore alternative sweeteners women with PCOS should consider in place of sugar as well as discuss the ones we should avoid altogether.
Sweeteners I Recommend For PCOS
Stevia is one of the latest entries in the sweetener industry and is becoming a healthy mainstream alternative to other sweeteners. One reason for its popularity is that it’s a “bio sweetener” since its sweetness is not artificially sourced. Stevia’s sweetness is traced back to glycoside (bound to sugar) compounds of steviol, with the two most important steviol glycosides being stevioside and rebaudioside A.
Stevia is truly a natural sweetener with actual health benefits. Low dose consumption of stevia is associated with anti-inflammatory and anti-oxidative effects, both of which have been linked to protection of the pancreas, brain, kidneys, and liver. 
Stevia is also 200-300 times sweeter than refined sugar on a per gram basis which means the amount of stevia you have to carry to is 200-300 times smaller and more portable. 
All that on top of stevia’s antihyperglycemic effect makes stevia a worthy sugar substitute. 
Caveat: Not all stevia products are created equally. Stevia is actually quite an expensive sweetener, so some companies compromise on purity and quality so they can sell it for less. Brands like Truvia use up to 40-steps to manufacture their patented stevia-ish product and make use of additives and other alternative sweeteners like xylitol and erythritol.
Xylitol and Erythritol are sugar alcohols and both are often touted for being natural additives. There’s really nothing wrong with these two sweeteners since the side effects associated with them often involve excessive consumption and the amount included in products are usually on the safe side.
The problem is that most stevia companies try to outsmart consumers by using more alternative sweeteners than the actual stevia itself.
Be vigilant and learn to read your labels. When a box says “all natural” or “pure” stevia, be skeptical. Look for organic green stevia powder. If you have no other options, look for the ones that put stevia as the first ingredient (being listed first means stevia is the primary ingredient) and make sure the ingredient count is no more than three. Remember: you’re buying stevia for the stevia, not for the additives.
There’s something to be said for what is probably the world’s oldest sweetener. Honey can have a variety of flavors and levels of sweetness depending on the source. Some can appear dark while others are crystal clear. On top of having a low glycemic index (which means less impact on your blood sugar) ranging from 40-55, honey has been studied for its potential antimicrobial activity. 
On top of being a household product, maple has been shown to have potential diabetes benefits due to its low glycemic index of 54.  It’s also been shown to have some benefits when it comes to inhibiting colorectal cancer cell growth.  When you buy a bottle of maple syrup, make sure you’re buying 100% pure maple syrup, not the ones containing corn syrup.
Yacon syrup supplies a good amount of fructooligosaccharides, carbohydrates that are prebiotic in nature. Yacon, on top of not spiking blood sugar levels compared to refined sugar, may have benefits for intestinal health and reduce appetite (by means of increasing insulin sensitivity) which can contribute to weight loss. 
Also known as the Buddha fruit, Monk Fruit is created by removing the seeds and skin of the fruit, collecting the juice produced from crushing it, which is then dried and converted to concentrated powder.
While Monk Fruit does contain fructose and glucose, its intense sweetness (200-300 times sweeter than refined sugar) is actually from antioxidants called mogrosides and is the reason why Monk Fruit is considered healthy. Mogrosides have been studied for their antioxidant, anti-cancer, and even anti-diabetic properties.
The mogrosides are separated from the juice which eliminates both fructose and glucose. Eliminating these two means the sweetener naturally has zero calories and doesn’t increase blood sugar.
Diva Note: The glycemic indexes of yacon, maple syrup, and honey are all relatively lower than that of refined sugar. Regardless, consumers should still be wary of using too much, or you’ll end up offsetting their benefits. This is specially the case when you already have high insulin. Also, remember that excessive consumption of any sweetener can trigger cravings for more sweets.
Remember back when zero-calorie and artificial sweeteners were said to be the best thing since sliced bread? We got the likes of Aspartame, Acesulfame potassium, Equal, NutraSweet, Sucralose, and other artificial alternatives entering the market and making everyone think they’d finally solve all their weight problems one sachet at a time.
Fast forward decades later and we’re still seeing the same problems. Diabetes is still at an all-time high, people still suffer from chronic inflammation, and America is still really, really fat.
So what went wrong? In fact, artificial sweeteners have some serious drawbacks when it comes to your health. They have been linked to potential cancer risks, metabolic syndrome disorders like PCOS, autism, and general toxicity. [10-13]
The Case Against Agave Nectar & Coconut Sugar
For years, people flocked to agave nectar (or agave syrup) for its natural sweetness. It’s true, agave does taste much sweeter than sugar while still having a low glycemic index of 11. While that seems to be quite an advantage, people are unaware agave is actually 90% fructose, and as we all know, the high concentration of fructose is the reason why we don’t like high fructose corn syrup. Not only that, the nutritional value associated with agave is all but gone after processing.
