The 5 Best Sugar Substitutes for People With Type 2 Diabetes

Posted by Kayla Phillips on


Taming a sweet tooth can be a challenge for anyone, but for people with type 2 diabetes, it’s necessary to keep how much you consume in carbohydrates, including sugar, under control.

Sugar substitutes offer sweetness while making it easier to control carbohydrate intake and blood glucose (sugar). There are many sugar substitutes to choose from, but they’re not all calorie-free, and they vary in terms of their impact on blood sugar.

When you’re deciding which sugar substitutes to use, consider that they come in two varieties, noted an article published in the journal Diabetes Spectrum:

  • Nutritive These provide calories and can affect your blood sugar.
  • Nonnutritive These provide little to no calories and, per a review published in May 2018 in the European Journal of Clinical Nutrition, will not raise your blood sugar. They can be several hundred to several thousand times sweeter than sucrose (table sugar), according to the aforementioned article in Diabetes Spectrum.

But even if you choose a calorie-free sweetener, enjoy the sweet stuff in moderation. According to a study published in the journal Physiology & Behavior, artificial sweeteners can alter your brain’s response to sweetness and affect your ability to feel satisfied when you eat sweet-tasting food or drink, putting you at risk for consuming too much of it. In fact, the American Diabetes Association recommends that in the case of beverages, it’s best not to rely on zero- or low-calorie options as a replacement for ones that contain sugar beyond the short term; but instead, to consume as little of any type of sweetener as you can, and simply drink more water.

With that in mind, here are nine low- or no-calorie options to consider:

Sucralose (Splenda), the Most Popular Sugar Substitute

This sweetener is excellent for people with type 2 diabetes. That’s because Splenda is 600 times sweeter than sugar, yet those little yellow packets have no effect on blood sugar, says Keri Glassman, RD, CDN, of Nutritious Life, a nutrition practice based in New York City.
In addition, Splenda passes through the body with minimal absorption. These attributes have helped it become the most used artificial sweetener worldwide, according to an article published in October 2016 in Physiology & Behavior.

The Food and Drug Administration (FDA), which has approved sucralose, recommends an acceptable daily intake (ADI) of 5 milligrams (mg) or less of sucralose per kilogram (kg) of body weight per day. A 132-pound (lb) individual would need to consume 23 tabletop packets of artificial sweetener per day to reach that limit.


Saccharin (Sweet ‘N Low), the Oldest Artificial Sweetener

If you’ve been using artificial sweeteners since the 1970s, you may remember a previous warning label that warned of saccharin increasing the risk for cancer. But rest assured it's safe. The research that prompted the label was done on animals, and further studies by the National Toxicology Program of the National Institutes of Health concluded that saccharin shouldn’t be on the list of potential carcinogens. Saccharin is currently FDA-approved. 

A 132-lb individual would need to consume 45 tabletop packets of the artificial sweetener per day to reach the ADI of 15 mg of saccharin per kg of body weight per day, according to the FDA.


Aspartame, a Low-Calorie Sweetener yet Not Okay for People With PKU

Aspartame, sold in blue packets under the brand names Equal and NutraSweet, is a non-nutritive artificial sweetener that is 200 times sweeter than sugar, according to the FDA. While not zero-calorie like some other artificial sweeteners, aspartame is still very low in calories.

While the FDA has reviewed the scientific research and found aspartame safe to eat, Glassman notes there have also been some conflicting study results on this sweetener’s safety. "Although its low-calorie reputation is appealing for most weight-conscious individuals, it has been linked to many negative side effects," Glassman says. Some animal research, including a study published in December 2014 in the journal Cytotechnology, has shown linkage to leukemia, lymphoma, and breast cancer. “Other research shows a [possible] linkage to migraines."

Yet the American Cancer Society notes that U.S. and European regulatory agencies have, respectively, concluded that aspartame is “safe” and that research doesn’t indicate an increased risk of cancer in humans.

