Benefits for people with diabetes
Low/no calorie sweeteners cause a lower rise in blood glucose levels after meals (post-prandially) if consumed instead of sugar and they do not otherwise affect blood glucose control or insulin secretion. The benefit of low/no calorie sweeteners on post-prandial glucose has also been recognised as a health claim by EFSA: “Consumption of foods containing low calorie sweeteners instead of sugar induces a lower blood glucose rise after their consumption compared to sugar-containing foods”1.
Low/no calorie sweeteners offer more “sweet” food choices to people with diabetes
Diabetes is one of the fastest growing health challenges of the 21st century, with the number of adults living with diabetes having more than tripled over the past 20 years. Based on the latest figures released by the International Diabetes Federation (IDF) in 2019, it is estimated that globally 9.3% of adults aged 20-79 years, a staggering 463 million people, are living with diabetes. A further 1.1 million children and adolescents under the age of 20 live with type 1 diabetes. IDF estimates that there will be 578 million adults with diabetes by 2030, and 700 million by 2045.2
Low/no calorie sweeteners offer people with diabetes broader food choices by providing the pleasure of sweet taste without raising blood glucose.3,4 As low/no calorie sweeteners have no impact on insulin and blood sugar levels and do not provide calories, they can also have a role to play in weight loss and weight control for people with type 2 diabetes. 5-7
The role of low/no calorie sweeteners in diabetes
Over the last decade, numerous health-related organisations worldwide have issued position statements, consensus reports or nutritional guidelines about the use of low/no calorie sweeteners in diabetes.
For example, Diabetes UK recently published a Position Statement on low/no calorie sweeteners (LNCS)5, concluding overall that: “LNCS are shown to be safe and they can be used as part of a strategy for adults and children in the management of weight and diabetes”.
Similarly, the consensus of the Latin-American Association of Diabetes (Asociación Latinoamericana de Diabetes (ALAD))6 overall acknowledges that the consumption of low/no calorie sweeteners is safe within the Acceptable Daily Intake (ADI) levels and further concludes that their use can have benefits in calorie reduction, weight loss and glucose control, when used to replace sugar in the context of a structured dietary plan.
Also, in a Consensus Report by the American Diabetes Association (ADA) on nutrition therapy for adults with diabetes or prediabetes7, the conclusion about low/no calorie sweeteners was that, “Replacing added sugars with sugar substitutes could decrease daily intake of carbohydrates and calories. These dietary changes could beneficially affect glycaemic, weight, and cardiometabolic control” and that “people should be counselled to avoid compensating with intake of additional calories from other food sources.”
For more information on the role of low/no calorie sweeteners in diabetes management we invite you to download the ISA factsheet Sweet talk on diabetes. How can low calorie sweeteners help? and the ISA infographic Low Calorie Sweeteners in Diabetes.
You may also find interesting to check the online materials developed over the years as part of the ISA online campaigns in support of World Diabetes Day, which include inspirational videos, animations and interesting infographics providing further information on key lifestyle and dietary guidelines for people with diabetes, including on the role of low/no calorie sweeteners in this context. Please click here to access these materials, also available in multiple languages.
- 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
- IDF, Diabetes Atlas 9th edition 2019. Available at: https://www.diabetesatlas.org/en/resources/
- Greyling A, Appleton KM, Raben A, Mela DJ. Acute glycemic and insulinemic effects of low-energy sweeteners: a systematic review and meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition 2020; nqaa167.
- Gardner C, et al. Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. (2012) Aug;35(8):1798-808.
- Diabetes UK. The use of low or no calorie sweeteners. Position Statement (Updated December 2018). Available at: https://www.diabetes.org.uk/professionals/position-statements-reports/food-nutrition-lifestyle/use-o…
- Laviada-Molina H, Escobar-Duque ID, Pereyra E, Romo-Romo A, Brito-Córdova G, Carrasco-Piña E, González-Suárez R, López-García R, Molina-Seguí F, Mesa-Pérez JA. Consenso de la Asociación Latinoamericana de Diabetes sobre uso de edulcorantes no calóricos en personas con diabetes [Consensus of the Latin-American Association of Diabetes on low calorie sweeteners in persons with diabetes]. Rev ALAD. 2018;8:152-74
- Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KHK, MacLeod J, Mitri J, Pereira RF, Rawlings K, Robinson S, Saslow L, Uelmen A, Urbanski PB, Yancy Jr. WS. Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report. Diabetes Care. 2019 May;42(5):731-754