Artificial Sweeteners and Type 2 Diabetes

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:

• Acesulfame potassium (Ace-K): Sweet One, Sunett
• Advantame: No brand name
• Aspartame: Equal, Nutrasweet, Sugar Twin
• Neotame: Newtame
• Saccharine: Sweet'N Low, Sweet Twin, Necta Sweet
• Sucralose: Splenda

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.

Effect of Artificial Sweeteners on Insulin

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.

Best and Worst Types for Type 2 Diabetes

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.

Analyzing Sugar Terms on Labels 

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

• Naturally occurring sugars: sugars that are naturally found in foods (like fructose in fruit and lactose in milk)
• Added sugars: any sugars or caloric sweeteners added to foods or beverages during processing or preparation
• Total sugars: includes both added sugars and natural sugars
• Sugar-free: less than 0.5 grams of sugar per serving and contains no ingredient that is a sugar
• Reduced sugar/Less sugar: at least 25% fewer sugars per serving than a standard serving size of the traditional form of the food or drink
• No added sugars/Without added sugars: no sugars or ingredients that contain sugar added during processing

"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:

• Brown sugar
• Corn sweetener
• Corn syrup
• Fruit juice concentrates
• High-fructose corn syrup
• Honey
• Invert sugar
• Malt sugar
• Molasses
• Raw sugar
• Sugar
• Sugar molecules ending in “-ose” (dextrose, fructose, glucose, lactose, maltose, sucrose)
• Syrup

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.

Diabetes-Friendly Sugar Alternatives 

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

• Natural sweetener extracted from the plant species stevia rebaudiana
• Comes as a powder, extract, or flavored drops
• Does not raise blood sugar levels
• Brand names include Truvia and Pure Via

Monk fruit

• Natural sweetener
• Does not affect blood sugar (but may come combined with other substances that do, check the label)

Allulose

• Simple sugar (monosaccharide)
• Should not affect blood sugar

Tagatose

• Used as a sweetener in beverages
  
• Preliminary research shows it may help control blood sugar, but more research is necessary

Fresh fruit

• Contains fiber, which helps slow down sugar absorption and reduce the impact on blood sugar levels
• Use fresh fruit because dried fruits and fruit juices can be high in sugar
  

Summary

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.