Nonnutritive Sweeteners: Help or Hindrance? (Part 1)

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:

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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Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

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