It is easy to get overwhelmed when you walk through grocery stores, with all the different brands and health claims for the many sugar substitutes. For those who have diabetes or prediabetes, it can be confusing.
There has been a rise in awareness about the dangers of adding sugars to foods due to the obesity and diabetes epidemics. According to the U.S. Dietary guidelines for Americans, added sugars should not exceed 10% of calories. This amounts to approximately 270 calories per daily.
This is because sugars can be sweetened or flavored, but they have very little nutritional value. This trend has prompted the food industry to seek out the best substitute for sugar. It must have the same taste as sugar without the excess calories that can lead to weight gain.
As a pharmacist, who is also board-certified in advanced diabetes management, my patients and I speak daily about blood sugars. I am often asked by patients if there is a sugar substitute. The short answer to that question is no. Here's the long answer.
Sugar alcohols
Two main categories can be made of sugar substitutes: high-intensity sweeteners and sugar alcohols. Sugar alcohols are sorbitol (xylitol), mannitol (mannitol), erythritol, maltitol and lactitol. Saccharin, aspartame and acesulfame potassium (Ace-K), sucralose and neotame are high-intensity sweeteners.
Toothpaste, chewing gum and other sugar-free foods are common sources of sugar alcohols. These are carbohydrates that have a chemical structure similar to sugar and also contain alcohol-making components. They are 25-100% sweeter and have the same taste as sugar. However, they are not calorie-free. They contain between 1.5 and 2 calories per gram. Compare the calorie count with sucrose (also known as sugar), which has four calories per Gram twice as many.
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Sugar alcohols are lower in calories but can still raise blood sugar levels, especially if consumed in large quantities. The effect of sugar alcohols is much less than that of sugar. This is due to the way these molecules are processed by the body. This is measured using the glycemic indicator.
Glycemic index refers to the speed at which food is broken down and absorbed. The higher the number, it means that food is broken down faster and sugar enters the blood more quickly. Sucrose has an index of 65, while sugar alcohols like xylitol have an index of seven. Sugar alcohols are more difficult to digest and result in a slower, lower rise in blood sugars after meals. This is usually better for diabetics. Sugar alcohols are more difficult to digest, so some may remain in the stomach. This can lead to digestive problems like cramping, gas, and diarrhea.
The downside to foods that contain sugar alcohols is that they often contain higher amounts of fat and salt to compensate for their lower sugar content.
Artificial sweeteners
High-intensity sweeteners are low- or no-calorie alternatives to sugar. They can be made from many different sources and are 100-20,000 times sweeter than sugar. Some have a metallic or bitter taste. Stevia and SGFE are two newer substitutes that come from plants. They are sometimes referred to as natural alternatives.
The American Diabetes Association 2019 guidelines state that high-intensity sweeteners can decrease carbohydrate and calorie intake. These calories cannot be replaced with calories from other foods. You will not lose the weight control benefits and your ability to lose weight.
This was observed in studies on high-intensity sweeteners. Some trials showed no weight loss or an increase in weight. Weight loss can be maintained in studies that have better control of the intake of food and where patients don't replace these calories with high-calorie foods.
Takeaway
All sugar substitutes must be labeled food additives and subject to regulation by the U.S. Food and Drug Administration. Some sugar substitutes are now being labeled as natural or derived from plants. This does not mean they are more effective in weight loss or blood sugar control. Side effects like bloating and diarrhea can still occur if the sugar substitute is taken in excess.
Researchers have raised concerns about the link between high-intensity sweeteners like saccharin or aspartame, and cancer. The National Cancer Institute has not yet found any evidence linking high-intensity sweeteners to an increased chance of developing cancer.
I am a specialist in advanced diabetes and a pharmacist. Every day, I speak with patients about controlling their blood sugar levels and diabetes. You can do this in three ways: medication, exercise and diet. These two options are likely to be more important over the long-term.
Patients who do not change their diet or exercise regularly will have a hard time lowering their blood sugar levels. It is possible that medication after medication will need to be added. Side effects are possible. It is possible to persuade patients that they need to change their diets, such as switching to a beverage with sugar substitute. This will make a big difference in controlling blood sugar and the dosage of medication.
Diabetes management should focus on reducing sugar-sweetened beverages. It is possible to switch from sugar-sweetened foods to high-intensity sugar alternatives. The best thing is to eat food and beverages that aren't highly processed and don't contain added sugars.
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This article was republished by The Conversation, a non-profit news site that shares ideas from academic experts. This article was written by Jamie Pitlick, Drake University.
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Jamie Pitlick is not affiliated with any company or organization that Jamie Pitlick consults, owns shares in, or receives funding from.
