For people living with Diabetes, a healthy diet is always essential in making sure blood sugar levels are under control. Paying close attention to what they eat, particularly the carbohydrate content and total calories consumed daily, becomes a way of life. Because of health trends in recent years, the food industry has responded with artificial or non-nutritive sweeteners (NNS) and various other products that have reduced-calorie or zero calorie sweeteners. While in theory, substituting zero or reduced calorie sweeteners for regular sugar would help reduce glucose intake, there is considerable uncertainty regarding their actual health benefits especially in people with Diabetes.
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What are non-nutritive/artificial sweeteners?
Sweeteners are food additives that emulate the taste of sugar and as such are sugar substitutes. These are substances that produce a more intense sweet taste in smaller amounts to match the sweetness of a higher amount of sugar. Besides people with Diabetes and obesity, a proportion of the general population also consume these sweeteners to control their caloric and energy intake. Most of the NNS are synthetic; however, there are some natural NNS available in the market.
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What are common examples of sweeteners?
| Sweetener (Type) | Common Brand Name(s) | Sweetness compared to sugar | Acceptable daily intake (ADI) (mg/kg/day) | Number of packets equivalent to ADI | Used in |
| Aspartame (Nutritive) | Nutrasweet® Equal® Sugar Twin® | 200x | 50 | 75 | Approved in 1981 General purpose sweetener Not used in baking/not heat stable |
| Saccharin (NNS) | Sweet and Low® Sweet Twin® Sweet’N Low® Necta Sweet® | 200-700x | 15 | 45 | Beverages, processed foods, cooking, bases or mixes |
| Sucralose (NNS) | Splenda® | 600x | 5 | 23 | Approved in 1999 General purpose sweetener Beverages, candies, baked goods, desserts |
| Steviol Glycosides (NNS) | Truvia® PureVia® Enliten® | 200-400x | 4 | 9 | Subject of GRAS notices (generally recognized as safe) for specific conditions of use |
| Acesulfame Potassium (NNS) | Sweet One® Sunett® | 200x | 15 | 23 | Approved in 2003 General purpose sweetener used in beverages, baked goods, candies and desserts Not used in meat and poultry |
| Neotame (NNS) | Newtame® | 7,000-13,000x | 0.3 | 23 | Approved in 2002, general purpose sweetener in foods except meat and poultry Heat-stable, can be used in baking |
Do sweeteners have any evidence of health benefit?
Although NNS/artificial sweeteners present a theoretical health benefit, the existing data from scientific studies do not point to a robust effect on health outcomes. In a review published in the British Medical Journal in 2018, data analyzed from a total of 56 studies showed that for most health outcomes (weight loss, diabetes risk, sugar control, blood pressure control), there seemed to be no significant clinical benefit to using NNS. A review from the Cochrane Library published in 2020 found similar findings, with the use of NNS having no evidence of benefit or harm on patient-important outcomes. Accordingly, both reviews recommend more high-quality studies with longer study durations and detailed descriptions of parameters to better assess the effect of NNS on health outcomes.
Nevertheless, people living with Diabetes can still improve their health by applying interventions with robust evidence for benefit such as weight loss (for those who are overweight), regular exercise, reduced fat intake, adherence to medical therapy and regular consult with their health provider. Ensuring good glucose control with diligent monitoring of blood sugar will also be helpful in reducing the risk of complications, and achieving this goal can be made easier with the assistance of the remote patient monitoring system offered by DrKumo.
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Takeaway:
Current evidence shows neither significant benefit or harm when using sweeteners. Strategies for good glucose control must be tailored to the individual, and there a lot of other interventions that are proven to improve outcomes for people with Diabetes. A healthy diet and regular exercise, along with regular intake of maintenance medications, are still the most effective ways to achieve good glucose control.
References:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982014/pdf/13197_2011_Article_571.pdf
3. https://www.bmj.com/content/bmj/364/bmj.k4718.full.pdf
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387865/pdf/CD012885.pdf
