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Nov 28, 2023

Artificial Sweeteners and Type 2 Diabetes: Safety, Risk

A look at the best and worst types for blood sugar levels People with type 2

A look at the best and worst types for blood sugar levels

People with type 2 diabetes need to watch their sugar intake. Several artificial sweeteners and sugar alternatives are available, but research on their use by people with diabetes is conflicted as to how beneficial it is and whether there are unintended effects such as potentially contributing to insulin resistance.

Consuming artificial sweeteners in place of sugar may help reduce caloric intake, which could be helpful for people with diabetes who would benefit from losing weight to help manage their condition. Sweeteners can be classified in several ways, the most general being sugar or sugar substitutes. They can also be classified as natural or artificial, nutritive or non-nutritive, and other groupings.

After careful testing, the U.S. Food and Drug Administration (FDA) has approved the artificial sweeteners:

Some other non-nutritive sweeteners, such as stevia, have not yet been approved by the FDA but have been deemed generally recognized as safe (GRAS).

Read on to learn more about sugar alternatives and what the research says about them.

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Though several studies have been conducted on animals to explore how artificial sweeteners affect insulin and blood sugar, how accurately the results translate to humans is not well established. Human research on the effect these sweeteners have on people with diabetes is conflicting and less extensive. Some research suggests that artificial sweeteners can cause the release of insulin, increasing blood insulin levels, which could lead to insulin resistance.

Some studies show an association between drinking artificially sweetened beverages and weight gain, metabolic dysfunction, and an increased risk of type 2 diabetes. Some of these studies show increased insulin levels after consuming some artificial sweeteners, such as aspartame and sucralose, compared to others, such as stevia. Other studies found that it might depend on the amount of artificial sweeteners consumed.

In one study, sucralose affects glucose metabolism only when consumed with carbohydrates, not on its own. Many studies show no or insignificant effect of artificial sweeteners on glucose and insulin levels. When systemic reviews and meta-analyses are considered overall, the human data suggests that artificial sweeteners do not significantly affect insulin levels. The data also does not conclusively show that artificial sweeteners reduce the risk of type 2 diabetes.

Current human research shows no conclusive evidence that artificial sweeteners increase the risk or decrease the risk of type 2 diabetes. Studies on the effects of artificial sweeteners on glucose and insulin levels are conflicting and inconclusive. More research is necessary.

Conducting research on the effects artificial sweeteners have on specific medical conditions is difficult because they are so prevalent in food products. This makes performing randomized controlled trials that look for patterns difficult.

One study of 120 healthy adults who took 2 grams of artificial sweeteners three times daily for two weeks found that the group who consumed sucralose and the group that consumed saccharine had noticeable spikes in their blood sugar following glucose tolerance tests compared to the group who took aspartame and the group who took stevia.

The researchers also found that the sweeteners influenced changes in bacteria in the gut and mouth, with corresponding changes found in blood samples. They noted that the blood metabolite changes in the sucralose and saccharine groups were similar to those in people with diabetes or vascular disease.

This does not mean that there are definitive "best" or "worst" artificial sweeteners for people who have type 2 diabetes, but it does suggest more research is necessary on the effect individual artificial sweeteners have on the body.

Artificial sweeteners have been deemed safe by the FDA, the Academy of Nutrition and Dietetics, the American Heart Association, and the American Diabetes Association when taken within the daily limits, which can be found on the FDA webpage. Though safe to consume, there is no conclusive evidence to show that artificial sweeteners help improve diabetes management. Experts recommend using the smallest amount of sweeteners possible and to use them as part of an overall healthy diet.

Some of the terms you may see on food labels or in descriptions include:

"Low sugar" is not defined and is not permitted to be claimed on foods or beverages.

Names for added sugars to look out for include:

Products that are sugar-free or reduced sugar are not necessarily healthy or diabetes-friendly. You still need to check the rest of the nutrition label for things like carbohydrate and fat amounts, calorie count, serving size, and other ingredients to get an overall picture of the food or drink.

Sugar alcohols (polyols) are not low-calorie sweeteners, but they have slightly fewer calories than sugar. They are often found in foods labeled "sugar-free" such as gum, candies, beverages, cookies, and ice cream. They may also be found in toothpaste and some medications, such as cough syrup. The most common sugar alcohols are:

Sugar alcohols don't cause a sudden increase in blood glucose. They also don't contribute to tooth decay. Sugar alcohols can have a laxative effect and may cause gastrointestinal discomforts such as gas, bloating, stomach cramps, and diarrhea, especially in higher doses. Caution: Xylitol can be fatal to dogs.

