The Truth About Sweeteners and Other Sugar Substitutes

Added sugar is one of the most unhealthy ingredients in the modern diet and one of the key reasons the prevalence of diabetes is increasing worldwide.

Based on the latest data from the Centers for Disease Control and Prevention (CDC), over 37 million Americans (or 11% of the US population) have diabetes. Pre-diabetes affects an estimated 96 million people aged 18 years or older.

Since millions of Americans have diabetes or are at risk of developing diabetes, sugar-free and alternative sweeteners are becoming popular. However, are these sweeteners a healthy choice?

Sweeteners are broadly classified into 2 types: nutritive and non-nutritive sweeteners.

Nutritive sweeteners have calories and can be natural - like honey or agave nectar, or artificial like high fructose corn syrup. They also include low-calorie, low carbohydrates, diabetes-friendly sugar alcohols like xylitol or erythritol.

Non-nutritive sweeteners have no calories and no carbs and include natural sweeteners like monk fruit and stevia and artificial sweeteners like sucralose and aspartame.

Natural zero calories, zero carbs, non-nutritive sweeteners

  • Stevia (brand names: PureVia, Sweet Leaf, Truvia). Stevia is 200 times sweeter than sugar and can be used in cold and hot beverages, baking, and cooking. Although stevia is a natural sweetener with zero calories and zero carbohydrates, it is often combined with erythritol or other sweeteners.
  • Monk fruit (Monk Fruit in the Raw, Pure Lo, Pure Fruit). Also known as Lou han go, monk fruit is 2oo to 300 times sweeter than sugar. It is made from monk fruit gourd, which is grown in China. Like stevia, monk fruit is a natural zero calories, zero-carb sweetener.

Considerations: In addition to zero carbs, zero-calorie, diabetes-friendly sweeteners, these natural sweeteners may provide additional benefits. For example, stevia may also help reduce high blood pressure. Some studies also suggest stevia has anti-obesity, antioxidant, anti-cancer, anti-inflammatory, and antimicrobial effects and may also help improve kidney function.

Cautious: In very rare cases, stevia may cause allergic reactions. Some products combine stevia or monk fruit with erythritol, other sugar alcohols, and artificial sweaters like sucralose. Choose non-GMO products from a reputable company. Some studies found counterfeit stevia products which were mixed with artificial sweeteners.

Artificial zero calories, zero carbs, non-nutritive sweeteners

  • Sucralose (Splenda) is 600 times sweeter than sugar and can be used in baking and cooking. Aspartame (NutraSweet) is 200 times sweeter than sugar, often used in beverages because it loses sweetness when heat exposure.
  • Saccharin (brands: Sweet ′N Low, Sweet Twin)should not be used in baking or cooking. It is 200 to 700 times sweeter than sugar and may taste metallic or bitter when added to liquids.
  • Acesulfame K (brands: Sweet One) is 200 times sweeter than sugar and can be used in baking or cooking.

Considerations: Although zero-carb sweeteners are regulated by the Food and Drug Administration (FDA) as food additives and labeled "generally recognized as safe" (GRAS), research studies found potential health issues related to artificial sweeteners.

Based on recent research, common artificial sweeteners like saccharin, sucralose, and aspartame can cause healthy gut bacteria to become harmful and invade the gut wall, potentially leading to serious health conditions like infection, sepsis, and multiple organ failure.

Previous studies found that despite being recommended for diabetes control, artificial sweeteners have hurt insulin sensitivity and increased the risk for diabetes. A large study that involved over 38 000 participants found that artificial sweeteners were associated with a risk of type 2 diabetes mellitus and may not be as healthy an alternative to sugar-sweetened beverages as they had been promoted. Other health concerns like increased cancer risk, chronic fatigue, and neurotoxicity have also been linked to artificial sweeteners.

According to Harvard researchers, artificial sweeteners may play another trick, too. They may prevent you from associating sweet taste with caloric intake, potentially leading to more sweets and weight gain.

Sugar alcohols (low calorie, low carbohydrates, diabetes-friendly) are mostly natural

Sugar alcohols are often added to natural or artificial non-nutritive sweeteners. They contain about 8 calories per teaspoon and, on average, about 2-4 grams of carbohydrates per teaspoon.

