Diabetes Forecast

5 Must-Know Facts About Sweeteners

Sugar substitutes: Safety, calories, and blood glucose impacts

By Meghann Moore, RD, CDE , ,

Wavebreakmedia Ltd/Thinkstock

The average American may not be an expert in diabetes, but there’s one thing most people know about the disease: Sugar is a big deal. That single fact is the source of myths (eat a large slice of cake and you’ll get diabetes!) and reality (eat a large slice of cake and your blood glucose will spike!). And because people like the taste of sweet but don’t want the calories or carbohydrate, sugar substitutes are also a big deal.

For people with diabetes, the science of sugar is part of daily life. That’s because sugar, a type of carbohydrate, quickly raises blood glucose levels. As more and more people are diagnosed with the disease, the attention on sugar is growing. Food manufacturers have jumped on the bandwagon by creating no-sugar-added and low-sugar foods.

Between 1986 and 2010, the number of American adults eating and drinking sugar-free foods and beverages jumped from 78 million to 187 million, according to the Calorie Control Council. Diet soft drinks are the most popular sugar-free products, followed by non-carbonated soft drinks, gum, and sugar substitutes.

Sugar substitutes, also known as nonnutritive sweeteners or artificial sweeteners, have little to no calories or carbohydrate and are often considered “free foods,” with generally no effect on your blood glucose or waistline. They are used in place of sugar to sweeten and enhance the flavor of foods. Because they are hundreds—if not thousands—of times sweeter than table sugar, you don’t need to use as much to get the same level of sugary sweetness.

Nonnutritive sweeteners can also be found in no-sugar-added, light, and diet versions of prepared foods, such as yogurt. And many can be used to replace some or all of the sugar in cooking or baking. Read on for the skinny on sweeteners—and how they affect your blood glucose and weight management.

1. I have diabetes. Is avoiding sugar more important for me than for other people?    

Sugar needen’t be avoided altogether—unless you wish to do so—but does need to be accounted for in your eating plan and any medication dosing. You may eat more sugar than you realize. It’s hiding in unexpected foods, such as bread, salad dressing, and pasta sauce.

People in the United States currently eat or drink about 15 percent of their total daily calories in the form of added sugar—those sugars added to foods and drinks by the manufacturer, cook, or consumer. The World Health Organization recommends limiting added sugars (as well as honey, syrup, and fruit juice) to less than 10 percent of total daily calories for all people, with or without diabetes. Eating more added sugar than this has been shown to increase the risk of obesity, heart disease, cancer, type 2 diabetes, and cavities.

Experts know that sugar-sweetened beverages contribute a lot of added sugar to the average American diet. The American Diabetes Association advises people with diabetes to limit or avoid drinking sugar-sweetened beverages to lower their chances of gaining weight and reduce their risk for heart disease. In fact, other major medical organizations recommend that all people drink fewer or avoid sugar-sweetened beverages, including soda and sports drinks.

2. Are artificial sweeteners safe?

Yes. There are currently six Food and Drug Administration–approved artificial sweeteners and two “generally recognized as safe” artificial sweeteners in the United States. Based on current scientific evidence, the FDA has concluded that these approved sweeteners meet the safety standard of “reasonable certainty of no harm” for the general population when they eat less than the acceptable daily intake. (See “Know Your Sugar Substitutes” below to learn how much of each sweetener you can eat and stay in the safe range.)

You might be wondering whether artificial sweeteners cause cancer, because surely you heard that they did, right? Yes … and no. In the 1970s, saccharin was linked to the development of bladder cancer in rats, and foods containing it were required to have a warning label. Since then, however, more than 30 human studies have shown that the results found in rats were not relevant to humans and that saccharin is safe for human consumption. Saccharin no longer has a warning label.

The Academy of Nutrition and Dietetics says that people can safely enjoy a range of nonnutritive sweeteners when they are part of an eating plan that is guided by current federal nutrition recommendations (such as the Dietary Guidelines for Americans and the Dietary Reference Intakes) as well as individual health goals and personal preference. The Academy does state, however, that there is not enough research on the safety of nonnutritive sweeteners during pregnancy or in the case of gestational diabetes.

3. Are natural sweeteners better for me than artificial options?

A lot of food manufacturers use the term “natural” to describe their products. But there is no industry-approved definition of the word, so its use is often meaningless. When it comes to nonnutritive sweeteners, “natural” usually refers to those that are made from a substance found in nature and/or without artificial or synthetic additives. Artificial sweeteners, on the other hand, are created in a laboratory.

But there is no research to suggest that nonnutritive natural sweeteners are healthier or better for you in any way compared with their competitors.

Natural sweeteners can also refer to sweeteners with calories, such as maple syrup, molasses, barley malt and rice syrups, honey, agave nectar, coconut sugar, date sugar, and sucanat. These sweeteners are essentially less processed and arguably better for you than sugar because they contain some trace vitamins and minerals. But don’t get excited—sugar is really still sugar, and it’s far from a healthy food choice. A good goal: no more sugar from all sources than the equivalent of 6 teaspoons for women and 9 teaspoons for men each day.

