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The growing popularity of date sweeteners may create a misleading “healthy” image despite their high fructose content and potential metabolic risks, according to a review of current evidence on date-based products. This article reviews the current evidence on the health effects of date-based sweeteners compared with table sugar.

According to the Federal Statistical Office, the per capita sugar consumption in Germany reached 33.2 kg in 2024, equivalent to a daily intake of 32 sugar cubes per person. Excessive sugar intake and frequent consumption of high-glycemic foods are associated with an increased risk for metabolic and cardiovascular diseases.

Studies have found that several sugar alternatives, including sugar substitutes and different forms of sugar, have entered the market in recent decades in an effort to reduce daily sugar intake. A newer trend involves using dates as a sugar replacement for snack bars, dairy products, muesli, and baked foods.

Despite their high calorie, carbohydrate, and sugar contents, dates have a moderate glycemic index, largely because of their fiber content. Fiber supports the gut microbiota and slows intestinal sugar absorption, making sharp glucose spikes less likely. One hundred grams of dates, or about four medium-sized Medjool dates, contain roughly 7 g of dietary fiber. Studies have also shown that daily date consumption improves bowel movement.

Unlike table sugar, dates also contain micronutrients and bioactive compounds, including polyphenols, tannins, flavonoids, carotenoids, amino acids, calcium, iron, magnesium, potassium, phosphorus, sodium, zinc, manganese, and vitamins A, B1, and B2. Copper, fluorine, and selenium found in dates contribute to nerve function and cell growth.

Laboratory studies linked date consumption with lower inflammatory markers in the brain, findings that researchers said could potentially reduce the risk for neurodegenerative diseases such as Alzheimer’s disease. Researchers are also studying the associations between inflammatory markers and memory and learning performance.

Risk Factors

In Germany, dried dates are typically sold, which lowers their water content and increases their sugar concentration compared with fresh dates. For example, 100 g of dried Medjool dates contain neary 68 g of sugar. A single dried Medjool date contains about 17 g of sugar, equivalent to approximately six sugar cubes.

Of these, 17 g of sugar, approximately 8.5 g is glucose and 8.5 g is fructose. The high fructose content of dates contributes to their low glycemic index. While glucose enters the bloodstream directly through active intestinal transport and is taken up by muscle and fat cells in an insulin-dependent manner, fructose is processed mainly in the liver after passive intestinal absorption. Excessive fructose intake can therefore lead to liver fat accumulation and increase the risk for nonalcoholic fatty liver disease and metabolic disorders over time.

Studies have shown that fructose metabolism occurs independently of insulin and therefore produces less satiety, potentially encouraging overconsumption.

Animal studies have further suggested that fructose consumption may promote tumor growth in melanoma, breast cancer, and cervical cancer. Although these tumor cells lack ketohexokinase C, the enzyme needed for fructose metabolism is used by the cells for growth.

However, primary hepatocytes expressing ketohexokinase C can release bioactive lipids, known as lysophosphatidylcholine, following fructose metabolism. Cancer cells subsequently absorb these lipids and produce phosphatidylcholine, a key component of cell membranes.

In vivo studies showed that fructose supplementation increased serum concentrations of certain lysophosphatidylcholines sevenfold. In mice, direct injection of these lysophosphatidylcholines was also associated with increased tumor growth.

Foods sweetened with dates instead of table sugar may offer some health advantages over conventionally sweetened products. Dates are naturally rich in fiber, which supports gut health, and contain micronutrients that contribute to normal physiologic function. They also function as natural thickening agents and can improve the texture of sweet foods.

Replacing table sugar with date syrup, rather than whole dates, may be more problematic. Dates, and therefore date syrup, contain excessive amounts of fructose. Without the fiber and water present in whole dates, fructose provides limited satiety because it is metabolized in the liver independently of insulin. Although this contributes to the relatively low glycemic index of fructose, it may also promote overconsumption. Excess intake has been associated with nonalcoholic fatty liver disease, other metabolic disorders, and tumor growth.

Within this context, broad conclusions about the health effects of dates compared with table sugar are difficult to make. Any food considered safe for human consumption, along with nutrients essential to human physiology, can have a place in the diet when consumed with a proper understanding of its biological effects.

This story was translated from Univadis Germany, part of the Medscape Professional Network.