Diabetes Self-Management Blog

The use of nonnutritive sweeteners (also known as artificial sweeteners or sugar substitutes) among people with diabetes is pretty common. But not all that long ago, there weren’t a whole lot of sweeteners to choose from.

Back in the 1950’s, the use of nonnutritive sweeteners came about for both cost- and calorie-cutting reasons. At that time, saccharin (Sweet’N Low), which was discovered back in the 1800’s, and cyclamate (discovered in 1937) were really the only sweeteners available. Cyclamate was banned in 1970 after a study showed that 8 out of 240 rats who consumed a mixture of saccharin and cyclamate developed bladder tumors.

Studies from the 1970’s also linked saccharin use with bladder tumors, and in the late 1970’s the US restricted its use. Then, due to public outcry, the FDA relaxed the restriction as long as products containing saccharin displayed a disclaimer that saccharin caused cancer in laboratory animals. In 2000, the warning label was removed as evidence showed that the incidence of bladder tumors in rats occurred by a mechanism that’s not relevant to humans.

Today, we have a fairly wide variety of nonnutritive sweeteners to choose from. Why do people use these sweeteners? Well, even though sugar is no longer “banned” from the eating plans of people with diabetes, for the most part, it makes sense to use artificial sweeteners, at least from a numbers standpoint. Regular or nutritive sweeteners such as table sugar, honey, and maple syrup contain calories and carbohydrate. And foods and beverages sweetened with caloric sweeteners are pretty laden with both. For example, a 12-ounce can of regular cola contains about 140 calories and 40 grams of carbohydrate (all of that from sugar). A can of diet cola has 0 calories and 0 grams of carbohydrate. You don’t have to be a math whiz to figure out which is the better choice if you’re watching calories and/or your blood glucose levels. Nevertheless, it’s important to note that people with diabetes have options in terms of what they choose to eat or not to eat (or drink). This means that drinking a can of regular cola isn’t necessarily off limits, but it might mean consuming less carbohydrate from other sources and/or taking more insulin.

With the exception of diet soft drinks, some sugar-free candies, and sugar-free gelatin, nonnutritive sweeteners are used in foods that already contain calories and carbohydrate from other sources. No-sugar-added ice cream or sugar-free cookies, for example, still have carbohydrate, and this carbohydrate still needs to be figured into one’s meal plan. And sometimes the “sugar-free” version isn’t a heck of a whole lot lower in carbohydrate or calories than the regular version, either. The bottom line is that you need to read the Nutrition Facts label on every food item that comes with one because you never know where those calories and carbohydrate (and fat, for that matter), are lurking.

So, here’s a closer look at some sugar substitutes that are currently (and readily) available in the US:

  • Saccharin (Sweet’N Low, SugarTwin, Necta Sweet). One of the oldest sweeteners on the market, saccharin is 200–700 times sweeter than sugar, and can be used in baking. It can have a bitter aftertaste. In the 1970’s, research linked saccharin with bladder cancer in rats, but the warning that had been added to packages based on these studies was eventually lifted after other research showed that it was safe to use. The “acceptable daily intake” (ADI) for saccharin is 5 milligrams (mg) per kilogram (kg) of body weight; that translates roughly into 9–12 packets per day. The ADI is the maximum amount of a sweetener considered safe to eat every day for as long as you live. ADIs are intended to be about 100 times less than the smallest amount that might cause health concerns.
  • Aspartame (Equal, NutraSweet, NatraTaste). Aspartame is made from two amino acids and is about 200 times sweeter than sugar. This sweetener, which was approved for use in the US in 1981, has been widely researched and is currently found in more than 6,000 foods and beverages worldwide. Despite its popularity and wide use, aspartame is blamed for a host of problems, including headaches, cancer, seizures, epilepsy, and Parkinson disease. The issue is that no conclusive studies have been able to link this sweetener to any of these conditions. Aspartame does contain phenylalanine (an amino acid), so people with a certain genetic disorder called phenylketonuria need to avoid aspartame. But for most people, aspartame is considered to be very safe. It’s not ideal for cooking or baking, though, since heat decreases aspartame’s sweetness.

Since I’m out of room for posting this week, I’ll continue with nonnutritive sweeteners next week, so stay tuned!

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Nonnutritive Sweeteners: Help or Hindrance? (Part 1)
Nonnutritive Sweeteners: Help or Hindrance? (Part 2)
Nonnutritive Sweeteners: Help or Hindrance? (Part 3)
Nonnutritive Sweeteners: Help or Hindrance? (Part 4)
Nonnutritive Sweeteners: Help or Hindrance? (Part 5)
Nonnutritive Sweeteners: Help or Hindrance? (Part 6)


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