Are artificial sweeteners safe for diabetics? Discovering their effects on blood sugar

Natural sources do not provide options to satisfy our sweet cravings without increasing our calorie intake. White sugar, brown sugar, honey and jaggery all have the same amount of calories. However, sugar substitutes help reduce calorie intake, as many of them contain almost zero calories. For example, a 500ml can of cola has about 12 teaspoons of added sugar – about 220 calories – while a can of diet cola has zero calories! In theory, sugar alternatives are an attractive proposition. However, they are not without controversy.
There are two general types of sugar substitutes: artificial sweeteners and sugar alcohols. Artificial sweeteners are synthetic alternatives, including saccharin, cyclamate, aspartame, sucralose, acesulfame, and neotame. Other types of sugar substitutes are sugar alcohols derived from plants, such as erythritol, mannitol, and sorbitol. In addition to sweetness, sugar alcohols add texture to food. Their sweetness ranges from 25% to 100% compared to regular sugar. Consuming large amounts of sugar alcohols may cause bloating, loose stools, or diarrhea, although tolerance usually develops over time.
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Stevia and monk fruit sugar are considered “natural” sweeteners because they are derived from plant sources. Sugar substitutes are widely used in processed foods including soft drinks, cookies, chocolate and jams. Some, such as sucralose, can also be used in baking or cooking. However, a “sugar-free” label on a product can sometimes be misleading, as it may lead us to believe that the product is “zero-calorie”, resulting in overconsumption. For example, a bar of sugar-free chocolate has about 60% the calories of a regular chocolate bar due to the fat content.
It is unclear whether replacing sugar in the diet with artificially sweetened products can reverse the health consequences of over-consumption of sugar, such as obesity, diabetes and heart disease. Some studies have found that artificial sweeteners may increase the risk of diabetes and obesity, while others have found no evidence. A 2022 WHO report found a modest association between consumption of artificially sweetened beverages and conditions such as cholesterol abnormalities and high blood pressure. It has also been suggested that these sweeteners may alter gut flora, potentially leading to weight gain and increased risk of diabetes.
A 2022 French study linked artificial sweetener consumption to an increased risk of heart disease, stroke, and cancer. Saccharin was once linked to cancer in rats and aspartame to brain tumors, although these claims lack solid evidence. Concerns about adverse effects on the kidneys, memory loss, dementia, and stroke have been reported but are unproven. Additionally, mixing alcohol with artificially sweetened beverages increases blood alcohol levels, increasing the risk of intoxication.
Also read: Not just sugar: 5 other factors that can hinder diabetes control

Artificial sweeteners can also affect our brain’s response to sweetness, making naturally sweet foods like fruit less appealing and increasing our cravings for sweets. For people who consume large amounts of sweetened beverages and are trying to reduce their intake, artificially sweetened beverages can be used temporarily while gradually converting them into water. May go. People who have intestinal disorders or have had bariatric surgery should avoid them completely.
So, what should those of us who are trying to lose weight or control diabetes do? The best approach is to eliminate sugar completely. If sweet cravings persist, it is usually safe to consume sweeteners in moderation. Daily consumption of 1–2 servings of sweeteners is considered safe, although conclusive data are lacking. Plant-based sweeteners such as monk fruit sugar or stevia may be safe alternatives, but this has also not been proven.

About the author: Dr. Ambrish Mithal is Chairman and Head of Endocrinology and Diabetes at Max Hospital, Saket.