Coconut sugar is a trendy sugar substitute popularized by its low glycemic index and rather unique taste. Apart from those two likeable traits, there really isn’t much to coconut sugar as far as health benefits are concerned. Case in point is how coconut sugar’s major component is still sucrose at roughly 75%. Sucrose is also known as table or refined sugar, and it’s made up of 50% fructose. That makes coconut sugar contain around 38% fructose.
We should remember the reason why we’re opting for alternative sweeteners is due to table sugar’s high fructose content. While coconut sugar has a marginally lower amount of the monosaccharide, it doesn’t necessarily make it something you can use excessively. If anything, in order to maximize its benefit on the glycemic index you have to make sure you don’t consume more than you would table sugar.
Having PCOS doesn’t have to mean you can’t satisfy your sweet cravings anymore. It only means you have to go the extra mile in making sure you don’t overload your system with refined sugar or even its artificial alternatives. The sweeteners I recommend here are not only palatable, but also much better than refined sugar or any other form of artificial alternative because of their potential health benefits and low glycemic indexes.
Regardless of any ingredient’s health benefits, it’s always good to play it safe and moderate your consumption.
As a certified health coach and best-selling author of Healing PCOS, Amy Medling often hears from women with Polycystic Ovarian Syndrome (PCOS) who are frustrated and have lost all hope when the only solution their doctors offer is to lose weight, take a pill and live with their symptoms. In response, she founded PCOS Diva and developed a proven protocol of supplements, diet and lifestyle programs that offer women tools to help gain control of their PCOS and regain their fertility, femininity, health and happiness.
- Shivanna N, Naika M, Khanum F, Kaul VK. Antioxidant, anti-diabetic and renal protective properties of Stevia rebaudiana. J Diabetes Complicat. 2013;27(2):103-13.
- Assaei R, Mokarram P, Dastghaib S, et al. Hypoglycemic Effect of Aquatic Extract of Stevia in Pancreas of Diabetic Rats: PPARγ-dependent Regulation or Antioxidant Potential. Avicenna J Med Biotechnol. 2016;8(2):65-74.
- Soejarto DD, Kinghorn AD, Farnsworth NR. Potential sweetening agents of plant origin. III. Organoleptic evaluation of Stevia leaf herbarium samples for sweetness. J Nat Prod. 1982;45(5):590-99.
- Gregersen S, Jeppesen PB, Holst JJ, Hermansen K. Antihyperglycemic effects of stevioside in type 2 diabetic subjects. Metab Clin Exp. 2004;53(1):73-6.
- Mandal MD, Mandal S. Honey: its medicinal property and antibacterial activity. Asian Pac J Trop Biomed. 2011;1(2):154-60.
- Nagai N, Ito Y, Taga A. Comparison of the enhancement of plasma glucose levels in type 2 diabetes Otsuka Long-Evans Tokushima Fatty rats by oral administration of sucrose or maple syrup. J Oleo Sci. 2013;62(9):737-43.
- Yamamoto T, Uemura K, Moriyama K, Mitamura K, Taga A. Inhibitory effect of maple syrup on the cell growth and invasion of human colorectal cancer cells. Oncol Rep. 2015;33(4):1579-84.
- Geyer M, Manrique I, Degen L, Beglinger C. Effect of yacon (Smallanthus sonchifolius) on colonic transit time in healthy volunteers. Digestion. 2008;78(1):30-3.
- Caetano BF, De moura NA, Almeida AP, Dias MC, Sivieri K, Barbisan LF. Yacon (Smallanthus sonchifolius) as a Food Supplement: Health-Promoting Benefits of Fructooligosaccharides. Nutrients. 2016;8(7)
- Soffritti M, Padovani M, Tibaldi E, Falcioni L, Manservisi F, Belpoggi F. The carcinogenic effects of aspartame: The urgent need for regulatory re-evaluation. Am J Ind Med. 2014;57(4):383-97.
- Araújo JR, Martel F, Keating E. Exposure to non-nutritive sweeteners during pregnancy and lactation: Impact in programming of metabolic diseases in the progeny later in life. Reprod Toxicol. 2014;49:196-201.
- Kalkbrenner AE, Schmidt RJ, Penlesky AC. Environmental chemical exposures and autism spectrum disorders: a review of the epidemiological evidence. Curr Probl Pediatr Adolesc Health Care. 2014;44(10):277-318.
- Van eyk AD. The effect of five artificial sweeteners on Caco-2, HT-29 and HEK-293 cells. Drug Chem Toxicol. 2015;38(3):318-27.