Five reasons why low calorie sweeteners can be a helpful tool in diabetes
Posted: 14 Nov 2016
Based on latest scientific evidence
Low calorie sweeteners are highly valued and used by people with diabetes, and there are at least five good reasons for doing so. The dietary recommendations for diabetes management include monitoring carbohydrate intake and further advice to choose carbohydrate intake from vegetables, fruits, whole grains, legumes, and dairy products over intake from other carbohydrate sources, especially those containing added fats, sugars and salt1. Therefore, replacing some of the sugar or sugar-sweetened products with low calorie sweetened options can be a helpful strategy in meeting the above recommendations to limit sugar intake.
Five reasons to choose low calorie sweeteners in place of sugars
There are at least five good reasons why to choose them in your diet, including that low calorie sweeteners:
- Help you reduce your sugars intake
- Do not affect blood glucose levels
- Provide low or no calories and can help in calorie reduction
- Can be an ally in weight management
- Provide more sweet-tasting options with less carbohydrates and calories
The science behind low calorie sweeteners’ role in diabetes
Low calorie sweeteners, or intense sweeteners as are alternatively called, are sweet-tasting ingredients that provide practically no calories, and are used in very small amounts to replace sugar in foods and drinks. Even from this basic description, it is easy to spot the benefits of low calorie sweeteners for people with diabetes: They can help people keep the desired sweet taste while reducing sugars intake, and provide more palatable options with less calories.
However, their most important benefit is that they do not affect blood glucose levels in both healthy individuals, normal-weight or obese, as well as people with diabetes. In a recent systematic review by Romo-Romo et al2 summarising the available randomised clinical trials (RCTs) of the literature, 26 out of 28 RCTs showed that different low calorie sweeteners do not affect glycaemic indexes such as blood glucose, insulin secretion and glycosylated haemoglobin (Hb1Ac), while the two studies that showed a potential impact included a very small sample size, 7 and 11 people accordingly, without including a control group, which of course are serious limitation not allowing any conclusions to be drawn3,4.
This review reaffirms EFSA’s Panel on Dietetic Products Nutrition and Allergies conclusions in 2011 that “Consumption of foods containing low calorie sweeteners instead of sugar induces a lower blood glucose rise after their consumption compared to sugar-containing foods”5, a health claim that was authorised by the European Commission in 2012 (Commission Regulation (EU) No 432/2012)6.
In a nutshell, research supports that low calorie sweeteners in place of sugars do have a benefit in glycaemic control and specifically in post-prandial glucose7. It is important to note, though, that foods containing low calorie sweeteners may affect glycaemia due to other potential ingredients in the product such as carbohydrates8. People with diabetes should check food labels to review the full ingredients list of all products.
Another important benefit for people with diabetes, is the role of low calorie sweeteners in reducing energy intake and in weight management. The balance of scientific evidence, as analysed in two recent systematic reviews and meta-analyses, indicates that use of low calorie sweeteners in place of sugar, in children and adults, leads to reduced energy intake and body weight9,10.
In conclusion, based on latest science, substituting low calorie sweeteners for added sugars in beverages and other foods has the potential to help people with diabetes with glucose control and better weight management, as recognised also in the position statements of the American Heart Association and American Diabetes Association11, as well as the Academy of Nutrition and Dietetics12.
For more information on the role of low calorie sweeteners in diabetes management you may download the ISA factsheet ‘Sweet talk on diabetes’ by clicking here .
You may also watch the ISA animated video for World Diabetes Day 2016 by clicking here and find out why ‘It’s easy to start with one simple step’. You may also read more about ISA campaign in support of World Diabetes Day 2016 and download related materials here.
- Evert AB, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care, 2013; 36: 3821-3842
- Romo-Romo A, Aguilar-Salinas CA, Brito-Cordova GX, et al. Effects of the non-nutritive sweeteners on glucose metabolism and appetite regulating hormones: Systematic review of observational prospective studies and clinical trials. Plos One 2016; 11(8): e0161264
- Pepino MY, et al. Sucralose affects glycemic and hormonal responses to an oral glucose load. Diabetes Care 2013; 36: 2530–2535
- Suez J, Korem T, Zeevi D, Zilberman-Schapira G, Thaiss CA, Maza O, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014; 514(7521):181–6.
- EFSA NDA (EFSA Panel on Dietetic Products Nutrition and Allergies). Scientific opinion on the substantiation of health claims related to intense sweeteners and contribution to the maintenance or achievement of a normal body weight (ID 1136, 1444, 4299), reduction of post-prandial glycaemic responses (ID 4298), maintenance of normal blood glucose concentrations (ID 1221, 4298), and maintenance of tooth mineralisation by decreasing tooth demineralisation (ID 1134, 1167, 1283) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA 2011 Journal 9: 2229
- Commission Regulation (EU) No 432/2012 of 16 May 2012 establishing a list of permitted health claims made on foods, other than those referring to the reduction of disease risk and to children’s development and health
- Russell W, et al. Impact of Diet Composition on Blood Glucose Regulation. Critical Reviews in Food Science and Nutrition, 2013; 56:4: 541-590
- Franz MJ, Powers MA, Leontos C, et al.The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults. J Am Diet Assoc 2010;110:1852–1889
- Miller P, Perez V. Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohorts (391.1). FASEB J 2014; 28: 391
- Rogers PJ, Hogenkamp PS, de Graaf K, et al. Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. Int J Obes 2016; 40(3): 381-94
- Gardner C, Wylie-Rosett J, Gidding SS, Steffen LM, Johnson RK, Reader D, Lichtenstein AH. Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2012; 126:509–519
- Fitch C, Keim KS. Academy of Nutrition and Dietetics. Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners. J Acad Nutr Diet 2012; 112: 739–58