The use of sugar, sweeteners, and sugar substitutes has often been a topic of hot debate. Until recently, using sugar has been discouraged in diabetic meal planning. Current scientific studies have not supported the necessity of completely abstaining from sugar, and now it’s becoming widely accepted that sugar may be used in moderation without causing deterioration in blood sugar control. Countless studies have investigated the safety profiles of artificial sweeteners.

Misinformation is rampant regarding the safety and acceptability of using both sugar and artificial sweeteners. A fair amount of alarmist propaganda is out there, mixed in with medical facts. Listen with a critical ear. Try to review the scientific studies, not the hearsay. Consider the source of the information. In the end, the decision of what to use is up to you.

Sugar

Historically, people with diabetes were advised to completely avoid eating sugar, in hopes that this would control their blood sugar. More recently, it’s become clear that strict avoidance of dietary sugar is unnecessary. Studies have shown that when sugar is eaten in reasonable amounts and in the context of a healthful diet, blood sugar control is not jeopardized. Keep in mind that all carbohydrates (except fiber) are digested and then absorbed as sugar into the bloodstream. Blacklisting one form of carbohydrate will not cure diabetes. What’s more important is eating a reasonable amount of total carbohydrate. How much carbohydrate you eat and how it is spaced throughout the day are much more influential on the blood sugar than the specific type of carbohydrate you choose. Although you may include refined sugar in the diet, it’s wise to moderate the amount of sugar that you consume. Sugary foods are often low in nutritional value, high in fat or calories, or all three.

There are naturally occurring sugars, as well as added sugars. Fruit and milk both have natural forms of sugar (fructose and lactose, respectively). Naturally occurring sugars and added sugars affect the blood sugar similarly. Lightning won’t strike you down for eating the occasional cookie, but the diet police (well-intentioned family, friends, and strangers) may swarm around you, scolding that people with diabetes can’t eat sugar. Everyone has been so conditioned to believe that sugar is evil that it’s been hard to dispel this myth.

Some sugar-sweetened items do tend to raise the blood sugar quickly. For example, it doesn’t take long to digest liquids, so the sugar from regular sodas and sugary drinks can enter the bloodstream rapidly. A 12-ounce can of soda (45 grams carbohydrate) is roughly equal to 9 teaspoons of sugar. Fruit juice has almost the same amount of sugar; it’s just a different type of sugar. Use caution with both regular soda and fruit juice. You may find that your blood sugar is easier to control if you use diet drinks instead. Also, be aware that goopy, frosted goodies can have a large amount of carbohydrate concentrated in a relatively small portion.

Other Calorie-Containing Sweeteners

Honey, maple syrup, pancake syrup, malt syrup, corn syrup, Karo syrup, corn sweeteners, molasses, jelly, jam, and marmalade are all concentrated forms of sweeteners. There’s no advantage or disadvantage to using any one of these over another. They’ll all affect the blood sugar similarly. They each contribute approximately 15 grams of carbohydrate per tablespoon, which is about the same as white sugar.

Fructose

Powdered fructose may have some advantage over white sugar because it produces a smaller rise in blood sugar than the same amount of white sugar. Since fructose tastes sweeter than sugar, less can be used. Fructose can be used in baking.

Fructose doesn’t require digestion in the intestines. It gets absorbed into the bloodstream as fructose, not glucose. Fructose is then transported to the liver, where it’s converted to glucose and stored as glycogen for later use. It’s released into the bloodstream as needed.

Studies have shown that when a very large intake of fructose was eaten (20 percent of total calories), the LDL cholesterol went up. Don’t give up fruit if you have high cholesterol, though. Just use moderation in the amount of fructose-sweetened products you use.

Sugar Alcohol

Mannitol, maltitol, lactitol, xylitol, sorbitol, hydrogenated starch hydrolysate, and isomalt are all sugar alcohols. Sugar alcohols don’t contain sugar or alcohol, but they are a type of carbohydrate. Sugar alcohols don’t impact the blood sugar as much as regular sugars, but they do still eventually produce some glucose in the blood. Since sugar alcohols aren’t technically a form of sugar, products sweetened with sugar alcohols can boast that they are “sugar-free.” That doesn’t necessarily mean the product is “carbohydrate-free” or “low calorie.” Most chocolates that are sweetened with sugar alcohols have just as much fat, calories, and total carbohydrate as regular chocolate candies. However, sugar alcohols don’t promote tooth decay.

Sugar alcohols may have a laxative effect, causing gas, bloating, and diarrhea. Tolerance varies from one individual to the next but is usually related to the amount of sugar alcohol consumed.

Artificial Sweeteners

The FDA has approved the following artificial sweeteners for use in the United States. The acceptable daily intake (ADIs) has a built-in 100-fold safety factor. The amounts that people actually consume are well below what has been determined to be safe.

Aspartame is sold under the brand names Equal, NutraSweet, SweetMate, and NatraTaste. The FDA approved aspartame in 1981. It is 180 times sweeter than sugar. If heated at extreme temperatures, aspartame loses its sweetness; therefore, it is not acceptable for use in most cooked or baked goods.

Aspartame is made of two amino acids: phenylalanine and aspartic acid. Amino acids are the natural building blocks of proteins. When aspartame is digested into its amino acid components, the body cannot distinguish whether those amino acids came from aspartame or from dietary proteins like chicken, milk, or eggs.

Small amounts of methanol are produced as a by-product from digesting aspartame. Methanol is a by-product that is also produced from digesting the regular foods that we eat. Natural juices, including fruit juice and tomato juice, produce three to six times more methanol than an equal portion of aspartame-sweetened soft drink.

There has been a lot of finger pointing in the direction of aspartame, but claims that it is harmful haven’t been substantiated. Whether to use aspartame or not is a matter of personal choice.
Patients with a very rare metabolic disease called PKU (phenylketonuria) should not use aspartame because they need to limit all sources of phenylalanine.

Acesulfame K is sold under the brand names Sunett, Swiss Sweet, and Sweet One. Gaining FDA approval in 1988, acesulfame K is 200 times sweeter than sugar. It is heat stable and can be used in baking.

Sucralose is sold under the brand name Splenda. The FDA approved Sucralose in 1998. It’s actually made out of sugar but has been modified so that it doesn’t affect the blood sugar or provide any calories. It’s 600 times sweeter than sugar. It’s stable at high temperatures and can be used in baked goods. Like the other artificial sweeteners, sucralose doesn’t promote tooth decay.

Saccharin is sold under the brand name Sweet ’N Low. Saccharin has been around since 1879. It’s approximately 300 times sweeter than sugar. It’s stable when heated, so can be used in baking. In the 1970s its safety came under question, as some studies showed that rats that were fed large amounts of saccharin developed bladder tumors. Saccharin has been scrutinized and studied over the past several decades and has now been determined to pose no cancer risks to humans. In May 2000, saccharin was removed from the government’s list of carcinogens (cancer-causing substances). The label warning that appears on saccharin will likely soon be dropped.