If you think that people with diabetes should always avoid sugar, think again — they can enjoy the sweet stuff, in moderation. “The best bet is to use a very minimal amount of real sugar as part of a balanced diabetic diet,” says Keri Glassman, MS, RD, CDN, of Nutritious Life, a nutrition practice based in New York City. That being said, sugar substitutes offer sweetness while controlling carbohydrate intake and blood glucose. There are many sugar substitutes to choose from, but they’re not all calorie-free and they vary in terms of their impact on blood sugar. “The major difference between the sugar substitutes is whether they are nutritive or non-nutritive sweeteners,” says Melissa Mullins, MS, RD, a certified diabetes educator with Johnston Memorial Hospital in Abingdon, Va. “Non-nutritive sweeteners provide no calories and no changes in blood glucose levels, which is perfect for people with diabetes.” Here are six sweet options to consider.
A sugar substitute is a food additive that provides a sweet taste like that of sugar while containing significantly less food energy. Some sugar substitutes are natural and some are synthetic. Those that are not natural are, in general, called artificial sweeteners.
Synthetic sugar substitutes are referred to as artificial sweeteners and have more intense sweetness than sugar. Artificial sweeteners have been controversial as to whether or not they pose any health risks, but so far no studies have conclusively found any and each sweetener is FDA approved. Some commonly used artificial sweeteners include:
Splenda: Good for Diabetes
Splenda is a brand name for sucralose, a non-nutritive or artificial sweetener, which is excellent for people with diabetes — type 2 diabetes in particular. Splenda is 600 times sweeter than sugar, says Glassman, but those little yellow packets have no effect on blood sugar. In addition, Splenda passes through the body with minimal absorption.
Saccharin: Watch Out for Weight Gain
Saccharin, the sweetener sold in pink packets under the brand name Sweet ‘N’ Low, is calorie-free and is about 300 to 500 times sweeter than sugar. Though it can be a sugar substitute option for those with diabetes, “research has shown that the intake of saccharin can lead to weight gain,” Glassman warns. “Usually, when one eats a sweet food, the body expects calories to accompany that food. When the body does not get those calories, it looks for them elsewhere. This can lead to greater calorie consumption throughout the day as your body craves the caloric satisfaction it has missed,” she explains.
Aspartame: Possible Side Effects
Aspartame, sold in blue packets under the brand names Equal and NutraSweet, is a non-nutritive artificial sweetener that is 200 times sweeter than sugar. While not zero calories like some other artificial sweeteners, aspartame is still very low in calories. But while the U.S. Food and Drug Administration has reviewed the scientific research and found aspartame to be safe for human consumption, Glassman notes that there have also been some conflicting study results on aspartame’s safety. “Although its low calorie reputation is appealing for most weight-conscious individuals, it has been linked to many negative side effects,” Glassman says. “Some research shows linkage to leukemia, lympho
ma, and breast cancer. Other research shows a linkage to migraines.” In addition, people with phenylketonuria (PKU), a rare condition in which they are unable to metabolize phenylalanine (a key component of aspertame), should not consume this sugar substitute.
Stevia: An All-Natural Option
Truvia, the newbie among sugar substitutes, is one brand of the sweetener derived from the leaf of the stevia plant, native to Central and South America. Truvia is calorie-free and has been shown to have little to no impact on blood sugar, which is why it is an
excellent sugar substitute for diabetic people. The U.S. Food and Drug Administration has approved the use of certain stevia extracts as a sweetener in foods and beverages, and other brands, including Pure Via and Sun Crystals. There have been anecdotal reports of side effects associated with over-consumption of stevia, including headaches and gastrointestinal symptoms, but to date there is no solid scientific research to back this up.
Agave: Super Sweetener
Derived from the sap of the agave plant, agave nectar is a form of sugar, but it is low on the glycemic index. This means that agave is absorbed more slowly by the body, causing a relatively lower spike in blood sugar and less of a sugar rush than other forms of the real thing. “Its low glycemic index makes it a good sugar substitute for diabe
tic people,” says Glassman. One caveat: agave has about 60 calories per tablespoon, making portion control essential. However, Glassman notes,”agave is 1.5 times sweeter than sugar, so you can use less.”
Sugar Alcohols: Low-Calorie Sweeteners
Sugar alcohols, or polyols, are derived from the natural fibers in fruits and vegetables. They do contain carbohydrates, so they are considered nutritive sweeteners. Though sugar alcohols are relatively low in calories and blood-sugar friendly, they can cause indigestion, bloating, diarrhea, and headaches. See how you respond to a small amount before incorporating them into your daily diet. Examples of sugar alcohols include sorbitol, mannitol, and xylitol.
Mullins says that sugar alcohols contain some carbohydrates, and some types break down more completely than others. “I recommend that people who are going to use these sugar substitutes keep track of carbohydrate levels,” says Mullins. “Subtract half the amount of sugar alcohols from the total number of carbohydrates to understand how many carbs are actually being consumed and the impact on blood glucose levels.”
Artificial sweeteners each have an acceptable daily intake (ADI). This can help a person determine how much of each sweetener to consume. “I recommend either Aspartame or Sucralose depending on a person’s taste preference and recommend using either in moderation,” says Gillian Arathuzik, R.D., C.D.E., Nutrition Diabetes Educator, at Joslin Diabetes Center.