Are sugar substitutes a good choice for people with diabetes?
Sugar substitutes or artificial sweeteners such as aspartame (NutraSweet) or sucralose (Splenda) can be healthy choices for anyone wanting to cut back on sugar and calories -- and that includes people with diabetes.
By themselves, most sugar substitutes are "free foods" that won't raise your blood sugar or load you up with calories. "Sugar alcohols" such as mannitol, sorbitol and xylitol -- found in some gums, candies, and baked goods -- don't pack many calories, but they can raise blood sugar.
But sugar substitutes aren't a free pass to eat whatever you want. If you're adding a sweetener to your morning cereal or buying artificially sweetened cookies or cakes, you should know that sugar-free foods may still have plenty of calories and carbohydrates. Even if you somehow managed to take every grain of sugar out of your diet, you'd still have to watch what you eat. Rather than diet sodas, for example, you might be better served by a glass of ice water with a squeeze of real lemon.
How are sugar substitutes different from real sugar?
Some sugar substitutes, including saccharin and aspartame, are man-made chemicals. Others, such as sucralose, are modified versions of real sugar. Whatever the source, sugar substitutes are hundreds or even thousands of times sweeter than the real thing. For this reason, you get plenty of sweetness from just a tiny amount of saccharin, sucralose, or other substitutes. Some artificial sweeteners, such as aspartame, have a few calories (saccharin and sucralose have none), but since you use just little at a time, the calories don't really matter.
Are sugar substitutes safe?
Sugar substitutes are thought to be safe. They have been tested again and again, and there's no evidence that they can do any harm in normal amounts. (The exception: Aspartame can be dangerous for people with phenylketonuria, a rare genetic disorder.) Although laboratory studies have found that huge does of saccharin can cause bladder cancer in animals, there doesn't seem to be much of a threat to humans. By U.S. Food and Drug Administration standards, a typical adult could consume nine to 12 packets of saccharin a day without worry.
The American Pregnancy Association recommends that women with gestational diabetes, diabetes mellitus, or insulin resistance should limit their exposure to nutritive sweeteners, which include both table sugar and some "sugar-free" sweeteners known as sugar alcohols (such as sorbitol, xylitol, isomalt, and mannitol). Although many women assume sugar alcohols don't contribute to excess weight gain during pregnancy, these substances do contain calories that can be converted into fat. Some experts also suggest that pregnant women also avoid saccharin.
Do I have to use sugar substitutes instead of the real thing?
Contrary to common belief, people with diabetes can eat sugar, as long as they don't go overboard. In fact, a gram of sugar isn't much different from a gram of any other carbohydrate, such as rice or pasta. But if you want to lose weight and get better control of your blood sugar, artificial sweeteners can be a big help. Just be sure to read food labels and continue to check your blood sugar levels regularly. And remember that it's unlikely you'll lose weight by using sugar substitutes -- to do that, you simply need to eat fewer calories.
Mayo Clinic. Artificial sweeteners: A safe alternative to sugar? 2008. http://www.mayoclinic.com/health/artificial-sweeteners/MY00073
Mayo Clinic. Artificial sweeteners: Any effect on blood sugar? 2008. http://www.mayoclinic.com/health/artificial-sweeteners/AN00348
American Diabetes Association. The diabetes food pyramid: Sugar. http://www.diabetes.org/nutrition-and-recipes/nutrition/sugar.jsp
Harvard Medical School. Are artificial sweeteners safe? https://www.health.harvard.edu/healthbeat/HEALTHbeat_033005.htm
American Pregnancy Association. Using artificial sweeteners during pregnancy. http://www.americanpregnancy.org/pregnancyhealth/artificialsweetner.htm
American Diabetes Association. Sugar and sugar substitutes. http://www.diabetes.org/for-parents-and-kids/diabetes-care/sugar.jsp
University of Pittsburgh Medical Center. Artificial sweeteners. http://www.upmc.com/HealthAtoZ/patienteducation/Documents/ArtificialSweet.pdf
International Food Information Council Foundation. IFIC Review: Low-Calorie Sweeteners and Health. http://www.ific.org/publications/reviews/upload/Low-Calorie-Sweeteners-and-Health.pdf