5 Best Sugar Substitutes for People with Diabetes

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Sugar substitutes have long been relied upon by people with diabetes who are looking for a sweetener that won't affect their blood sugar levels. However, there's a big difference in the health effects of artificial sweeteners versus sugar alcohols and natural sweeteners. While every artificial sweetener on the market is regulated by the U.S. Food and Drug Administration (FDA) and considered safe for consumption, new research has shown that they may do more harm than good in terms of preventing obesity and diabetes.

Types of Sweeteners

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 for the body.

Artificial Sweeteners

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

The six non-nutritive sweeteners approved by the U.S. Food and Drug Administration (FDA) are saccharin (Sweet'N Low, Sugar Twin), aspartame (Equal, Nutrasweet), acesulfame potassium (Sunett, Sweet One), sucralose (Splenda), neotame, and advantame. Of these, neotame and advantame are approved for use as a general food additive and are largely unavailable as tabletop sweeteners.

These sugar substitutes are manufactured chemical compounds that offer little to no nutritional value (although neither does sugar) and all except for aspartame aren't actually absorbed by the body. They can, however, successfully satisfy a sweet tooth without the risk of raising your glucose levels, as they contain zero carbohydrates or calories, for that matter. In fact, most of the non-nutritive sweeteners pass through the body without being digested.

While earlier research considered artificial sweeteners to be considered generally safe, more recent research has shown that using these substitutes may actually contribute to diabetes and obesity, as they can change how your body metabolizes fat and energy, and may also alter your gut microbiome (the bacteria colonizing your intestinal tract that can affect your metabolism, immune system, growth, and brain neurotransmitter creation).

One study found that animals fed a diet high in aspartame and acesulfame potassium had altered fat metabolism and accumulation of acesulfame potassium in the blood, which can have a negative effect on blood vessels.

A major review study discovered that acesulfame potassium and saccharin negatively affect the microbiome in several animal studies, showing decreased bacterial strains and changes in gut microbiota populations that affected metabolism and inflammation, which also may lead to a progression or worsening of type 2 diabetes by inducing glucose intolerance, especially in the case of saccharin.

Sugar Alcohols

A number of so-called nutritive sweeteners, such as isomalt, maltitol, mannitol, sorbitol, and xylitol are found in many sugar-free gums and candies. These are technically called sugar alcohols and, unlike artificial sweeteners, can raise blood sugar but usually not to levels considered harmful.

Sugar alcohols, also known as polyols, are extracted from the natural fibers of fruits and vegetables. 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

Natural sweeteners like stevia and monk fruit have gained popularity in recent years and are considered safe for diabetics. These plant-based extractives 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.

Use in Cooking and Baking

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 watch out for when cooking and baking with alternative sweeteners include:

  • Your baked goods may be lighter in color as natural sugar browns more deeply when baked, and artificial sweeteners don't brown as nicely.
  • Cooking time may need to be adjusted
  • There may be a texture or aftertaste you're not used to
  • The volume of cakes or cookies may be slightly decreased as you're using much less sweetener

5 Nutritive and Natural Sweeteners to Use if You Have Diabetes

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.

Xylitol

Commonly found in many fruits and vegetables, xylitol is a sugar alcohol compound that has a similar sweetness to sugar. Xylitol contains 40 percent 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.

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

Erythritol

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 percent of the sweetness of sugar and just 6 percent 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.

Monk Fruit Extract

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 150 times sweeter than table sugar. It doesn't raise blood glucose levels, making it a great choice for people with diabetes.

The FDA has recognized monk fruit as safe to use for all populations, with no side effects. While it has been utilized in TCM for thousands of years as an anti-inflammatory 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 fully outweighed by the fruit's many benefits.

Yacon Syrup

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 a prebiotic).

Yacon syrup has started to be 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, caramelly sweetness that lends itself well to baked goods, sauces, and desserts.

Stevia (Truvia, PureVia)

Stevia is a plant-based product extracted from the leaves of the Stevia rebaudiana plant. Stevia was fully approved for food usage by the FDA in 2008 and has fast become the popular, "natural" alternative to chemically manufactured artificial sweeteners.

Stevia in its powdered form is marketed under various brand names, including Truvia and PureVia. It has three grams of carbs per packet and a glycemic index of zero. 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 does have a characteristic aftertaste that is well-tolerated by most 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.

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