Diabetes Diet

The Scoop on Sugar Substitutes
What does it mean when the package says “sugar free?”

By Alice Lesch Kelly

It’s a myth that people with diabetes can’t eat any sugar. You can have foods and drinks sweetened with sugar if you work them into a smart eating plan that takes all your carbohydrates into account. Having too many sweets can push blood sugar out of your target range, however, so sugar substitutes are sometimes a good way to satisfy your sweet tooth while maintaining good control.

Two types of sugar substitutes are available:

Non-caloric sweeteners. These artificial sweeteners contain no calories and no carbohydrates, and they do not raise blood sugar levels. They are used to sweeten beverages, desserts, and candies. Some but not all can be used in cooking and baking. Non-caloric sweeteners include aspartame (NutraSweet, Equal), saccharin (Sweet’N Low, Sweet Twin, and Necta Sweet), acesulfame K (Sunett and Sweet One), neotame (not yet marketed under a brand name), and sucralose (Splenda).

Some people with diabetes believe that artificial sweeteners do raise their blood sugar, but there is no research showing this, according to Christine Gerbstadt, M.D., R.D., C.D.E., a spokesperson for the American Dietetic Association (ADA). If blood sugar jumps after you eat an artificially sweetened food, the culprit may be other ingredients in the food, such as caffeine, carbohydrates, or protein. Even stress can hike blood sugar.

Reduced-calorie sweeteners. These sweeteners are known as sugar alcohols, even though they contain no alcohol. Although they are made by chemically altering natural sugar, they are metabolized very differently. They do contain carbohydrates and some calories, although less than real sugar. They are found primarily in packaged foods such as cookies, gum, and candy. Reduced-calorie sweeteners include sorbitol, mannitol, lactitiol, maltitol, xylitol, isomalt, erythritol, and hydrogenated starch hydrolysates.

Sugar alcohols do raise blood sugar, and the American Diabetes Association recommends subtracting half of the sugar alcohol grams when you compute a food’s total carbohydrate count. For example, if a cereal bar has 6 grams of sugar alcohol and a total of 15 grams of carbohydrates, you would count it as 12 grams of carbohydrates (15 - 3 = 12).

Are they safe?
The Food and Drug Administration considers these artificial sweeteners safe. In the past, saccharin was believed to cause bladder cancer, but further research determined that it poses no danger for humans.

Aspartame has been accused of causing headaches. However, there are no reliable studies that prove this claim. The only people who are advised to avoid aspartame completely are those with a rare inherited disorder called PKU (phenylketonuria).

As with any foods, moderation is the best policy when it comes to artificial sweeteners, says Gerbstadt. “A diet excessively high in foods with artificial sweeteners tends to leave less room for vegetables, whole grains, protein-rich foods, and the judicious use of fruits.” There's also the issue of training your palate to need less sweetness in foods; if you artificially sweeten everything, you won't ever learn to like things unsweetened.

Artificial sweeteners aren’t for everyone, says Amy Jamieson-Petonic, R.D., an ADA spokesperson. “Some people have trouble tolerating them,” she says. For example, sugar alcohols “may cause gastrointestinal side-effects such as bloating, flatulence, or diarrhea.” If you find that a particular sweetener bothers you, avoid it and try using a different one.

As you decide what artificially sweetened foods to include in your diet, remember that food labels claiming a food is sugar-free can be misleading. “Sugar-free” doesn’t necessarily mean calorie-free or carbohydrate-free — these foods may still have significant amounts of carbohydrates and calories, either because they are sweetened with sugar alcohols or other non-sugar sweeteners or because they contain other high-carbohydrate ingredients. Pay attention to the total carbohydrate content listed on the food label.

Alternatives to artificial sweeteners

You may want to try other diabetes-friendly sweeteners, such as:

• Agave nectar: This natural sweetener, which comes from the agave plant, is much sweeter than sugar, so a little goes a long way. Many people find it has a smaller impact on blood sugar than other sweeteners. It does contain carbohydrates, however, so try it and test vigilantly afterward.

• Stevia: This naturally sweet herb does not raise blood sugar levels. Several formulations of stevia have been given GRAS (generally regarded as safe) status by the U.S. Food and Drug Administration, so you can now find it sold as a sweetener in grocery stores.

• Natural flavorings. Very small amounts of flavorings such as vanilla extract, almond extract, lemon, lime, or cinnamon can add flavor to unsweetened foods and give the impression of sweetness.