From the Guidelines
Current research on substitute sugars suggests they are generally safe for consumption in moderation but have mixed health effects, and healthcare professionals should recommend reductions in sugar intake and calories with or without the use of nonnutritive sweeteners (NNS) 1.
Key Findings
- The FDA has approved many nonnutritive sweeteners for consumption by the general public, including people with diabetes, and they have undergone extensive safety evaluation by regulatory agencies 1.
- Artificial sweeteners like aspartame, sucralose, and saccharin provide sweetness without calories, potentially aiding weight management and blood sugar control for diabetics.
- However, recent studies indicate possible negative impacts on gut microbiome composition, glucose tolerance, and metabolic health with regular consumption.
- Natural sugar substitutes like stevia, monk fruit, and sugar alcohols (xylitol, erythritol) appear to have fewer adverse effects but may cause digestive discomfort in some individuals.
Recommendations
- Healthcare professionals should continue to recommend reductions in sugar intake and calories with or without the use of NNS 1.
- Assuring people with diabetes that NNS have undergone extensive safety evaluation by regulatory agencies and are continually monitored can allay unnecessary concern for harm.
- Health care professionals can regularly assess individual use of NNS based on the acceptable daily intake and recommend moderation 1.
- For optimal health, experts suggest using substitute sugars sparingly as part of a balanced diet focused on whole foods, rather than relying on them as a primary strategy for reducing sugar intake or managing weight.
Considerations
- The optimal macronutrient distribution of weight loss diets has not been established, and low-carbohydrate diets may be associated with greater improvements in triglyceride and HDL cholesterol concentrations than low-fat diets 1.
- The primary goal with respect to dietary fat in individuals with diabetes is to limit saturated fatty acids, trans fatty acids, and cholesterol intake so as to reduce risk for CVD 1.
From the Research
Current Research on Substitute Sugars
- The effects of substitute sugars on glucose regulation and energy intake have been investigated in several studies 2, 3, 4.
- A study published in 2017 found that substituting sweeteners with non-nutritive sweeteners (NNS) may aid in glycaemic control and body weight management, but the energy 'saved' from replacing sucrose with NNS was fully compensated for at subsequent meals 2.
- Another study published in 2019 suggested that natural alternative sweeteners may reduce hyperglycemia, improve lipid metabolism, and have antioxidant effects, particularly in those with baseline diabetes 3.
- Research on specific substitute sugars, such as erythritol, has raised concerns about their potential impact on cardiovascular health 5, 6.
- A study published in 2020 found that a synbiotic yogurt using monk fruit extract as a sweetener improved glucose regulation and gut microbiota in rats with type 2 diabetes mellitus 4.
- A Mendelian randomization study published in 2024 found no supportive evidence that increased erythritol increases coronary artery disease, but suggested that erythritol may decrease BMI 6.
Types of Substitute Sugars
- Non-nutritive sweeteners (NNS), such as aspartame, monk fruit, and stevia, have been studied for their effects on glucose regulation and energy intake 2.
- Natural alternative sweeteners, such as monk fruit extract, have been found to have potential benefits for glucose control and lipid metabolism 3, 4.
- Artificial sweeteners, such as erythritol, have been linked to increased cardiovascular risk, but the evidence is not yet conclusive 5, 6.
Potential Health Effects
- Substitute sugars may have varying effects on glucose regulation, energy intake, and cardiovascular health, depending on the type and individual response 2, 3, 5, 4, 6.
- Some studies suggest that natural alternative sweeteners may have benefits for glucose control and lipid metabolism, while others raise concerns about the potential impact of artificial sweeteners on cardiovascular health 3, 5, 6.