Diabetes UK reaffirms low calorie sweeteners’ intake recommendation


Posted: 01 March 2018

New nutrition guidelines by Diabetes UK support low calorie sweeteners’ use in diabetes

Highlights:

  • The new Diabetes UK nutrition guidelines for diabetes prevention and management endorse the use of low calorie sweeteners
  • Numerous scientific and medical or nutrition organisations around the world support the use of low calorie sweeteners in diabetes
  • Low calorie sweeteners can be a useful dietary tool for people with diabetes as a means to help reduce carbohydrate intake without affecting blood glucose

Over the years, several scientific and medical organisations around the world have issued guidelines for the nutritional management of diabetes, which primarily aim to serve as a guide for health professionals in educating their patients, and ultimately, to help people make more balanced and healthier choices in order to improve their glucose control. What’s certainly not, and should not be anyway, within the scope of these recommendations is to deprive people of the pleasure of eating.

Yet, for many people, living with diabetes often means being constantly concerned about what and how much to eat and deprived especially when it comes to the desirable sweet taste. But having diabetes shouldn’t keep people from enjoying a variety of foods including some favourites in moderation; indeed, reducing excess sugar intake is a key recommendation in diabetes management, however, low calorie sweeteners can be a useful dietary tool in helping patients to reduce calorie and carbohydrate intake as part of a good-tasting diet while also satisfying their cravings for sweet taste without affecting blood glucose levels.

So, what’s the recommendation about low calorie sweeteners’ use in diabetes according to the different nutrition guidelines around the world? On the occasion of the publication of the latest Diabetes UK nutrition guidelines in February 2018, this article presents a summary of what the nutrition guidelines in different European countries and in the US and Canada recommend about the usage of low calorie sweeteners in the diet of people with diabetes.

New Diabetes UK nutrition guidelines: Low calorie sweeteners may be recommended

The 2018 Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes,1 released in March this year, reconfirm the earlier endorsement and recommendation regarding the consumption of foods and drinks with low calorie sweeteners in diabetes and state that, “low calorie sweeteners are safe and may be recommended [for people with diabetes]”. This statement is in line with the previous Diabetes UK recommendations in 20112, which recognised that: “Non-nutritive sweeteners are safe when consumed within the daily intake levels and may reduce HbA1c [glycated haemoglobin] when used as part of a low-calorie diet”.

In the full guideline report, the expert panel of specialist dietitians describes low calorie sweeteners as “sweetening agents that provide little or no calories (energy) and have no effect on glycaemia”. It is also stated that for people who are accustomed to sugar sweetened products, low calorie sweeteners have the potential to reduce overall energy and carbohydrate intake and may be preferred to sugar when consumed in moderation and can be a useful strategy for those individuals seeking to control their calorie intake and manage their weight. The full guideline document is available for download here.

These latest nutrition guidelines were developed by an expert panel of specialist dietitians who updated the earlier recommendations from 2011 upon reviewing the recent published literature and grading the available evidence. The new elements added in the 2018 guidelines include that the focus is on food, rather than on nutrients, where this is possible, and that an individualized, flexible approach to diabetes and weight loss management is recommended.

UK guidelines consistent with recommendations by other diabetes-related organisations

Further to the just-released nutrition guidelines by Diabetes UK, the American Diabetes Association (ADA) consistently supports in its annually revised Standards of Medical Care in Diabetes (latest update in 2018)3 the potential for low calorie sweeteners to reduce overall calorie and carbohydrate intake with no significant effect on glycaemic control, and that most systematic reviews and meta-analyses show benefits for low calorie sweetener use in weight loss. Similarly, in 2017, different diabetes- and/ or nutrition-related scientific organisations in the US4, Poland5 and Greece6, 7 recommend the replacement of (part of) sugar with low calorie sweeteners and call health professionals to educate adults with diabetes that intake of approved low calorie sweeteners will not have a significant influence on glycaemic control. This is also in line with earlier recommendations in Hungary8 and Canada9, which conclude that low calorie sweeteners don’t increase blood glucose levels and can be part of a healthy diet in diabetes.

Overall, when it comes to low calorie sweeteners’ use in the context of the medical nutrition therapy (MNT) recommendations for type 1 and type 2 diabetes, it is widely recognised that, based on a wealth of scientific evidence, low calorie sweeteners are safe and do not affect blood glucose and insulin levels, and thus, that they can help reduce overall calorie and carbohydrate intake when used in place of caloric sweeteners such as sugar.

For more information, you may read about what the recommendations of different diabetes/ nutrition-related scientific organisations in Europe (UK, Poland, Greece, Hungary), the US and Canada support about the use of low calorie sweeteners in diabetes management in the below table.



Table: Nutrition guidelines for diabetes management by diabetes- and nutrition-related scientific organisations in different European countries (UK, Poland, Greece, Hungary), the US and Canada: recommendations regarding the use of low calorie sweeteners in the diet of people with diabetes

Take-home message

Bottom line, low calorie sweeteners and foods and drinks containing them can be safely used by people with diabetes to help curb cravings for something sweet without risking a spike in blood glucose levels, provided that other ingredients of the food/ drink don’t influence blood glucose either. Using low calorie sweeteners in place of sugar can also help reduce overall calorie intake and be a helpful tool in nutritional strategies for weight management10, which is especially important for people with type 2 diabetes that need to lose weight. Of course, there should be no expectation that low calorie sweeteners, by themselves, would cause weight loss or decrease blood glucose levels, but they can certainly be part of an overall healthy diet aiming to improve overall glycaemic control in diabetes.

References

  1. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes (2018). Dyson PA., et al. Diabetic Medicine 2018, Feb 14; Accepted Author Manuscript. doi:10.1111/dme.13603. The full guideline document is available at: https://www.diabetes.org.uk/professionals/position-statements-reports/food-nutrition-lifestyle/evide...
  2. Dyson PA, Kelly T, Deakin T, Duncan A, Frost G, Harrison Z et al.; on behalf of Diabetes UK Nutrition Working Group. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabetic Medicine 2011; 28:1282–1288.
  3. American Diabetes Association. 4. Lifestyle management: Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018;41(Suppl. 1):S38–S50
  1. Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Systematic Review of Evidence for Medical Nutrition Therapy Effectiveness and Recommendations for Integration into the Nutrition Care Process. Franz MJ., et al. Journal of the Academy of Nutrition and Dietetics 2017;117(10):1659 – 1679
  2. 2017 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clin Diabet 2017; 6, Suppl. A: A1–A80. DOI: 10.5603/DK.2017.0001. [in Polish]
  3. Guidelines for diabetes management. Hellenic Diabetes Association 2017. Available online: http://www.ede.gr/wp-content/uploads/2017/odigies.pdf [in Greek]
  4. Patient nutrition guide for diabetes control. Hellenic Diabetes Association 2013. Available online: http://ede.gr/wp-content/uploads/2013/diatrofi.pdf [in Greek]
  5. Diagnosis of diabetes mellitus, treatment and care of diabetes in adulthood. The Hungarian Diabetes Society professional guideline, 2014. Zsolt G. et al (edited by Dr. Jermendy György). Diabetologia Hungarica 2014; XXII. évfolyam 1. Supplementum [in Hungarian]
  6. 2013 Canadian Diabetes Association Clinical Practice Guidelines. Sugar and sweeteners. Available online: http://guidelines.diabetes.ca/cdacpg/media/documents/patient-resources/111020_Sugars_and_Sweeteners_...
  7. Rogers, P J, 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 40, no. 3 (2016): 381-94