If you’re living with diabetes, or even if you’re not, you might think sweet foods are a barrier to a healthy, balanced diet. As a general rule, everyone should be eating less sugar, however this doesn’t mean sugar has to be eliminated completely.
Whether you are trying to lose weight, or manage blood glucose levels, you may be interested whether sweeteners can help. It is important to know about the different types of sweeteners available and how to take them effectively (1).
What Are Sweeteners?
Sweeteners are ingredients that are added to food to enhance sweetness. They can be grouped in different ways: one way is to loosely group sweeteners as: sugar or sugar substitutes. Another way to group them is whether the sweetener is: natural or artificial (1). They can be found in products such as drinks, desserts, ready meals, cakes, chewing gum and toothpaste (2).
Types of Sweeteners
Nutritive Sweeteners
There are different types of nutritive sweeteners, but they all contain carbohydrate and provide calories. They are usually referred to as ‘sugars’ or ‘added sugars’, but they can also appear in the ingredient list of food packaging as: glucose, fructose, sucrose, maltose and honey and syrup.
One group of nutritive sweeteners is polyols, which are sugar alcohols, and include: erythritol, isomalt, maltitol, mannitol, sorbitol and xylitol.
A common myth is that natural sweeteners are “better” than refined sugar, however the reality is that these sweeteners are all broken down by the body into individual sugar molecules, contributing calories and raising blood sugar, the same way table sugar does (5).
Non-nutritive or artificial sweeteners
Non-nutritive sweeteners can be one way of reducing your overall carbohydrate and calorie intake if you use it instead of sugar. These are sometimes called ‘artificial sweeteners’ and are usually found in: ‘sugar-free’ foods and drinks, fizzy drinks, fruit juices, jellies, yogurts and chewing gums.
There are various artificial sweeteners licensed for use in the UK. These include aspartame, saccharin, sucralose, acesulfame, cyclamate (2).
Artificial sweeteners do not enter the blood stream and do not directly raise blood sugar. Instead, they stay in the digestive tract until they pass in the stool. In addition, some studies have found artificial sweeteners, particularly sucralose, aspartame and saccharin can alter the microbiome. These changes can disrupt how cells recognise insulin, leading to elevated blood sugar levels when normal carbohydrate-containing foods are consumed.
Other studies have shown artificial sweeteners may change our appetites and response to the taste of sweetness. Since artificial sweeteners can be 100-700 times sweeter than regular sugar, when our taste buds detect that level of sweetness, a signal is sent to our brain that a large influx of calories is coming. However, due to the fact that the sweeteners contain few or no calories, our brain and taste receptor remain confused why may cause stronger sugar craving to develop (5).
Sweeteners and Safety
A major concern for individuals who want to start taking sweeteners and reduce their sugar intake is regarding how safe they are as there are mixed reviews and research about certain sweeteners.
All non-nutritive sweeteners used in foods in the EU have to undergo rigorous safety testing before being approved by the European Commission. Food ingredient manufacturers have to provide evidence from safety studies showing that the sweetener in question:
- Doesn’t cause any adverse effects, including cancer
- Doesn’t affect reproduction
- Doesn’t cause allergic reactions
- Isn’t stored within the body, or metabolised into other potentially unsafe products (1)
Sweeteners and Health
Lower calorie or no calorie sweeteners will not necessarily make a food or drink healthy but it can be helpful in reducing sugar intake (2). However, recent research indicates that artificial sweeteners may be counterintuitive, especially when trying to manage or prevent diabetes.
Some artificial sweeteners claim to be “sugar-free” or “diabetic-friendly”, but research suggests they have the opposite effect. The body responds differently to artificial sweeteners than it does to regular sugar. Artificial sugar can interfere with the body’s learned taste, confusing the brain and sending signals telling you to eat more, especially sweet foods.
Sugar and Diabetes
If you have type 1 diabetes, there is no need to cut out sugar from your diet. While the exact cause of type 1 diabetes is unknown, it isn’t linked to lifestyle so sugar doesn’t directly cause the condition. However, the question whether sugar directly causes type 2 diabetes is a bit complicated.
Sugar is naturally found in fruit, vegetables (fructose) and dairy foods (lactose). It’s also added to food and drink by manufacturers, or by ourselves at home. These types of added sugars are called ‘free sugars’ and they are also present in pure fruit juices, smoothies, syrups and honey.
Though we know sugar doesn’t directly cause type 2 diabetes, you are more likely to get it if you are overweight. You gain weight when you take in more calories than your body needs, and sugar foods and drinks contain a lot of calories. Therefore, the more sugar you consume, the more weight will be gained and the more likely you are to develop diabetes type 2. However, it is important to remember this is a complex disease and sugar is unlikely to be the only reason the condition develops. It is also known that sugar sweetened drinks, like canned soft drinks, are associated with an increased risk of type 2 diabetes, and this is not necessarily linked to their effect on body weight (4).
Conclusion
It’s clear that sugar is damaging to our health in large amounts. However, replacing all sugar with sugar substitutes may not be beneficial either. More research is needed in order to determine the exact consequences/benefits of sweeteners. In general, it is safest to take for a short-term period to help people lessen their use of sugar and lose or manage weight. With this in mind, you should always be aware of how sugar substitutes affect your food and drink choices as they may get your tastebuds used to sweetness. On the other hand, artificial sweeteners can also help people enjoy sweetness without excess calories. If used in moderation, they can be part of a healthy diet (6).
Frequently Asked Questions (FAQ’s)
Can people with diabetes have sweeteners?
Yes. People with diabetes can use many sweeteners, but moderation and label reading are important.
Are natural sweeteners healthier?
Not always. Natural options like honey or agave still raise blood sugar, unlike stevia or monk fruit.
What’s the best sweetener for diabetes?
It depends on your body and taste. Stevia, monk fruit, and sucralose are common low-calorie choices.
How do I choose the right sweetener?
Try different kinds, check how your blood sugar responds, and talk with your dietitian.
References
- https://www.diabetes.org.uk/living-with-diabetes/eating/carbohydrates-and-diabetes/sugar-sweeteners-and-diabetes
- https://www.nhs.uk/live-well/eat-well/food-types/are-sweeteners-safe/
- https://www.healthline.com/health/type-2-diabetes/diabetes-stevia#health-risks-of-artificial-sweeteners
- https://www.diabetes.org.uk/living-with-diabetes/eating/sugar-and-diabetes
- https://www.massgeneral.org/news/article/artificial-sweeteners#:~:text=A%20common%20myth%20is%20that,choice%20for%20those%20with%20diabetes
- https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/artificial-sweeteners/art-20046936#:~:text=In%20general%2C%20it%20is%20safest,part%20of%20a%20healthy%20diet
