We've received several pitches regarding new info on sugar substitutes here at the 'Mine recently. So we decided it was time to revisit these products, since our last coverage of artificial sweeteners in the context of Diet Soda, the wondrous Agave Syrup, and all the sweet-tasting "lesser evils" we have to choose from.
On the surface, sugar-free and calorie-free products seem like a great idea for PWDs (people with diabetes). No sugar, no problem... Right?
Unfortunately not. As many of us realize, it's not that simple. Many of these products are packed with chemicals that may have all sorts of unseen negative effects.
Also struggling to decide what's best for her body, our newest addition Amanda was keen to do some research on the various choices available and what the experts are saying about them.
NEWSFLASH: FDA Clears Dexcom Share Direct
Dexcom gets regulatory approval of its 'on-the-go' mobile apps for CGM data-sharing.
State of the Union: It's Time to Cure Diabetes
President launching new precision medicine initiative to better treat, cure diseases like diabetes.
'Robotic Pancreas' Appears On American Idol
Carlos Santana's nephew Adam Lasher shows off Dexcom G4 during live performance.
Special to the 'Mine by Amanda Cedrone
I try to keep my diet pretty clean and natural -- even if it means bolusing for some real sugar here and there. However, I will occasionally opt for sugar substitutes, as it's just easier sometimes. I hear a lot on this topic, between headlines, general conversation and my friends telling me I shouldn't drink diet soda, so naturally I wanted to look into it myself.
Inquiring minds want to know, especially my own!
Of course, this post is by no means exhaustive and it's impossible to look at everything. There are tons of studies on artificial sweeteners, each resulting in different conclusions on various things. What I have compiled is a summary of recent headlines, widely published and accepted facts on the products, as well as expert opinions. Hopefully, this will help us PWDs make slightly more informed decisions on what to put into our bodies.
With that being said, let's go!
On the Sugary Master List
First, a primer. Several sugar substitutes are widely used in the food we consume, so here's a quick look at all of the different FDA approved and/or widely used products.
- Sucralose: AKA Splenda. Derived from sugar.
- Saccharin: AKA Sweet'N Low. Derived from benzoic sulfilimine.
- Aspartame: Made from two different amino acids, aspartic acid and phenylalanine. Commonly known as Equal.
- Acesulfame Potassium is made using acetoacetic acid and potassium. Found under the brand name Sweet One and and Sunett.
- Neotame: Made using the same amino acids as aspartame. It is not used under any brand name yet.
- Stevia: Comes from a plant native to South America. Technically, crude and whole leaf Stevia have not been approved by the FDA. However, some products containing steviol glycosides, which help to create the sweet taste of the Stevia leaf, are on the FDA's Generally Recognized As Safe List. Rebaudioside A is one such steviol glycoside that is popular, and the FDA claims that it is different from Stevia in that it is highly purified.
- Luo han guo: Also known as monk fruit. Comes from a plant native to southern China and northern Thailand. (Fun fact: It was first cultivated by Buddhists!) The fruit undergoes a process which turns the sweet tasting part of the fruit to powder which is used in food products. That powdered product is also on the FDA's generally recognized as safe list.
A couple of weeks ago, I received a sample of a new sugar substitute product called Habitall, which is marketed as an all-natural, low-calorie and "diabetic friendly" sugar substitute. It has three ingredients: erythritol, polydextrose and monk fruit. According to the website, erythritol is a sweetener found in fruits and vegetables; polydextrose is an indigestible, soluble fiber produced from glucose, sorbitol and citric acid; and monk fruit is mentioned above. One teaspoon of Habitall contains 1.7 calories and 4.9 grams of carbohydrates. It's ranked zero on the glycemic index -- one of the reasons it's being marketed to diabetics.
I gave it a shot and was pretty happy with the results. First, I used it in my morning coffee during the week to substitute for the normal few teaspoon of sugar I use. I didn't even taste a difference, and I didn't have to bolus for it. Score!
I'm in love with baking, so I'm always looking for ways to make my end products more diabetic-friendly. That's why I also decided to make a fruit pie with Habitall instead of sugar. It came out great! I didn't notice any difference, except that I didn't have to bolus as much for my pie. My grandpa, who is not diabetic and does not eat sugar-free anything, had some of the pie and didn't notice any difference.
The company is small and just starting out, so the only place to buy the product currently is from their online fundraising site, where you can make a contribution while ordering a pound or two. As mentioned, I was impressed, so I'd definitely be apt to buy it in the future.