Nevertheless, people with phenylketonuria (PKU), a rare condition in which they are unable to metabolize phenylalanine (a key component of aspartame), should not consume this sugar substitute, notes the NHS. If you don’t have PKU, aspartame is safe to consume.

A 132-lb individual would need to consume a whopping 75 tabletop packets of the artificial sweetener per day to reach the ADI of 50 mg of aspartame per kg of body weight per day, notes the FDA.


Stevia (Truvia or Pure Via), a Natural Sweetener Option

Steviol glycosides are sweeteners derived from the leaf of the stevia plant, which is native to Central and South America. Truvia and Pure Via, both brands of stevia-based sweetener, are calorie-free, and stevia is often used as a sweetener in foods and beverages. According to the 2019 Standards of Medical Care in Diabetes, published in January 2019 in Diabetes Care, nonnutritive sweeteners, including stevia, have little to no impact on blood sugar. The FDA has approved the use of certain stevia extracts, which it has generally recognized as safe (a term that is applied to food additives that qualified experts deem as safe, and therefore not subject to the usual premarket review and approval process).

Memorial Sloan Kettering Cancer Center notes that people have reported side effects, like gastrointestinal symptoms, after eating high amounts of stevia. But to date, there is no solid scientific research to prove these claims. 

The FDA recommends an ADI of 4 mg or less of Truvia per kilogram of body weight per day. A 132-lb individual would need to consume nine tabletop packets of the artificial sweetener per day to reach that limit.


Sugar Alcohols, a Low-Calorie Option for Sweetening Your Fare


Sugar alcohols, or polyols, are derived from the natural fibers in fruits and vegetables, according to the Joslin Diabetes Center. Per the International Food Information Council Foundation, commonly used sugar alcohol sweeteners in many so-called “sugar-free” desserts, candies and gums include:

  • Xylitol
  • Sorbitol
  • Mannitol
  • Isomalt

Though sugar alcohols are relatively low in calories and more blood sugar–friendly than carbohydrates, they may have a laxative effect and cause indigestion, bloating, and diarrhea in some people, the FDA points out. Products containing sorbitol and mannitol must bear a label warning that excess consumption can cause a laxative effect, per the FDA.

The gastrointestinal symptoms arise because sugar alcohols are not completely absorbed in the digestive tract, says Lynn Grieger, RDN, CDE, a medical reviewer for Everyday Health who’s based in Prescott, Arizona. She explains that unabsorbed carbohydrates from these sweeteners pass into the large intestine, where they are fermented by gut bacteria to produce gas. See how you respond to a small amount before incorporating them into your daily diet.

Also, keep in mind that sugar alcohols do contain some carbohydrates and are nutritive sweeteners, so they can affect blood sugar levels.

“It’s important for people with diabetes to read the nutrition facts label for total carbohydrate content and plan accordingly,” says Grieger. “Remember that the information in a nutrition facts label is based on one serving, and it’s easy to eat more than one serving of foods that contain sugar alcohols, which can increase the total carbohydrate consumed.” If you count carbs to manage diabetes, a common rule of thumb is to subtract half the amount of the sugar alcohol carbs listed on the nutrition label from the total carbs listed, according to the University of California in San Francisco.


Erythritol, a Sugar Alcohol with Fewer Side Effects Than Other Options


Erythritol is also a sugar alcohol sweetener, but unlike the others just mentioned, it has less than 1 calorie per gram, notes the International Food Information Council Foundation, and doesn’t have a big effect on blood sugar levels, per the American Diabetes Association. It’s an ingredient in the stevia-derived sweetener Truvia and is marketed under the brand-name Swerve. Swerve measures cup-for-cup like sugar, and you can use it like table sugar, or in cooking and baking recipes that call for sugar. 

If other sugar alcohol sweeteners give you tummy trouble, this may be a better option for you. It is less likely to produce gas, bloating, and diarrhea that happen from fermentation by gut bacteria because only about 10 percent of the erythritol you consume enters the colon, per past research. The rest leaves the body through your urine.

