If there is one, clear message for people with diabetes it’s to limit sugar intake. Let’s be honest, we all like the taste of sweet. So, to get that sweet taste without added calories many people try sugar substitutes. Cutting calories and avoiding carbs sounds like an obvious choice. But the question is are sugar substitutes as good for us as we think they are?


What are Sugar Substitutes?

Let’s start with defining sugar substitutes. These are usually grouped together with other terms like low-calorie sweeteners, nonnutritive sweeteners, high-intensity sweeteners, or artificial sweeteners. Sugar substitutes are 200-20,000 times sweeter than sugar. Since only a small amount is needed, they provide very few or no calories. There are six sugar substitutes approved by FDA as food additives in US: acesulfame K, advatame, aspartame, neotame, saccharin, and sucralose. Stevia and monk fruit (Luo Han Guo) are also added to foods and given “generally recognized as safe” (GRAS) status. Stevia and monk fruit are technically not artificial sweeteners being that they come from plants. They are often marketed as natural sweeteners.


The FDA has an acceptable daily intake (ADI) level for seven sugar substitutes. The ADI is the amount of the sugar substitute that is considered safe if consumed daily for a lifetime. The ADI is based on body weight. For example, the ADI for sucralose for a person who weighs 132 pounds is 23 packets per day. To learn more about this, check out information from the FDA .


Sugar substitutes are commonly used in foods and beverages that are marketed as “sugar-free” or “diet”. Most of the consumption of sugar substitutes is from low-calorie beverages. A variety of foods may contain sugar substitutes including candy, baked goods, pudding, syrup, jams and jellies, yogurt, condiments, and snack foods. To know if a product contains a sugar substitute, you need to read the ingredient list on the food label. Because ingredients are listed by weight, sugar substitutes are usually listed at the end of the ingredient list.


Pros and Cons

There has been a lot of research done on sugar substitutes. There is research to support that using sugar substitutes reduces calorie and carbohydrate intake without affecting glucose levels. Many studies also associate sugar substitutes with weight loss.


Most sugar substitutes aren’t metabolized, so they are thought to leave the body and have no other effects. Research has shown that this isn’t the full story. Sugar substitutes can change the bacteria in our gut. Some studies have shown that consuming sugar substitutes increases hunger, appetite, and calorie intake causing weight gain. Studies have also shown a rise in glucose levels after consuming sugar substitutes. One of the most recent studies showed that regularly drinking beverages containing sugar substitutes increased risk of stroke, heart disease and death from any cause.


The research on sugar substitutes is controversial and there a lot of variables. The reality is that we all have a different response to sugar, sugar substitutes, and our other food and beverage choices thanks to genetics, our environment, and the balance of bacteria in our gut.


Here is what ADA says about sugar substitutes in their 2019 Standards of Medical Care in Diabetes:

“The use of nonnutritive sweeteners may have the potential to reduce overall calorie and carbohydrate intake if substituted for caloric (sugar) sweeteners and without compensation by intake of additional calories from other food sources. For those who consume sugar-sweetened beverages regularly, a low-calorie or nonnutritive-sweetened beverage may serve as a short-term replacement strategy, but overall, people are encouraged to decrease both sweetened and nonnutritive-sweetened beverages and use other alternatives with an emphasis on water intake”.


The current Dietary Guidelines for Americans states:

Artificial sweeteners—like saccharin, aspartame, acesulfame potassium (Ace-K), and sucralose—can help you cut down on calories. But they may not be a good way to manage your weight in the long run.


The Bottom Line

Sugar substitutes taste sweet-the more sweet-tasting things you eat the more you want that sweet taste. So, the message for both added sugar and sugar substitutes is to limit. Start by drinking more water and avoiding diet drinks. Be an informed consumer and read the ingredient list on food labels for sugar substitutes. What you eat and drink matters so make it count for your health.


by Christine McKinney, RD LDN CDE



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