Sugar or artificial sweeteners? What's best for diabetes

Sugar or artificial sweeteners? What’s best for diabetes

Dec 18, 2023

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

10 responses to “Sugar or artificial sweeteners? What’s best for diabetes”

Haruko Sagami

Dec 21, 2023

How do you feel about Allulose?

Reply
1. Jordan Simonson
  
  Jan 2, 2024
  
  Hi Haruko, I was able to talk to our nutrition team and this is what they said, "Allulose would be just fine to use in moderation. It is approved by the FDA and is considered “GRAS” (Generally Recognized as Safe). Allulose is a sugar naturally found in figs, raisins, wheat, maple syrup and molasses. Studies have shown allulose tastes pretty similar to regular sugar and doesn’t have the bitter or “chemical” taste found in some other artificial sweeteners.
  
  Since Allulose occurs naturally in very small amounts, the allulose found packaged for sale isn’t its natural form. It has been created artificially by food scientists from fructose (fruit sugar). Chemically, allulose is similar to fructose, which is found naturally in fruits. It is also not absorbed into the body, and therefore, does not contribute to your daily caloric intake and does not have an effect on blood sugars based on current research.
  
  If consumed in large amounts, allulose may cause some stomach upset, gass, bloating and nausea. This can be common with other artificial sweeteners as well if consumed in excess quantities." -Thank you, Jordan
  
  Reply
Dawn

Jun 5, 2016

As a nutritionist and researcher, I will fully disagree with nearly everything in your article.
1. ALL Artificial sweeteners are neurotoxins (please research Dr Christiane Northrop as she has a great description of what artificial sweeteners do to the body)
2. Consuming aspartame is not much different than smoking as both turn to methanol and formaldehyde in the body. Formaldehyde and methanol are KNOWN to cause kidney damage amongst other things.
3. Saccharine has been linked to cancer.
4. Surcralose is a chlorocarbon, meaning it turns into chlorine in the body. This crosses the blood brain barrier causing lesions on the brain.

Now, research peer reviewed studies and see what chlorine, methanol, and formaldehyde do to the body. Also research neurotoxicity. When you consume something that is 100-600x sweeter than sugar, your body craves more sugar. Whether diabetic or not, people need to get back to WHOLE FOODS, which means real sugar (sugar in the raw that's brown), honey, molasses, and maple syrup. The stuff created in a plant are the things increasing our rate of disease…also, have you ever seen a person who is diabetic and utilizing artificial sweeteners ever reverse diabetes? I sure haven't; however, I see it reversed EVERYDAY in my practice when I have people STOP eating products and START eating food. One last tidbit of info – NO research has actually been completed on if ANY artificial sweetener affects blood sugar…NOT A SINGLE STUDY – nor has any study been completed to determine that they ARE calorie free! Get back to basics and whole foods people.

Reply
1. Kirsten Shakal
  
  Jun 6, 2016
  
  Dawn, thank you for the feedback. I am sharing your comments with the Shine365 blog team and Marshfield Clinic dietitians. To our knowledge, the information we've shared on artificial sweeteners is accurate. We do our best to update information as it is discovered. -Kirstie
  
  Reply
2. Lukas
  
  Feb 21, 2019
  
  There are about 50 calories in a tablespoon of sugar, I believe you accidentally listed this in a teaspoon format. I hope this helps.
  
  Reply
  1. Kirsten Shakal, Shine365 Editor
    
    Feb 21, 2019
    
    Lukas – You're absolutely right! Thank you for bringing this to our attention. We're working on updating this chart to reflect that information. -Kirstie
Shirley Burt

Feb 6, 2016

Great info. I'm 81, have a normal A1C and still worried about using the sweetners.

Reply
Ginny Wegner

Apr 30, 2015

Are artificial sweeteners harmful for children? (Crystal light rather than lemonade with sugar)

Reply
1. Jake Miller
  
  May 4, 2015
  
  Hi, Ginny,
  
  Thanks for the question.For children, the long-term effects of consuming artificially-sweetened beverages are unknown, so it’s best for kids to avoid them, according to research from Harvard School of Medicine. For both adults and children, it's recommended to limit amounts of any kind of sweetener in the diet, including sugar, sugar alcohols, high fructose corn syrup, Splenda, NutraSweet, and stevia, according to dietitian Teresa Murphy, Marshfield Clinic.
  
  Thanks
  
  Reply
Karen Pagel

Apr 30, 2015

Great information on sweeteners. Very helpful., Thanks, Karen

Reply