A healthy living blog from Marshfield Clinic Health System

Sugar or artificial sweeteners? What’s best for diabetes

Are artificial sweeteners safe for diabetes? Should I use honey or agave nectar instead of sugar? I have diabetes – what is the best sugar substitute?

artificial sweeteners falling into spoon from someone with diabetes

Sugar substitutes are an option to provide desired sweetness to food without spiking blood sugars, but balance is key.

With conflicting information available about sugar and artificial sweeteners, these questions might have crossed your mind.

Sugar substitutes are an option, but moderation is important

If you have diabetes, you can manage your blood sugars better by limiting your intake of sugar, honey, molasses and agave nectar, which can raise blood sugars. Sugar substitutes are an option to provide desired sweetness to food without spiking blood sugars, but balance is key.

Many sugar substitutes have been approved by the FDA as GRAS (generally recognized as safe), but still should be consumed in moderation.

“Additional studies still need to be done regarding their long-term health effects. Some studies have found that artificial sweeteners can contribute to weight gain by increasing sugar cravings and dependence,” said Ashley Short, registered dietitian nutritionist and certified diabetes care and education specialist with Marshfield Clinic Health System.

Aspartame as a sugar substitute

Aspartame is an artificial sweetener that goes by the brand names Nutrasweet, Equal and Sugar Twin. It has a sweet taste without the calories and no impact on your blood sugar for diabetes, but still should be used in moderation.

The World Health Organization (WHO) lists aspartame as a possible cause of cancer. More research is needed to determine the connection between cancer and aspartame.

Sucralose as a sugar substitute

Sucralose is another artificial sweetener commonly used for diabetes and approved by the FDA as GRAS.

“Again, it is best to use in moderation just like aspartame. Sucralose may cause problems at higher dosages, but most people consume nowhere near that amount,” Short said.

Stevia and Monk fruit as sugar substitutes

Stevia and Monk fruit are also approved by the FDA as GRAS. Unlike some chemically based sugar alternatives, monk fruit extract and stevia are considered natural. Stevia is extracted from a plant and monk fruit is extracted from a fruit.

“Be careful reading ingredients on sugar substitutes. For example, some products that contain monk fruit will also contain erythritol. Erythritol is a sugar alcohol and is a type of artificial sweetener. Some studies have shown erythritol can increase blood clot formation and may be linked to heart attack and stroke. More studies are needed to make any definitive conclusions,” Short said.

Sugar alcohols may also lead to unpleasant side effects such as gas, bloating and diarrhea, especially if consumed in excess portions.

Adding flavor to beverages

When it comes to beverages, plain water is a great choice, but many people desire flavor or sweetness to their beverages.

“Other than using sugar substitutes, you can try infusing your water with fruit, if you’re seeking a ‘natural approach’. Cucumber water is also an option,” said Short.

Some water brands, such as Hint water, use natural fruit flavors and contain zero calories and zero sugar per serving.

You can use sugar substitutes or artificial sweeteners for cooking or baking, add them to your tea or coffee or check food labels for the ingredients listed on the chart below. Taste preference is also something to consider when choosing an artificial sweetener or sugar substitute.

Spot added sugar in your diet

You do not have to avoid regular sugar completely, but it is good to consume in moderation, especially added sugars. The American Heart Association recommends limiting added sugars to 100 calories (25 grams or six teaspoons) per day for women and 150 calories (37.5 grams or nine teaspoons) per day for men.  To put this into perspective, one 12 oz can of regular soda contains 8 tsp of sugar or 32 grams of sugar.

It’s important to read food labels well when grocery shopping.

“Added sugars are listed on food labels now under the total sugar. Some products you wouldn’t think are high in added sugars,” Short said.

Even if a product’s label says ‘sugar-free’ does not mean that product is calorie-free. Our daily calorie intake is what can ultimately affect weight.

In summary, it’s important to remember the saying – “all things in moderation”.

“It’s really a matter of outweighing the risks and the benefits. For example, someone with diabetes who is having high blood sugars daily from drinking one regular soda is at higher risk for negative health effects than if having one diet soda containing artificial sweeteners,” said Short.

Download this sweetener comparison chart

 

a comparison of artificial sweeteners for home use

For questions about sugar and diabetes, talk to a Marshfield Clinic Health System provider.

Schedule appointment Message your provider

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