Sugar Substitutes - What's The Story?

Added sugar from drinks, snack foods, desserts and food processing is a prime suspect in America’s obesity and type 2 diabetes epidemics. And with diabetes, added sugar (not natural sugars from, for example, fruit and beans) adds no nutritional value except for calories, but affects blood glucose levels profoundly. So, why not cut the sugar and keep the sweetness with sugar substitutes?

Sugar substitutes – also called “artificial” sweeteners, non-nutritive sweeteners, or low calorie sweeteners – are man made or natural compounds that are many times sweeter to the taste than sugar. So, a very small amount can give the same level of sweetness, but add negligible calories and have no impact on blood glucose levels. For the record, honey, agave nectar, and syrups may be “alternative sweeteners”, but are not sugar substitutes – they are sugar.

The sugar substitutes I’d like to discuss are essentially calorie free or extremely low in calories. You’re probably familiar with the blue (aspartame), pink (saccharine) and yellow (sucralose) packets from restaurants, and may have tried the natural products stevia and monk fruit extract. And, you know that every soft drink has a sugar-free/calorie-free companion product. Some sugar substitutes may suit your tastes, others not so much. Some are suitable for cooking and baking, others aren’t. These products are all different, and it would take too much space to discuss these, and many other (primarily commercial), sugar substitute products separately.

What most share in common, however, are various assertions, claims, and declarations that sugar substitutes are unhealthy in some way or another. The many and varied accusations range from serious consequences like cancer-causing and weight gain to metabolic disruptions, such as increasing desire for sweets. If these concerns have kept you from trying sugar substitutes, you may want to consider something else these products all have in common.

Sugar substitutes are regulated as a food additive by the U.S. Food and Drug Administration (FDA), and all approved sweetening products are classified by FDA as Generally Recognized As Safe, GRAS for short. That means the FDA has accepted credible evidence (with huge safety margins, by the way) that the products are safe for their intended use as a food additive. The benefits of sugar substitutes to weight and diabetes management are affirmed in official position statements by the American Diabetes Association and the Academy of Nutrition and Dietetics. The safety of sugar substitutes is affirmed by official position statements of the American Academy of Pediatrics and the American Cancer Society. Valid studies demonstrate the effectiveness of sugar substitutes in weight and blood glucose management. And, the FDA could, and would, suspend the GRAS designation for any food additive should credible evidence arise showing the product to be unsafe.

Evidence suggests that the consumption of approved sugar substitutes in reasonable quantities is considered safe for most people*, and can be especially important for weight management and for managing blood glucose levels in type 2 diabetes. That includes ready-to-eat/drink products like soft drinks, and foods you prepare at home. As is the case with many decisions we make in life, it's important to weight the benefits and risks and make the decision that is best for you. In this case, when considering the potential risks associated with artificial sweeteners, we should also consider the evidence about the health effects of uncontrolled blood glucose levels.

If you want sweet (and you could always drink water or unsweetened tea) and you have diabetes, sugar substitutes are an option to consider.

*aspartame is incompatible with a rare genetic condition called phenylketonuria (as are all foods high in the amino acid phenylalanine, like meat, chicken, eggs, nuts, legumes, cheese, milk and others)