4. Will nonnutritive sweeteners help me lose weight?

Seventy-three percent of people who consume low- or no-calorie sweeteners say they use these products to reduce their total daily calories. Products containinglow- or no-calorie sweeteners may help with weight loss if they are used in place of their full-calorie counterparts—provided you don’t eat or drink those calories (or more) through other sources.

For example, drink a can of diet soda instead of the sugar-sweetened alternative, and you’ll save 150 calories. But if you drink that calorie-free soda and then indulge in a 150-calorie (or more) snack, you lose the potential weight-loss benefit.

Although the research isn’t conclusive—and, in fact, is somewhat controversial—some scientists believe that consuming food and beverages with artificial sweeteners can increase hunger, appetite, and calorie intake by decreasing the feeling of fullness or by training your taste buds to like sweet things so that you’ll then eat more of them.

The bottom line: If you want to use nonnutritive sweeteners to help you lose weight, don’t eat more of something else to make up for the calories saved.

5. Will artificial sweeteners make me gain weight or can they cause diabetes?

Last year, a team of researchers published their controversial findings that artificial sweeteners may lead to obesity and type 2 diabetes in mice by changing the bacteria in their intestines that affect metabolism. The change essentially stimulated gut bacteria growth and helped calories turn into body fat more efficiently.

The study went something like this: Researchers fed saccharin, sucralose, or aspartame to a group of mice every day. They gave a control group of mice glucose or sucrose daily. After 11 weeks, the mice fed artificial sweetener had abnormally high blood glucose levels whereas the sugar-eating mice did not. When the researchers killed off the gut bacteria in the artificial sweetener–eating mice, blood glucose levels went back to normal.

The researchers wondered whether the same connection could be true in humans, too. So they tracked blood glucose levels in seven people who normally didn’t eat or drink artificially sweetened products. The volunteers were given the FDA’s acceptable daily intake of saccharin for six days. By the end of the study, blood glucose levels had risen in four of the seven participants and their intestinal bacteria had changed.

There are many criticisms of the study, including its design (what happens in rodents does not necessarily happen in humans), size, length, and the quantity of artificial sweetener used in the study (much greater than the average daily intake).

So what does all of this mean for you? It’s too soon to draw any conclusions about artificial sweeteners causing obesity or type 2 diabetes. Although additional research is needed, artificial sweeteners are still considered a reasonable choice over sugar for weight and blood glucose management.

Sweet Tips

  • Although artificial sweeteners can be used in place of sugar in many foods, thus lowering the calorie and carbohydrate content, this does not necessarily mean those foods are carb free, sugar free, or calorie free.
  • When considering blood glucose and body weight, be sure to check Nutrition Fact labels for the total carbohydrate and calories in your foods.
  • Eating foods made with nonnutritive sweeteners is one way to get your sweet fix without the negative impact of nutritionally poor sugar. Plus, they may help with weight loss—if they truly replace some of your caloric intake. But consider that a sweet piece of fruit has far more good-for-you vitamins and minerals.
  • Artificial sweeteners continue to be recognized as safe and are not known to cause either diabetes or weight gain.

Sweet Facts

  • Sugar (brown, powdered, raw, and white) and maple syrup have 2.5 to 4.6 grams of carbohydrate per teaspoon and 10 to 18 calories.
  • Powdered sugar has less carbohydrate (2.5 grams) and fewer calories (10) per teaspoon than other types of sugar.
  • Agave and honey have 5.3 to 5.7 grams carbohydrate per teaspoon and 21 calories.

How Much Sugar Is OK to Eat?


Acceptable daily intake (ADI): the amount of a substance in a food or drink that is considered safe to consume each day over the course of a person’s lifetime

Calorie free: a food or drink with less than 5 calories per serving

Food and Drug Administration (FDA): the U.S. organization responsible for protecting the public’s health by assuring that most foods are safe, wholesome, sanitary, and properly labeled

Generally recognized as safe (GRAS): a food is given this designation by the FDA when experts evaluate its safety and conclude that the substance is safe under the conditions of its intended use. A company can make an independent GRAS determination for a substance with or without notifying the FDA.

Nonnutritive sweeteners: those that contain less than 2 percent of the calories in an equivalent amount of sugar or have no calories at all. Also known as artificial sweeteners, sugar substitutes, low-calorie sweeteners, noncaloric sweeteners, or high-intensity sweeteners

Nutritive sweeteners: those that contain more than 2 percent of the calories in an equivalent amount of sugar

Sugar: sweet-flavored carbohydrate substance used in food. Includes white sugar, powdered sugar, brown sugar, dehydrated cane juice, corn syrup, and high-fructose corn syrup, among others

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