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

Here's what you need to know to understand the impact of sweeteners—both nutritive and non-nutritive—on your blood sugar.

different types of sugarUnderstanding the impact of sweeteners on your blood sugar is essential for people with diabetes.

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.

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:

  • Aspartame (the blue packet—Equal and NutraSweet)
  • Saccharin (the pink packet—Sweet N’ Low)
  • Sucralose (the yellow packet—Splenda)
  • Stevia (the green packet—Truvia, PureVia)
  • Luo han guo, also known as monk fruit extract
  • Acesulfame Potassium, also called Ace-K or acesulfame K
  • Neotame
  • Advantame (which is made with aspartame)

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

Natural or Nutritive SugarNatural, or nutritive, sources of sugar have calories and impact blood sugar. Ordinary table sugar, brown sugar, coconut sugar, honey and agave are members of this group.

  • Table (Cane) Sugar. Cane sugar is the most common form of sugar and when processed, a variety of refined sugars result—ordinary white table sugar, brown sugar, turbinado sugar (brown in color and less processed than cane sugar), confectionary (or powdered) sugar. They all contain about 14 calories and 4 grams of carbs per teaspoon. The only difference is the crystal size and color.
  • Honey. Made by honey bees from the nectar of flowers it is slightly sweeter than table sugar and contains more calories and carbs per teaspoon—21 calories and 6g of carbohydrate. Honey, may contain small amounts of vitamins like zinc and selenium and has no preservatives.
  • Agave Nectar. A nutritive sweetener produced from the heart of the agave plant (and also used to make tequila).  Agave syrup originally claimed to be ideal for people with diabetes due to its low glycemic index. It has a glycemic index (GI) of 11; table sugar’s GI is 68 and honey’s is 50. Plus, since it’s sweeter than table sugar most people use less to satisfy a sweet tooth. But here’s the rub: it still has the same calories as honey—1 teaspoon of agave syrup has 21 calories and 4.6 grams of carbohydrates. 
  • Coconut Sugar. The newest type of natural sweetener on the market, is made from the sweet sap of the coconut palm tree. It consists of 70% table sugar and contains inulin, which is a type of fiber linked to an improvement in gut health, digestion and even type 2 diabetes. More recently, it’s been revealed that the amount of inulin fiber can vary depending on the manufacturer and apart from that it’s worth noting that improvements in health were only seen when participants ingested up to 30g of inulin. Getting that amount of inulin from coconut sugar is nearly impossible. It also contains about the same amount of calories and carbohydrates as table sugar: 1 teaspoon has 15 calories and about 5 grams of carbohydrates

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

artificial sweetenersArtificial or non-nutritive sweeteners have no impact on blood sugar. Popular name brands include: NutraSweet, Sweet N' Low, Splenda and Truvia,

  • Stevia. Also called rebaudioside A, or steviol glycosides, Stevia is extracted from the leaves of the stevia plant but should not be confused with the Stevia plant. The Stevia plant contains active ingredients and is sold as a dietary supplement. Stevia is 200-400 times sweeter than sugar. Brand names include: A Sweet Leaf, Sun Crystals, Steviva, Truvia and PureVia.
  • Sucralose. Six hundred times sweeter than sugar, sucralose is heat stable and can be used in cooking and baking. Brand name: Splenda.
  • Luo Han Guo, also known as Monk Sugar. This newer sweetener is 150 to 300 times sweeter than table sugar (sucrose). Brand names include: Monk Fruit in the Raw, Nectrese, PureFruit, PureLo.
  • Neotame and Advantame. If you aren’t familiar with these products, it’s probably because they aren’t widely-used commercially and aren’t available as tabletop sweeteners.

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!

Updated on: April 27, 2017
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