Artificial sweeteners make enjoying desserts, sweetened drinks, and other tasty treats a little more carefree for people with diabetes. Because these sugar substitutes have lower carbohydrate and calorie counts than actual sugar, for once those who monitor and measure every gram can feel like everyone else! However, recent studies have dredged up concerns about these sweeteners (also known as "non-nutritive" or "high-intensity"). Should you sprinkle on a little pink packet without a second thought? Let's sift through the research on sugar substitutes to separate assumptions from reality.
Assumption: "They don’t contain carbs, so they won’t impact my blood glucose."
Reality: When obese adults who do not normally use artificial sweeteners drank a sucralose (brand name Splenda) solution followed by a sugar solution, they had greater increases in insulin and blood glucose than they did when they drank plain water prior to the sugar solution, in one small study from Washington University School of Medicine in St. Louis. And new research from Israel found that artificial sweetener consumption may alter gut bacteria in a way that decreases glucose tolerance.
Other studies, however, have found no impact, and people with diabetes typically tolerate artificial sweeteners without a problem, says Amanda Kirpitch, MA, RD/LDN, CSSD, CDE, a nutrition and diabetes educator at Joslin Diabetes Center in Boston. Bottom line: There’s not enough research to say definitively that artificial sweeteners will influence your numbers. Still, if you’re following your diabetes care team’s instructions to a T and your blood glucose readings are still high, talk to your health care provider about trying a different sweetener — or skipping sugar substitutes altogether.
Assumption: "They’re a healthier way to settle a craving for something sweet."
Reality: Research has shown that the parts of the brain that respond to sugar are also stimulated by artificial sweeteners, says Kirpitch. So it would stand to reason that artificially sweetened foods satisfy a sweet tooth. However, there are still questions to be answered, namely: Does the flavor of sweetness without the ensuing calories actually increase cravings or hunger, as some research has suggested?
Kirpitch finds that most patients can substitute a “diet” product and feel satisfied without the need to overcompensate elsewhere. Since this can vary from person to person, be mindful of whether or not sugar-free snacks actually calm your sweet tooth. You may find better success with a naturally sweet, fiber-rich snack along with some protein — for example, that classic combo of a small apple with a tablespoon of peanut butter — to help quell the craving and balance your blood sugar. “Whole foods are always best and always a goal to strive for,” says Kirpitch.
Assumption: "They help you lose weight."
Reality: “Using artificial sweeteners alone is unlikely to promote weight loss, especially over time,” Swithers says. Kirpitch concurs: Weight loss is impacted by many factors, some of which we may not even be aware of yet. In the short run, if you substitute artificial sweeteners for sugar and keep everything else exactly the same, it is likely that you’ll lose weight. But longer-term research indicates that people who’ve chosen artificial sweeteners are more likely to end up gaining weight. Your best bet for losing weight is to pair an exercise regimen (if your doctor approves) with a portion-controlled food plan that focuses on quality, high-fiber whole foods, such as vegetables, fruits, whole grains, and lean proteins.
Assumption: "They’re safe."
Reality: The short answer: The experts who study the foods we eat don't agree. The US Food and Drug Administration has approved the sweeteners aspartame (brand name NutraSweet), saccharin (Sweet’N Low), sucralose (Splenda), acesulfame potassium (whose shorthand name is ace-K), and neotame (so new it doesn’t have a brand name) for use as additives in foods in the United States. The consumer group the Center for Science in the Public Interest (CSPI), however, recommends avoiding acesulfame potassium, aspartame and saccharin because of (mainly animal) studies linking their use with cancer, and downgraded sucralose from “safe” to “caution” after a recent study. On the other hand, the National Cancer Institute suggests that, in reviewing human data and many studies, it appears that artificial sweeteners don't seem to be linked to an increased risk of cancer in humans. As for the plant-derived sweetener stevia, which is touted as a more natural option, CSPI says it's probably "safe," but wants to see better studies; other professional organizations concur.
What it all means for you
As with many aspects of your overall diet, it may be wise to exercise caution and moderation with artificial sweeteners. And don’t lose sight of the big picture, says Swithers: “Cutting back is the first place to start … We need to think of highly sweetened foods and drinks as occasional treats rather than major components of our daily meals.”
