To be honest, the first thought is that most worry far too much about sugar. Sugar is not a four-letter word.
· The metabolic end fate of ANY carbohydrate, whether fruit, vegetable, fructose, sugar, agave, or HFCS is conversion to glucose.
· The main macronutrient source for the muscles is carbohydrate – glucose, sugar.
· The organ that uses the greatest percentage of dietary carbohydrate is the brain. The only source of nutrition for the brain (in absence of starvation / fasting) is sugar / glucose.
· Fructose, as it is a carbohydrate as found in fruits and most vegetables, has been consumed by man for millennia.
· The differences today? Cheap food; excess calorie consumption, consumption of primarily highly-processed foods; along with absence of consumption of whole foods.
· Most are consuming magnitudes increase in calories – often from empty-calorie carbohydrates – and not nutrient-dense, calorically-balanced foods.
Whether from pure sugar, honey (which is high in fructose), agave syrup, or similar, in moderation carbohydrates are necessary parts of the diet (and in sweet foods, a treat), again, in context with an overall healthy diet. We need to read closely exactly what is being said:
“…"Agave syrup is almost all fructose, highly processed sugar with great marketing," said Dr. Ingrid Kohlstadt, a fellow of the American College of Nutrition and an associate faculty member at Johns Hopkins School of Public Health. "Fructose interferes with healthy metabolism when (consumed) at higher doses"…”
Yes, out of balance, without moderation, ANY sugar is an issue. No one consumes “glucose” alone. Most always, anytime one consumes carbohydrate one consumes fructose. While fructose is metabolized differently than glucose, the metabolic end-fate is the same, conversion to glucose. The issue with fructose, again, is volume. It is well known that many people get a majority of their carbohydrate intake from both processed juice drinks and soda.
“…If you simply must have some sweets, a small amount of agave nectar every once in a while isn't going to kill you. Just don't buy into the idea that it's any better for you than plain old sugar or HFCS…”
Nor any worse. At its most basic, what is fructose? A low-glycemic index, non-insulinogenic carbohydrate as found in fruits and many vegetables.
“… A sugar is a sugar is a sugar, [says Kantha Shelke, a food chemist specializing in natural foods and principal with the Chicago-based food science think tank Corvus Blue]…”
Yes, and sugar [carbohydrate] has been consumed by man since his existence began. The difference today? Imbalanced food intake. Period. Fructose, regardless of form, is the major carbohydrate in fruits and vegetables. The issue is volume.
The question may be what is the agave nectar being used on?
If someone is mixing up a big glass of agave-sweetened water, how different is that from soda? Not much. Empty calories.
If someone is using agave syrup in moderation, along with a macronutrient balanced, calorically balanced, whole-food diet, is it an issue? I think most all would agree that no it is not.
What is interesting regarding the question on PCOS, is that is “sugar” the main problem in PCOS? In some yes, the majority no. The issue in PCOS is likely genetic insulin signaling so that those who still consume a quality diet may have symptom. That is why compounds such as myoinositol, which function on signaling / messenger molecules, are of help in many with PCOS away from straight diet (which should be the first item addressed in any patient). Many women with PCOS are of normal insulin and normal weight.
“…Polycystic ovary syndrome (PCOS) is a syndrome involving defects in primary cellular control mechanisms that result in the expression of chronic anovulation and hyperandrogenism. This syndrome has been for many years one of the most controversial entities in gynecological endocrinology. Polycystic ovary syndrome has been proven to be a familial condition. Although the role of genetic factors in PCOS is strongly supported, the genes that are involved in the etiology of the syndrome have not been fully investigated until now, as well as the environmental contribution in their expression. The heterogeneity of the syndrome entertains the mystery around this condition which concerns thousands of infertile women worldwide. Some genes have shown altered expression suggesting that the genetic abnormality in PCOS affects signal transduction pathways controlling steroidogenesis, steroid hormones action, gonadotrophin action and regulation, insulin action and secretion, energy homeostasis, chronic inflammation and others. The present review of the contemporary literature constitutes an effort to present all the trends in the current research for the etiology of polycystic ovary syndrome…” Hippokratia. 2009 Oct;13(4):216-23. Genetics of polycystic ovary syndrome. Prapas et al.