What People With Diabetes Should Know About Sugar Substitutes

Overconsumption of sugar is a problem nationwide, though it is especially troublesome for those with diabetes. Over the past two decades, there has been a surge in nonnutritive sweeteners (also known sugar substitutes) designed to help consumers avoid the calories and metabolic response of sugar, and aid in glycemic management. Artificial sweeteners can help diabetics manage their blood glucose while allowing them to consume many of their favorite foods. However, is there a downside to the intensely sweet sugar substitutes? Here, we take a deeper dive to explore the nonnutritive sweeteners available today and their potential negative effects.

Nutritive sweeteners such as table sugar, brown sugar, fructose, honey, maple syrup, and agave nectar supply four calories per gram and raise blood glucose levels upon consumption. The Dietary Guidelines for Americans suggest individuals limit their intake of added sugars to account for no more than 10 percent of total daily calories for optimal health. It is imperative that diabetics limit their intake of these sweeteners for blood glucose management and to prevent further diabetes-related complications.

Sugar substitutes can be divided into two groups: artificial sweeteners and sugar alcohols. Artificial sweeteners with FDA approval include aspartame, saccharin, acesulfame potassium, advantame, sucralose, and neotame. These products are calorie-free and induce a negligible glycemic response. Stevia is also a calorie-free nonnutritive sweetener, though it differs from artificial sweeteners in that claims can be made that it is from a natural plant source. Because sugar substitutes are many times sweeter than table sugar, smaller amounts are needed to achieve the same level of sweetness as sugar in food.

Sugar alcohols include sorbitol, xylitol, lactitol, mannitol, erythritol, and maltitol. Unlike artificial sweeteners, sugar alcohols still provide calories (approximately 2 calories/gram), and therefore do still induce a slight glycemic response. Because sugar alcohols are not fully digested and absorbed, they can lead to gastrointestinal distress for some individuals. Sugar alcohols are primarily found in sugar-free candies, chewing gum, and some desserts, and may reduce the risk of dental cavities.

Nonnutritive sweeteners are regulated by the Food and Drug Administration as food additives or generally recognized as safe. The position of The Academy of Nutrition and Dietetics is that consumers may safely enjoy a range of nutritive sweeteners and nonnutritive sweeteners when consumed within an eating plan that is guided by nutrition governing bodies, such as the Dietary Guidelines for Americans. The American Diabetes Association cautions that using sugar substitutes can come with a few additional concerns, including higher fat content for palatability, supplementary additives or stabilizers, potential gastrointestinal side effects (mainly with sugar alcohols), and possibly a substantial amount of carbohydrates remaining in the product despite advertised claims. For these reasons, both nutritive and nonnutritive sweeteners should be consumed in moderation.