It's important to note that just because a sweetener isn't labeled "sugar" doesn't mean it isn't sugar or doesn't affect your body the way sugar does. For example, honey is often touted as a "healthy" sugar alternative, but your body still processes it as sugar. A 2015 study found that honey, high-fructose corn syrup, and cane sugar caused the same blood sugar increase.

Similarly, agave nectar is often marketed as a health food but is up to 90% liquid fructose.

Some of the following sugar alternatives can be helpful for people with diabetes who are watching their sugar intake, in addition to the artificial sweeteners approved by the FDA:

Stevia

Monk fruit

Allulose

Tagatose

Fresh fruit

Artificial sweeteners are considered a safe alternative to sugar, including for people who have type 2 diabetes. Sugar substitutes include FDA-approved artificial sweeteners such as aspartame and sucralose, sugar alcohols such as sorbitol and xylitol, and natural sweeteners such as stevia and monk fruit. Research is conflicting and inconclusive on how artificial sugars may affect insulin and blood glucose.

Splenda (sucralose) is a calorie-free sugar substitute. Most research suggests that artificial sweeteners such as Splenda are neither good nor bad for blood sugar, but some studies have found that Splenda can increase insulin resistance.

Products labeled zero sugar are not necessarily healthy. They can contain other ingredients that affect blood sugar, such as carbohydrates. They may also be high in fat or calories. To determine whether a zero-sugar product is healthy, you need to look at the whole nutrition facts label and ingredients.

No artificial sweeteners have proved to affect insulin or blood sugar levels, positively or negatively. Preliminary studies suggest that allulose and tagatose may be beneficial for blood sugar control, but the data is not conclusive and more research is necessary.

Mathur K, Agrawal RK, Nagpure S, Deshpande D. Effect of artificial sweeteners on insulin resistance among type-2 diabetes mellitus patients. J Family Med Prim Care. 2020;9(1):69. doi:10.4103/jfmpc.jfmpc_329_19

Purohit V, Mishra S. The truth about artificial sweeteners – are they good for diabetics? Indian Heart Journal. 2018;70(1):197-199. doi:10.1016/j.ihj.2018.01.020

Diabetes UK. Sugar, sweeteners and diabetes.

U.S. Food and Drug Administration. Additional information about high-intensity sweeteners permitted for use in food in the United States.

Diabetes Teaching Center at the University of California, San Francisco. Artificial sweeteners.

Johns Hopkins. Facts about sugar and sugar substitutes.

diaTribe. How sweet it is: all about artificial sweeteners and diabetes.

Yarmolinsky J, Duncan BB, Chambless LE, et al. Artificially sweetened beverage consumption is positively associated with newly diagnosed diabetes in normal-weight but not in overweight or obese Brazilian adults. The Journal of Nutrition. 2016;146(2):290-297. doi:10.3945/jn.115.220194

Pang MD, Goossens GH, Blaak EE. The impact of artificial sweeteners on body weight control and glucose homeostasis. Front Nutr. 2021;7:598340. doi:org/10.3389/fnut.2020.598340

Suez J, Cohen Y, Valdés-Mas R, et al. Personalized microbiome-driven effects of non-nutritive sweeteners on human glucose tolerance. Cell. 2022;185(18):3307-3328.e19. doi:10.1016/j.cell.2022.07.016

Diabetes.co.uk. Popular artificial sweeteners found to raise blood sugar.

American Heart Association. Sugar 101.

Diabetes Strong. The best sweeteners for people with diabetes.

Harvard T. H. Chan. Low-calorie sweeteners.

Grembecka M. Sugar alcohols—their role in the modern world of sweeteners: a review. Eur Food Res Technol. 2015;241(1):1-14. doi:10.1007/s00217-015-2437-7

Raatz SK, Johnson LK, Picklo MJ. Consumption of honey, sucrose, and high-fructose corn syrup produces similar metabolic effects in glucose-tolerant and -intolerant individuals. The Journal of Nutrition. 2015;145(10):2265-2272. doi:10.3945/jn.115.218016

Guerrero-Wyss M, Durán Agüero S, Angarita Dávila L. D-tagatose is a promising sweetener to control glycaemia: a new functional food. BioMed Research International. 2018;2018:1-7. doi:10.1155/2018/8718053

St. Luke's Health. A diabetic's guide to natural sweeteners.

Nichol A, Holle MJ, An R. Glycemic impact of non-nutritive sweeteners: a systematic review and meta-analysis of randomized controlled trials. Euro J Clin Nutr. 2018;72(1):796-804. doi:10.1038/s41430-018-0170-6

By Heather JonesHeather M. Jones is a freelance writer with a strong focus on health, parenting, disability,and feminism.