Dos and Don'ts for Sugar and Its Substitutes

When it's time for a treat, nothing beats something sweet—but not all sweeteners are equal. To learn which ones are safe to use if you have diabetes, check out our rundown of the old familiars as well as some newer options.

Caloric Sweeteners

Also called "nutritive" sweeteners, these natural carbohydrates include classic white table sugar as well as brown sugar, fructose, agave, molasses and honey. Since they raise blood glucose and contain calories, most adults with diabetes should avoid them.

If you take insulin, however, you should keep products that contain natural sweeteners (like orange juice or hard candies) on hand, in case your blood sugar drops too low.

Low Calorie Sweeteners

These sweeteners, composed of sugar alcohols, have about half the calories of nutritive sweeteners. They include mannitol, sorbitol and xylitol and are found in sugar-free chewing gums, some flavored syrups, mouthwash and flavored liquid medicines. They can raise blood sugar slightly, but it’s rare for anyone to consume enough for this to occur; ingesting excessive amounts often leads to gastrointestinal upset before it causes a significant surge in blood glucose.

Non-Nutritive Sweeteners

The most popular artificial non-nutritive sweeteners are sold under a variety of brand names. They include aspartame, sucralose, saccharin and acesulfame potassium. Natural versions—made from processed and refined plant extracts—include monk fruit and stevia.

All of them have zero calories and are safe for people with diabetes. Stevia and sucralose are considered the best ones to use when baking.

Sugar Substitutes for Weight Loss

Research has been inconsistent as to whether sugar substitutes decrease, increase or have no effect on appetite and satiety. As sugar substitutes have grown in popularity, more Americans have become overweight—but that doesn't mean that sugar substitutes are the culprit.

Studies comparing weight or changes in weight in people who drink diet beverages and those who do not have yielded conflicting results, probably because so many other factors come into play. For instance, people who consume diet drinks are often overweight to begin with. And when they lose weight, it could be because they take additional weight control steps.

On the other hand, people who drink such beverages may not lose weight because they may compensate for the calories they "saved" by indulging in more of other foods. In 2012, a Scientific Statement from the American Heart Association and American Diabetes Association concluded that it's plausible that sugar substitutes could promote modest weight loss, but that longer, well-designed clinical trials are lacking.

From our sister publication Diabetes Focus, Fall 2013

Publication Review By: Christine Gerbstadt, M.D., R.D.

Published: 08 Aug 2013

Last Modified: 08 Aug 2013