There’s no ADI for erythritol, but the FDA hasn't questioned notices submitted by erythritol makers that the sweetener is “generally recognized as safe.”


Monk Fruit Sweetener, Another Natural Option for Sweetening Your Foods


Also known by the names Luo Han Guo fruit extract and Siraitia grosvenorii Swingle fruit extract, this nonnutritive sweetener comes from a plant native to southern China. The extract contains 0 calories per serving, per the International Food Information Council Foundation, and per the FDA, is 150 to 200 times sweeter than sugar. Popular brands include Monk Fruit in the Raw and Lakanto. The FDA has not questioned notices submitted by monk fruit sweetener makers that the extract is “generally recognized as safe.” The agency doesn’t specify an ADI for monk fruit sweetener.

Acesulfame Potassium, a Popular Sugar Substitute in Diet Soda


Also known as Ace-K, this non-nutritive sweetener is FDA-approved and about 200 times sweeter than sugar. Often manufacturers combine it with other sweeteners, though it is also sold for tabletop use under the brand name Sweet One. You will also find it in some of your favorite diet soft drinks, such as Coca-Cola Zero Sugar and Diet Mountain Dew. The FDA recommends an ADI of 15 mg or less of Ace-K per kilogram of body weight per day.

A 132-pound individual would need to consume 23 tabletop packets of the artificial sweetener per day to reach that limit.


Allulose (Dolcia Prima), a New Artificial Sweetener That’s No Longer Considered an Added Sugar


Allulose (also known as D-allulose or D-psicose, per the U.S. National Library of Medicine) is an extremely low-calorie sweetener that occurs naturally in small amounts in wheat, raisins, dried figs, brown sugar, and molasses, according to the FDA. Marketed under the brand name Dolcia Prima (which Tate & Lyle, Splenda’s manufacturer, makes), it has 90 percent fewer calories than sucrose, while being 70 percent as sweet.

You can find Dolcia Prima in Magic Spoon Cereal, which is sold online; and expect to see it soon in beverages, desserts, candy, yogurt, and other treats. That’s because allulose got a big boost from the FDA in April 2019, when the agency declared it can be excluded from the total and added sugars listed on nutrition labels going forward.

“The latest data suggests that allulose is different from other sugars in that it is not metabolized by the human body in the same way as table sugar,” says Susan Mayne, PhD, director of FDA’s Center for Food Safety and Applied Nutrition. “It has fewer calories, produces only negligible increases in blood glucose or insulin levels, and does not promote dental decay.”

Under the revised guidance, manufacturers can use a caloric value of 0.4 calories per gram to calculate the total number of calories per serving of allulose, instead of the previous 4 calories per gram. The sweetener still must be included in the total carbohydrates listed, though. While allulose isn’t on the list of FDA-approved sweeteners, the agency hasn’t questioned notices submitted by manufacturers that the sweetener is “generally recognized as safe.” 

But the European Union has yet to approve allulose, according to an article published in April 2019 in Food Manufacture, nor has Canada added it to their list of permitted sweeteners. Furthermore, research into its effectiveness for controlling blood sugar is limited to small studies, such as a small randomized, double-blinded trial published in June 2018 in the journal Nutrients, which was funded by Tate & Lyle. The authors observed that small doses of allulose (5 or 10 g) did not have a significant effect on blood glucose levels when taken with a standard glucose tolerance test, but they recommended larger sample sizes for future studies. 

One Last Thing About Using Sugar Substitutes When Managing Type 2 Diabetes

As you can see, there are many artificial sweeteners to help you reach your blood sugar goals. Just remember that maintaining them will be easier if you practice moderation and don’t allow sweet-tasting food and beverages to lead you to overconsume them. “A major goal should be to reduce all types of sweeteners in your diet, including sugar substitutes, so that you become accustomed to the naturally sweet taste of food,” says Grieger. Then trust your body to tell you when enough is enough. 

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