Sugar substitutes for diabetes

There are many sugar substitutes available for people living with diabetes.

Sugar alcohols, stevia, aspartame, honey, coconut sugar, and maple syrup are common sugar substitutes found in processed foods or drinks and are sold at grocery stores. The American Diabetes Association recommends using sugar substitutes, like stevia and aspartame, in moderation as a replacement for sugar if you commonly eat or drink sugar-sweetened products.¹ Aspartame, stevia and sugar alcohols have fewer calories and less of an effect on blood sugar then regular sugar.³ Natural sugar substitutes like honey, coconut sugar, and maple syrup can increase blood sugar. It is recommended to avoid these products if you have uncontrolled diabetes.^1,8,9

Sugar Alcohols

Sugar alcohols are a type of sugar found naturally in fruits and vegetables. They are commercially processed and used to sweeten processed foods. Although their name includes "alcohol," they do not contain alcohol. There are many different types of sugar alcohols. It is important to read food ingredient lists to know whether sugar alcohols are used to sweeten a specific food or drink. Common sugar alcohols are:

• Erythritol
• Glycerol (also called glycerin or glycerine)
• Mannitol
• Sorbitol
• Isomalt
• Lactitol
• Maltitol
• Hydrogenated starch hydrolysates
• Xylitol

Sugar alcohols are used to sweeten gum, desserts, frostings, jelly spreads, and candies. Benefits of sugar alcohols are that they taste sweet, but have fewer calories. They also do not cause plaque build-up on the teeth or cavities in the mouth. Disadvantages of sugar alcohols are that they can cause stomach gas, bloating and diarrhea. Often people associate them with being in healthier processed foods, but sometimes these foods still contain other types of carbohydrates and fats. It is important to read the nutrition facts and ingredient list of processed foods.^3,11,13

Stevia

Stevia is a natural substance that is made from leaves of the South American Stevia plant.⁴ Stevia is 200 to 300 times sweeter than natural sugar, yet it does not cause an increase in blood sugar.¹⁴ Stevia is approved by the Food and Drug Administration as safe to use in foods and drinks, and is often used to sweeten processed foods.⁸ This sugar substitute is available to purchase as a powder or liquid, and is also known as the "green packet." At large amounts, Stevia can taste very bitter, but at small amounts, it tastes sweet. Stevia does not cause stomach gas, bloating and diarrhea like sugar alcohols.¹⁴ You may find it sold under brand names like Truvia, SweetLeaf, Nustevia, and Stevia in the Raw.³

Aspartame

Aspartame is also approved by the Food and Drug Administration as a safe sugar substitute. People with a genetic condition called phenylketonuria have problems processing aspartame in the body, so they should avoid or decrease intake of aspartame.⁵ Both aspartame and sugar contain 4 calories per gram, but aspartame is about 200 times sweeter than sugar. The small amount of aspartame needed to sweeten foods or drinks does not have an effect on your blood sugar. Aspartame is usually used to sweeten "sugar-free" or "diet" drinks. It is known as the "blue packet" and is sold under the names NutraSweet and Equal in a powder form.¹⁴

Honey

Honey is a sweet, natural substance made by honey bees. Honey is similar to sugar and causes an increase in blood sugar, yet more research is needed to determine the glycemic index of honey. (Glycemic index tells us how quickly a food can increase your blood sugar.) Honey is often used to sweeten homemade foods or drinks. Unlike other sugar substitutes, raw honey contains vitamins and nutrients that cause it to have antioxidant and anti-inflammatory properties. Antioxidants deactivate disease causing free radicals in the body, and anti-inflammatory substances decrease swelling in the body. However, processed honey is stripped of its nutrients and may contain less vitamins and nutrients than raw honey. Honey is considered sweeter than sugar, so you may need less honey to sweeten a food or drink. Additionally, some honey products have added sweeteners, so it is important to read the ingredient list when adding honey to foods or drinks.¹⁰ It is recommended to avoid honey if your diabetes is uncontrolled.

