What you need to know about artificial sweeteners and diabetes

If you live with diabetes, chances are that you've given some thought to choosing an alternative sweetener. When sugar isn't an easy option, what can you use to dress up your cup of coffee or enhance a homemade baked good?

Thankfully, numerous sweeteners are available, and the number of options on the market seems to expand all the time.

But which alternative sweetener is best for you and your diabetes health? The choices can range in formulation and intensity, so it's important to give them consideration. Here's what to know about artificial sweeteners and diabetes.

Sugar consumption can affect gut health

Even for those who don't have to worry about their blood sugar levels, a high-sugar diet is still something to avoid. Research has shown that the type and number of bacteria in an individual's intestines change as a result of what they eat.

Your body depends on those bacteria to produce some of the vitamins and short-chain fatty acids that it needs, so it's important to keep the bacteria in the gut happy and healthy. Interestingly, fructose found in whole fruits doesn't damage the gut microbiome, but consuming lots of fructose in the form of high fructose corn syrup (found in many commercial products) and sucrose (table sugar) can ultimately result in an increased risk of fatty liver disease.

Misconceptions about artificial sweeteners abound

Artificial sweeteners are rumored to cause health problems, from weight gain to cancer. But there might not be much merit to these claims.

The rumor that alternative sweeteners cause cancer is likely a result of decades-old research done on laboratory rats that were fed large amounts of saccharin. For some time, the Food and Drug Administration (FDA) required saccharin to carry a black-box warning label. However, updated research has shown no association between cancer and saccharin consumption in humans, so the black box warning label is no longer required.

Regarding weight gain, there is an association between diet soda consumption and being overweight. But research hasn't proven that drinking diet soda causes weight gain, just that the two are linked. It's possible that people who have poor eating habits tend to choose diet soda to try to "offset" the effects of other less than ideal food choices.

Several alternative sweeteners are approved for use in the US

The FDA has approved eight "high-intensity" sweeteners for use in the United States. "High intensity" means these substances are very sweet in small portions, and they provide little to no calories when added to food. The eight sweeteners below appear in the order they were approved by the FDA, from oldest to newest:

1. Saccharin (most commonly sold as "Sweet'N Low" — the pink packets)
2. Aspartame (most commonly sold as "Equal" — the blue packets)
3. Acesulfame K (most commonly sold as "Sweet One")
4. Sucralose (most commonly sold as "Splenda" — the yellow packets)
5. Neotame (sold under the brand name "Newtame")
6. Advantame
7. Steviol glycosides (commonly known as stevia)
8. Luo Han Guo fruit extracts (monk fruit sweetener)

Meanwhile, sugar alcohols are also used as alternative sweeteners. These are commonly found in sugarless gum and candy, but can also be purchased for individual use. The three most frequently used sugar alcohols in these products are:

1. Xylitol
2. Sorbitol
3. Mannitol

Unlike high-intensity sweeteners, sugar alcohols are considered "nutritive" sweeteners because they do contain calories. Sugar alcohols contain about 1.5 to 3 calories per gram — as opposed to 4 calories per gram for regular table sugar. They're also digested much more slowly, and they require little to no insulin to be used in the body.

The biggest problem with sugar alcohols is that they can cause an upset stomach if eaten in larger quantities. Gas, bloating, and diarrhea are common side effects of consuming too much sugar alcohol.

How to choose between artificial sweeteners

If you're looking to balance artificial sweeteners and diabetes, know that it can be done! You may find that you react differently to different types, so listen to your body as you try them.

Each of the eight alternative sweeteners approved by the FDA is on the Generally Recognized as Safe (GRAS) list, meaning they have been studied and found not to cause harm to human health. The small exception here is aspartame, which isn't safe for people with phenylketonuria (PKU), a genetic condition limiting the ability to break down the amino acid phenylalanine.

In addition to your diabetes, you may want to consider the following factors when deciding which artificial sweetener is right for you:

• Heat stability. Among the eight sweeteners above, aspartame is the only sweetener that isn't heat-stable. Aspartame loses its sweetness when exposed to high temperatures, so it's not a good choice for baking.
• Taste. Alternative sweeteners vary from about 100 times sweeter than table sugar (monk fruit) to approximately 20,000 times sweeter than table sugar (advantame). Different people have different taste perceptions when it comes to artificial sweeteners. You may perceive one sweetener as having a bitter aftertaste, but someone else might not. This is where that individual experimentation comes in.
• Portability. Most restaurants provide sweetener packets for their patrons, but saccharin, stevia, sucralose, and aspartame can be found in tablet form for those who want to carry their sweetener with them, just in case.

In short, there's no one perfect artificial sweetener for people with diabetes. Individuals can have different preferences for different reasons.

No matter which artificial sweetener you choose, rest assured that choosing to keep your blood sugar levels as stable as possible is always the right decision. So if you choose to use an alternative sweetener, find one that you tolerate well and use it in moderation.

Want to know more about the connection between diabetes, your diet, and your gut microbiome? Explore Health Insights to discover how probiotics can affect diabetes management.