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Ask Dana: Are artificial sweeteners good or bad to use for managing diabetes?

QUESTION:

Dear Dana,

I have heard a lot of controversy around the use of artificial sweeteners in the past few years.  I enjoy using artificial sweeteners in many things and consider it an important part of my diabetes management.  Recently I thought maybe I should reconsider that.  I have been led to believe artificial sweeteners are beneficial to me because they allow me to avoid sugar. But, should I have concerns about how they impact other aspects of my health?

– Billy English
Newport, Rhode Island

ANSWER:

Dear Billy,

Thank you for your question about the health concerns and benefits of artificial sweeteners, and whether the answer is different for individuals with diabetes. It’s important to weigh the pros and cons of using sugar substitutes, as each person’s needs and health conditions may vary.

For many people, including those with diabetes, artificial sweeteners can provide a way to enjoy sweet-tasting foods and beverages without significantly impacting blood sugar levels or adding extra calories. This can help with blood sugar control and weight management, which are important aspects of diabetes management.  While these sweeteners are generally considered safe for consumption by regulatory agencies such as the US Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA), thereare some health concerns associated with their use. As such, these regulatory agencies have set an Acceptable Daily Intake (ADI) limit for these ingredients.

artificial sweeteners

Notably, there have been numerous studies leading to evidenced-based conclusions that certain artificial sweeteners are linked to health concerns. 

  • First, there is some evidence to suggest that consuming artificially sweetened beverages may lead to weight gain. One theory is that the sweet taste of these drinks may increase cravings for high-calorie foods, leading to overeating and weight gain.
  • Studies have also shown that consuming artificial sweeteners may be associated with an increased risk of type 2 diabetes. The exact mechanism behind this is not well understood, but it is thought that the sweet taste of these substances may disrupt the body’s ability to regulate blood sugar levels.
  • Third, research has suggested that artificial sweeteners may have a negative impact on the microbiome of the gut, which could lead to a variety of health problems. For example, changes in gut bacteria have been linked to obesity, inflammation, and other health issues.  Animal studies have suggested that certain artificial sweeteners may be linked to an increased risk of cancer. However, the evidence in humans is less clear, and regulatory agencies still consider these sweeteners to be safe for human consumption.

With these concerns in mind, there are several artificial sweeteners that are considered safe and healthy for human consumption when used in moderation.

Erythritol is a sugar alcohol that is found naturally in some fruits and fermented foods. It has a very low glycemic index and is not metabolized by the body, so it doesn’t contribute to spikes in blood sugar levels.

Xylitol is another sugar alcohol that is found naturally in some fruits and vegetables. It has a low glycemic index and is believed to have a number of health benefits, including improved dental health.  It is worth noting that consuming large amounts of sugar alcohols can cause digestive issues such as bloating, gas, and diarrhea, particularly in people who are sensitive to them.

It should be noted that there are natural sweeteners that have less calories and less glycemic impact on blood sugars without the health concerns associated with artificial sweeteners.

Stevia is a natural sweetener derived from the leaves of the Stevia rebaudiana plant.

Monk fruit extract is a natural sweetener derived from the monk fruit, which is native to southern China. Both have a sweet taste without the calories or potential negative health effects of sugar.

Allulose is a rare sugar found naturally in small quantities in some fruits and vegetables.  Allulose has a similar taste and texture to sugar but has a fraction of the calories and does not contribute to a large spike in blood sugars.  Other natural sugars like honey and agave nectar do not have negative health consequences but do contain dense calories and will impact blood sugars.

As with all parts of diabetes management, it is important to monitor your blood sugars and notice your body’s reactions to different sweeteners, as individual responses may vary.  Consult with your healthcare team for personalized advice and guidance when making dietary decisions.  The Registered Dietitians at IDS can help guide you towards making good choices for both weight and diabetes management and help you become more confident on choosing nutritious, and delicious, foods.

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