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Jan 15, 2024

5 Best Sugar Substitutes for People With Type 2 Diabetes

People with diabetes looking for a sweetener that won't affect their blood sugar

People with diabetes looking for a sweetener that won't affect their blood sugar levels frequently turn to sugar substitutes. However, although every artificial sweetener on the market is regulated by the U.S. Food and Drug Administration (FDA) and is considered safe, there is research to show they may do more harm than good in preventing obesity and diabetes. If you have diabetes or are at risk of developing it, it's important to understand the types of sugar substitutes and how they affect the body.

Sweeteners can be divided into two camps: nutritive and non-nutritive. Artificial sweeteners have no nutritional value, while sugar alcohols and natural sweeteners such as honey boast some nutritional benefit.

You've probably seen artificial sweeteners in individual packets at your local diner, but they're also found in diet drinks, light yogurt, baked goods, ice cream, gum, cereal, cough drops, and candy, among other foods. Most artificial sweeteners are rgarded as "intense sweeteners" as they're several times sweeter than white table sugar (sucrose). Splenda, for example, is 600 times sweeter than sugar.

The eight non-nutritive sweeteners approved by the FDA are:

Note that neotame and advantame are approved as general food additives and are unavailable as tabletop sweeteners.

Although sugar substitutes are manufactured chemical compounds that offer little to no nutritional value, many people find they can satisfy a sweet craving without raising glucose levels as they contain neither carbohydrates nor calories. In fact, some of non-nutritive sweeteners pass through the body without being digested.

However, there is research to show that using sugar substitutes non-judiciously may be associated with diabetes and obesity in several ways. For one, they can change how the body metabolizes fat and energy.

Artificial sweeteners also may alter the gut microbiome—the beneficial bacteria the colonize the intestinal tract and can affect metabolism, immune health, growth, and brain neurotransmitter creation.

One small study found that women with obesity who drank three diet sodas daily had altered gene expression, including new markers for inflammatory cytokines (cells that promote inflammation).

Also, in studies both acesulfame potassium and saccharin have been found to negatively affect the microbiome of animals, who experienced decreased strains of bacteria and other changes in gut microbiota. If humans are similarly affected by these sweeteners, they could experience changes in metabolism and inflammation potentially leading to worsening of type 2 diabetes by inducing glucose intolerance. Saccharin may be particularly problematic.

A number of so-called nutritive sweeteners such as isomalt, maltitol, mannitol, sorbitol, and xylitol are found in many sugar-free gums and candies. Technically known as sugar alcohols, or polyols, they are extracted from natural fiber in fruits and vegetables.

Sugar alcohols can raise blood sugar though usually not enough to cause harm. Their impact on blood sugar can vary, ranging from a glycemic index of 13 for xylitol to nine for sorbitol. Others, like mannitol, border on zero. Despite their relatively low impact on blood glucose, certain sugar alcohols (like xylitol and mannitol) may have a laxative effect if overused. These sweeteners are less commonly found in grocery stores but can be sourced from a major drugstore and health food retailers.

Natural sweeteners like Stevia and monk fruit have gained popularity in recent years and are considered safe for diabetics. These plant-based extracts may also be several hundred times sweeter than sugar, and Stevia, thaumatin, and Luo Han Guo (monk fruit) extracts have all been approved by the FDA as sugar substitutes.

Because many sugar substitutes are much sweeter than sugar, it takes a smaller amount to achieve the desired sweetness. Therefore, when cooking or baking, your recipe may need to be adjusted if you're swapping white table sugar for a sweeter alternative.

While the sweetener package may have specific instructions for cooking and baking, this may come down to trial and error (try to use less than you think at first and adjust accordingly after tasting), or you can search for specific recipes that use sugar substitutes or natural sweeteners in place of white sugar.

A few other things to be aware of when cooking and baking with alternative sweeteners:

There are several sugar alternatives that may be preferable if you have diabetes, as these options tend to have a lesser effect on blood sugar than traditional sugar.

Commonly found in many fruits and vegetables, xylitol is a sugar alcohol compound that is similar in sweetness to sugar. Xylitol contains 40% fewer calories than sugar at 2.4 calories per gram, and has negligible effects on blood sugar and insulin, thanks to a lack of fructose.

Look for brands such as Xlear and Xyla on the market. Xylitol may be sourced from birch trees or from plant fiber known as xylan.

Also a sugar alcohol, erythritol has been praised for its sweetness while having little to no calories. Erythritol is sourced from fermented wheat or starch and contains 70% of the sweetness of sugar and just 6% of the calories, at 0.24 calories per gram.

Erythritol is very safe to use but still may cause some digestive upset if consumed in large quantities (as with any sugar alcohol). Because humans don't have the necessary enzymes to digest erythritol, most of it is absorbed into the bloodstream and is then excreted into the urine unchanged, meaning it won't raise blood sugar levels.

Popular in Traditional Chinese Medicine (TCM), monk fruit, or Luo Han Guo, is a diabetes-safe sugar alternative that is extracted from a dried melon. Monk fruit extract contains zero calories, zero carbs, and is about 150 times sweeter than table sugar. It doesn't raise blood glucose levels, making it a useful choice for people with diabetes.

The FDA recognizes monk fruit as safe for all people, with no side effects. While it has been used in TCM for thousands of years as an anti-inflammatory agent and to combat sore throat, there have been no long-term scientific studies on its usage yet.

You may see monk-fruit-sweetened products popping up on the shelves, such as Monk Fruit In the Raw or Lakanto Monkfruit Sweetener, both powdered forms. It does have a slight aftertaste, but this minor drawback may be outweighed by the products many benefits.

Harvested from the roots of the yacon plant, native to the Andes mountains in South America, yacon syrup is a fiber-rich sweetener that's full of fructooligosaccharides, a form of soluble fiber that serves as food for the bacteria in your microbiome (known as prebiotics).

Yacon syrup been studied for weight loss, but its true benefit is in its high fiber content that helps balance glucose levels. It has a glycemic index of 1.

Yacon looks and tastes a bit like molasses, with a deep, caramel sweetness that lends itself well to baked goods, sauces, and desserts.

Stevia is a plant-based product extracted from the leaves of the Stevia rebaudiana plant. Stevia in its powdered form is marketed under various brand names, including Truvia and PureVia. It has 3 grams of carbs per packet and a glycemic index of 0. Stevia may also be found as a liquid extract. It doesn't offer quite the intensity of sweetness as most artificial brands but does remain stable when heated. It has a characteristic aftertaste that is well-tolerated by most people but may be very noticeable to some.

Stevia can also be grown indoors as a potted plant—you can add a single fresh leaf to a cup of tea for an unprocessed alternative to the powdered form.

There is no set limit for people with diabetes, though general dietary recommendations say to limit added sugars to less than 10% of your daily calories. The most important thing is to track your carbohydrate intake (including sugars) and account for them in your diabetes management plan. Work with your healthcare provider on the amount that's right for you.

Fruits with a glycemic index less than 55 are ideal. These include cherries, berries, apples, pears, and oranges, among others.

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By Stacey HuguesStacey Hugues, RD is a registered dietitian and nutrition coach who works as a neonatal dietitian at Beth Israel Deaconess Medical Center in Boston.