Erythritol is naturally-occurring sugar alcohol fermented and crystallized, which is about 60% -70% as sweet as sugar.

Xylitol has a similar sweetness as regular sugar but contains 40% fewer calories. Xylitol is naturally found in small quantities in many fruits and vegetables. The sweetener is processed from birch trees or plant fibers.

Considerations: Sugar alcohols can be used in moderation by individuals with diabetes. Although sugar alcohols are technically carbohydrates, they are not considered net carbs and do not cause spikes in blood sugar levels. Therefore are used in low-carb, diabetic-friendly products. In addition to being low carb, some sugar alcohols have been researched for other health benefits. Xylitol, for example, may help prevent caries and tooth decay, reduce the risk of ear infections, and yeast infections, and may even have anti-aging qualities because it promotes collagen stimulation.

Other sugar substitutes (nutritive sweeteners with carbs and calories)

Fructose is the fruit sugar and contains 4 grams per teaspoon. It is twice as sweet as sugar and can be used in baking. It should be consumed in small amounts because high intakes may increase blood sugar levels and cholesterol levels.

High fructose corn syrup (HFCS), on the other hand, is found in processed foods and is an artificial sweetener made from corn syrup. HFCS adds unnecessary high amounts of sugar to the diet, thus promoting diabetes and excess weight. Furthermore, HFCS has been linked with fatty liver disease, and increases inflammation in the body.

Honey is well known for its many health benefits, including antioxidant, antibacterial, and antiviral qualities, and it promotes wound healing. Honey contains small amounts of vitamins, minerals, and enzymes. Research also shows honey may improve digestion, boost energy, and support brain health. Honey has a glycemic index of 60, which is classified as a medium; therefore, honey should be small for individuals with diabetes. It also contains almost 6 grams of sugar and around 20 calories per teaspoon. Babies under the age of 12 months should not consume honey.

Agave nectar has 5 grams of carbohydrates and 20 calories per teaspoon. A low glycemic index does not cause spikes in blood sugar levels. The sugar in agave is about 20% glucose and 80% fructose. However, it should be consumed in small amounts because it contains more calories than table sugar.

Other popular Natural sweeteners containing calories and carbohydrates besides honey and agave include maple syrup, coconut sugar, and dates.

Key take-aways

When choosing sugar substitutes, it pays to be a savvy consumer. Artificial sweeteners and sugar substitutes can help with weight management. But they aren't a magic bullet and should be used only in moderation.

Food marketed as sugar-free isn't calorie-free, so it can still cause weight gain. Remember that processed foods, which often contain sugar substitutes, generally don't offer the same health benefits as whole foods, such as fruits and vegetables.

Regardless of the type of sweetener you choose, avoid consuming it in excess. Remember that agave, honey, and maple syrup contain more calories and carbohydrates and should be consumed in small amounts.

Stevia and monk fruits are naturally derived zero carbs, zero calories sweeteners and are often combined with sugar alcohols in low carb, diabetes-friendly products.

Sucralose, aspartame, and Acesulfame K are the most commonly used zero carbs, zero calories artificial sweeteners.

Resources

https://www.cdc.gov/diabetes/data/statistics-report/index.html

https://healthonline.washington.edu/sites/default/files/record_pdfs/Sweeteners.pdf

https://www.ncbi.nlm.nih.gov/pubmed/24128404

https://scitechdaily.com/new-research-uncovers-potential-dangers-of-artificial-sweeteners-can-cause-gut-bacteria-to-invade-the-intestine/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903011/

https://pubmed.ncbi.nlm.nih.gov/12119821/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC90255/

https://pubmed.ncbi.nlm.nih.gov/15832042/

https://www.sciencedirect.com/science/article/abs/pii/S014929180380334X

https://www.sciencedirect.com/science/article/abs/pii/S0924203116300157

https://pubmed.ncbi.nlm.nih.gov/26400114/

https://pubmed.ncbi.nlm.nih.gov/11229668/

https://www.health.harvard.edu/blog/artificial-sweeteners-sugar-free-but-at-what-cost-201207165030

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