Artificial Sweeteners or Natural Sugar: Which is Best for People with Diabetes?

Written by Marina Chaparro, RD, CDE, MPH

Walk down the supermarket aisles and you’ll find a dizzying array of sweeteners. Everything from ordinary (white) table sugar to newly-formulated sugars, sugar substitutes and more. Some claim benefits for people with diabetes that promise to have no effect on blood sugar. But with so many choices—from ordinary table sugar (aka cane, sucrose), maple sugar and agave to newer arrivals like coconut sugar, monk sugar and stevia, to nonnutritive sweeteners (sucralose, aspartame, etc.)—how do you know which one is best for you and your blood sugar? 

It's important to know that use of the word natural is not a term regulated by the FDA, nor does it have a clear definition. These so-called “natural” sweeteners, also referred to as nutritive sweeteners, are a type of sugar (typically sucrose), which provide calories from carbohydrates.

All nutritive sugars have about 14 calories per teaspoon and contain 5 grams of carbohydrates. Food companies seem to use the word “natural” as a marketing gimmick to give consumers a sense of additional health benefits. Popular nutritive sweetners include: brown sugar, honey, coconut sugar and agave syrup. But remember, sugar is sugar. Whether honey or table sugar, they all contain carbohydrates and will raise blood glucose levels.

Having Sugar Knowledge is Important

Contrary to popular belief, people with diabetes can consume sugar but it’s best when consumed in foods where it occurs naturally as it does in whole fruits. Understanding the type of sugar you consume and how much, is essential for successful diabetes management.

People with pre-diabetes or type 2 diabetes, don’t have the adequate insulin needed to maintain steady blood sugars and have trouble absorbing simple carbohydrates. Carbohydrates have the greatest impact on blood sugars because they are converted into glucose or energy for the body.

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Unlike natural (nutritive) sweeteners, non-nutritive products—also called artificial sweeteners—are regulated by the FDA and do NOT affect blood sugars. They were formulated to enhance flavor without additional calories and are many times sweeter than sugar. Artificial sweeteners are considered a “free food” since they have few to no carbohydrates.

Currently, there are eight sugar substitutes that have been approved in the US by the FDA:

Artificial sweeteners have been one of the most studied food additives and remain controversial as they’ve been linked to everything from insulin resistance, weight gain, distorting healthy gut bacteria and even cancer.

However, it’s important to note that many of these studies have been conducted in rats and those results have never been reproduced in humans.
Other studies linking artificial sweeteners to weight gain and insulin changes remain inconclusive with varying results. 

The Academy of Nutrition and Dietetics states “consumers can safely enjoy a range of nutritive sweeteners and nonnutritive sweeteners when consumed within an eating plan that is guided by current federal nutrition.”  What the research tells us now is that artificial sweeteners are safe to consume, but more studies are needed to further explore these association. (The good news is, many such studies are in the works!)

Know Your Supermarket Players

Below is what you need to know to understand the differences between natural and artificial sweeteners.

Sugar Sweeteners (Nutritive): Impacts Blood Sugar

Artificial Sweeteners (Non-nutritive): No Impact on Blood Sugar

Bottom Line

Knowing what to eat when you have diabetes can be overwhelming. Having to decide which sugar to use can add another perplexing layer. People with diabetes need to understand which sweeteners will impact their blood sugars and account for it in meal planning.  Research shows meeting regularly with a registered dietitian is associated with improved cholesterol levels, weight management success, decreased need for medications and a reduced risk for other diseases.  

Just because a sugar is labeled “natural” or “organic” does not make it a healthier choice. Honey, agave syrup and cane sugar might come from natural sugar sources, but they still raise blood sugars.  Whether a sugar is natural or not is less important than whether it will be absorbed into the blood stream. 

As a certified diabetes educator and a person with type 1 diabetes, I believe in making choices that work for you. Fortunately for people with diabetes, it’s safe to enjoy a range of artificial sweeteners without impacting blood sugars.  Artificial sweeteners give people with diabetes more options and help them feel less deprived when sweetening their favorite foods.

But truly the best thing you can do for your blood sugar is to avoid adding sugar (no matter what form it comes in) to your food. To satisfy a sweet tooth, try adding sweetness without adding sugar. Try a little unsweetened almond milk to flavor your morning coffee or add berries (fresh or frozen and defrosted) to plain Greek yogurt, for example.

For overall health, it’s best to focus on a wholesome diet that includes less processed foods, more whole grains, fresh fruits and vegetables and a very limited amount of sweets or food with added sugar.  That goes for people without diabetes too!

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