Coconut Sugar

Coconut sugar is a brown, crystalized substance made from coconuts. This natural substance contains vitamins and nutrients, and it is similar to regular sugar in that it causes increases in blood sugar. It is recommended that people with uncontrolled diabetes avoid coconut sugar.²

Maple Syrup

Another natural sweetener, maple syrup, is made from the sap of maple trees. Similar to honey and coconut sugars, maple syrup contains vitamins and nutrients, and also has antioxidant properties. Maple syrup contains a large amount of natural sugar, so it causes an increase in blood sugar. Yet, the effect on blood sugar or glycemic index of maple sugar is slightly less than regular sugar.^4,10 If your diabetes is uncontrolled, it is recommended that you avoid maple sugar.¹

Certain sugar substitutes, such as sugar alcohols, aspartame, and stevia, can be used in diabetes to help prevent increases in blood sugar¹. These sugar substitutes tend to be sweeter than regular sugar and are only needed in small amounts to sweeten foods or drinks¹⁴. Honey, coconut sugar, and maple syrup can increase blood sugar and should be avoided if you have uncontrolled diabetes.^2,9 It is important to read food labels so that you know what sweeteners are used in processed foods and drinks, and whether they contain other fats and sugars.¹⁴

Published on May 25, 2020

References

1. American Diabetes Association. "5. Facilitating Behavior Change and Well-Being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2020." Diabetes Care, American Diabetes Association, 1 Jan. 2020, care.diabetesjournals.org/content/43/Supplement_1/S48.

2. Alternative sugars: Coconut sugar. Br Dent J 223, 749 (2017). https://doi.org/10.1038/sj.bdj.2017.1011.

3. "Artificial Sweeteners and Type 1 Diabetes." University of Iowa Stead Family Children's Hospital, 19 Nov. 2018, uichildrens.org/health-library/artificial-sweeteners-and-type-1-diabetes.

4."By Any Other Name It's Still Sweetener." Www.heart.org, Feb. 2019, www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/by-any-other-name-its-still-sweetener.

5. Center for Food Safety and Applied Nutrition. "High-Intensity Sweeteners." U.S. Food and Drug Administration, FDA, 2017, www.fda.gov/food/food-additives-petitions/high-intensity-sweeteners.

6. Commissioner. "Has Stevia Been Approved by FDA?" U.S. Food and Drug Administration, FDA, 2018, www.fda.gov/about-fda/fda-basics/has-stevia-been-approved-fda-be-used-sweetener.

7. Fitch, Cindy, and Kathryn Keim. Journal of Human Nutrition and Dietetics, vol. 25, no. 5, 2012, https://doi.org/10.1016/j.jand.2012.03.009.

8. Gardner, Christopher, et al. "Nonnutritive Sweeteners: Current Use and Health Perspectives." Circulation, vol. 126, no. 4, 2012, pp. 509–519., doi:10.1161/cir.0b013e31825c42ee.

9. Meo, Sultan Ayoub, et al. "Honey and Diabetes Mellitus: Obstacles and Challenges – Road to Be Repaired." Saudi Journal of Biological Sciences, vol. 24, no. 5, 2017, pp. 1030–1033., doi:10.1016/j.sjbs.2016.12.020.

10. "Pure Maple Syrup Contains Medicinally Beneficial Compounds, Pharmacy Researcher Finds." ScienceDaily, ScienceDaily, 25 Mar. 2010, https://www.sciencedaily.com/releases/2010/03/100321182924.htm.

11. "Sugar Alcohol - Yale New Haven Hospital." Sugar Alcohol - Yale New Haven Hospital, https://www.ynhh.org/services/nutrition/sugar-alcohol.aspx.

12. "Sugar Alcohols." Accessdata.fda.gov, 2019, www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/sugar-alcohol.html.

13. "Sugar Alcohols." American Diabetes Association, May 2014, archives.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/sugar-alcohols.html.

14. "Sugar Substitutes." Cleveland Clinic, 2019, my.clevelandclinic.org/health/articles/15166-sugar-substitutes--non-nutritive-sweetener.