Sugar substitutes - there are two types


Last week, one of my subscribers asked me, “What is the best sugar substitute to use since I am a diabetic?” 
Unfortunately, the answer to that is not very clear.
There are two types of sweeteners: caloric sweeteners (CS) and non-caloric sweeteners (NCS). The five most common caloric sweeteners listed on food labels are corn syrup, sorghum, cane sugar, high fructose corn syrup, and fruit juice concentrate. One study done during 2005 and 2009 and found that 53% of baby food formulas, 75% of salad dressings and dips, and 78% of vegetable juices contained at least one added caloric sweetener. 
Back in 2005, 1% of foods and beverages contained non-caloric sweeteners. Between 2005 and 2009, Americans chose more foods and drinks containing NCS instead of caloric sweeteners every year. That trend has continued ever since. 
Non-caloric sweeteners (NCS) have been used for decades as food additives and are considered safe. 
Although they don’t contain calories like common sweeteners, non-caloric sweeteners have NOT been shown to encourage weight loss or improve blood sugar control in people with diabetes. 
Shouldn’t a sweetener without any calories help you lose weight? Why doesn’t it help lower your blood sugar level if you add a sweetener without any calories to your beverages instead of some form of sugar?
Research published in the October 2014 issue of Nature magazine may explain this observation. Samples of 4 different sweeteners were given to mice: sugar or one of three commonly used non-caloric sweeteners: aspartame, saccharin, and sucralose. The mice given the NCS showed changes in the makeup of their intestinal bacteria, while sugar had no effect. 
Then, the mice whose intestinal bacteria had shown changes handled the food they ate differently. They had higher blood sugars after eating, and their blood sugars took much longer to drop back to normal levels. This pattern closely matches glucose intolerance, which is associated with an increased risk of becoming diabetic. 
When researchers introduced samples of the changed mice’s gut bacteria into normal mice, the normal mice’s gut bacteria changed. And when it did, the same pattern of higher blood sugars that mimicked glucose intolerance occurred. 
Repeating the same experiment on a small group of humans, only a few people showed changes in their gut bacteria after using a sugar substitute. However, the people whose gut bacteria changed showed the same pattern of glucose intolerance as the affected mice. 
The effect of non-caloric sweeteners on gut bacteria doesn’t happen consistently in humans. However, it could explain why switching from using sugar to an artificial sweetener doesn’t always help diabetics lose weight or control their blood sugar levels.  
Two other sugar substitutes are also available, both derived from natural sources.  Stevia is a calorie-free sweetener from a plant native to South America in the chrysanthemum family and related to the ragweed plant. Stevia was approved for use as a food additive in 2008 and is marketed as the sweetener Truvia®. 
Xylitol is a low-calorie sweetener extracted from natural sources such as corn. Because of its protective effect on tooth enamel, xylitol is added to sugarless gum and mints. It is marketed as a sugar substitute for baking. Xylitol may be a dentist’s friend, but it’s a dog owner’s nightmare. 
Xylitol is safe for humans but deadly to dogs. Xylitol triggers a dog’s pancreas to pump out lots of insulin, dropping their blood sugar to dangerous levels. This triggers seizures and causes liver damage, even liver failure. Unfortunately, even small amounts of xylitol can kill a dog.
According to Jason Fung, MD, author of the books The Obesity Code and The Diabetes Code, the real obstacle to weight loss isn’t too many calories. Instead, it’s from insulin resistance caused by too much insulin released into the bloodstream. 
We know caloric sweeteners like sucrose, fructose, agave, and honey will raise blood sugar. The increase in your blood sugar level triggers a burst of insulin from your pancreas, designed to lower your blood sugar back to normal. 
Even though non-caloric or very low caloric sweeteners like Stevia don’t raise your blood sugar, they still trigger insulin release. In addition, some can trigger your pancreas to release MORE insulin than caloric sweeteners like sugar or honey. Instead of losing weight, the increased insulin release can interfere with your weight loss efforts.
There isn’t any sweetener that is clearly better than any other. Unfortunately, using a non-caloric or low-caloric sweetener doesn’t guarantee you’ll lose weight or control your blood sugar. You can try them out, but the less you use, the better. 
Dr. Louise Achey, Doctor of Pharmacy, is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog
® 2021 Louise Achey


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