Sweet N Safe?
Of course, the big question on everyone's mind these days is just how safe artificial sweeteners are.
The Washington University School of Medicine in St. Louis recently published a study on the effects sucralose has on the body's ability to deal with glucose. The study appeared online in April in the medical journal Diabetes Care. It suggests that consuming sucralose before glucose can have an adverse effect on blood sugar and insulin levels, and so the study has gotten a decent amount of attention in articles in consumer publications like Prevention, the Huffington Post and Men's Health.
"These findings support the notion that sucralose is not metabolically inert but has physiologic effects," the study claims. That means some bad things can happen to your system.
But not everyone agrees. Certified Diabetes Educator (CDE) and D-Advocate Hope Warshaw, who also works as a consultant to McNeil Nutritionals that makes Splenda, brought a few possible flaws in this study to our attention.
She points out that the study was small, consisting of only 17 people -- 13 African Americans and four Caucasians -- and it was conducted on obese, non-insulin resistant individuals who normally do not consume sugar substitutes. Really, there was no control or review of the exercise and diet regime of those involved in the study prior to the tests conducted.
So Hope says the very limited scope means the study isn't an accurate indicator of the effects that sucralose has on the general population, especially considering that a number of studies conducted in the past have found the opposite to be true.
In July 2012, the American Heart Association and American Diabetes Association published a scientific statement on sugar substitutes -- or "non-nutritive sweeteners" as they call them. Here are a few items of note from that:
- Much of the published word on sugar substitutes uses research conducted in animal models and evaluations of potential toxicity, "neither of which were areas of focus for this statement. Hence, the review that follows is notably limited by the lack of an extensive evidence base." In other words, the AHA and ADA are issuing a statement based on inconclusive research... OK.
- Food processors and manufacturers are required to include sugar substitutes in ingredient lists but, with the exception of saccharin, are not required to provide the amount used in products or to release the information to federal agencies or the general public. Huh?
- Studies suggest that using sugar substitutes generally results in weight loss or has negligible effect on weight. Good to know.
- Consuming two or more servings of diet soft drinks per day was associated with an increased risk of coronary heart disease and chronic kidney disease. Oy!
- Middle-aged men and women consuming one or more servings of diet soft drinks per day had more than 30 percent higher risk of developing metabolic syndrome, according to some studies. Conclusive evidence?
On its own, the ADA doesn't necessarily endorse sugar substitutes, but it does suggest them as a tool for diabetics with a sweet tooth to avoid real sugar.
The man who authored the ADA/AHA statement, Christopher Gardner at Stanford University School of Medicine, also talked about this issue at the recent ADA Scientific Sessions. He said their recent study doesn't address safety concerns because the FDA has already done that. Instead, it focuses on sugar substitutes and how they affect weight gain or loss. The statement, he said, is based on literature that is anything but extensive, and a lot more research is needed in this area.
Right, we're getting the picture here.
"The best advice for diabetics is to follow general dietary guidelines and avoid added sugars as much as possible," he said. "When it comes to sweet treats, if (PWDs) can't avoid them, then using those non-nutritive sweetener products could benefit them, but they would have to use them consciously."
I also spoke with CDE Nora Saul, nutrition services manager at the Joslin Diabetes Center in Boston, and she advocates moderation for her patients... surprise, surprise!
"This is what I tell patients: Moderation is good in all things," she said. "If you can avoid sugar substitutes and use real sugar in small amounts, that's terrific. But sugar substitutes do have a place."
Naturally Nora recommends diet soft drinks over regular soda, for example.
The bottom line is that while the FDA has said that sugar substitutes are safe, the jury's still out on the long-term effects they might have.
"It's possible some of them might cause some health problems because they haven't been around that long and don't have a track record of, 'What if you consume this for 30 years?" Nora says.
Interestingly, Nora says that Joslin recommends that their pregnant patients completely avoid sugar substitutes due to a study that suggests they could induce preterm labor. Yikes!
So really, who knows...? Sugar substitutes are very appealing and helpful for us PWDs working to control our blood sugar levels, so clearly we're going to keep using them. But with possible long-term risks looming, they become just another item we need to consume in small, rationed doses. Darn!
What are your thoughts on sugar substitutes? We know the DOC has a diet soda addiction thing going on... But do you also use sweeteners for baking or other purposes? Do you worry about safety?