Sweeteners and Diabetes

From the American Diabetes Association

• Celiac Disease and Diabetes
• Checking Food Labels
• Eating Out If You Have Diabetes
• Meal Planning With Diabetes
• Nutrition and Diabetes FAQs

If you have diabetes, that doesn't mean you can't eat sweets. People with diabetes can eat desserts, use sweeteners, and still keep their blood glucose (sugar) levels in their target range. These options are available for sweetening your foods:

• Sugar and other sweeteners with calories including honey, brown sugar, molasses, fructose, cane sugar, and confectioners sugar
  
  
• Reduced-calorie sweeteners including erythritol, hydrogenated starch hydrolysates, isomalt, lactitol, maltitol, mannitol, sorbitol, and xylitol
  
  
• Low-calorie sweeteners such as ascelfume potassium, aspartame, saccharin and sucralose

Sugar and Other Sweeteners with Calories

In the past, people with diabetes were warned to completely avoid sugar. Experts thought that eating sugar would rapidly increase blood glucose, resulting in levels that were too high. Some people even thought that eating sugar caused diabetes, an idea that we now know isn't true.

Research has shown that the total amount of carbohydrate affects blood glucose levels the most. But, the type of carbohydrate (e.g. sugar vs. starch) can also affect blood glucose levels. Learn more about the types of carbohydrate and the glycemic index.

Now experts agree you can eat foods with sugar as long as you work them into your meal plan as you would any other carb-containing food. The same guidelines apply to other sweeteners with calories, including brown sugar, honey, and molasses.

Of course, most sweets and desserts don't provide the important vitamins and minerals found in more healthful foods, so you'll want to make sure you're still getting the nutrients you need. Many sweets, in addition to having carbs, are also high in fat and calories.

If you like sweets, but also want to lose weight, you can try these tips:

• Satisfy your sweet tooth with fresh or dried fruit
  

• Eat a small serving of your favorite dessert, instead of something ordinary
  

• When you are eating out, split desserts with a friend or family member
  

• Cut back on the amounts of sugar and fat in your recipe favorites
  

• Try new recipes for lower-calorie sweets
  

• Choose lower-calorie, lower-fat versions of your favorite desserts
  

• Use a low-calorie sweetener instead of sugar for your coffee or tea

How can I have sweets and still keep my blood glucose on target?

The key to keeping your blood glucose on target is to substitute small portions of sweets for other carb-containing foods in your meals and snacks. Carb-containing foods include bread, tortillas, rice, crackers, cereal, fruit, juice, milk, yogurt, potatoes, corn, and peas. For many people, having about 45 to 60 grams at meals is about right. Serving sizes make a difference. To include sweets in your meal, you can cut back on the other carb foods at the same meal.

For example, you'd like to have cookies with your lunch. Your lunch is a turkey sandwich with two slices of bread. Your first step is to identify the carb foods in your meal. Bread is a carb. You decide to swap two slices of bread for two slices of low-calorie bread and have the cookies — it's an even trade. Your total amount of carbohydrate remains the same for the meal.

What to Check in the Nutrition Facts

You can also use the Nutrition Facts Label on foods to guide you. The first thing to check is the serving size. The second is the total carbohydrate. The total carbohydrate tells you how much carbohydrate is in one serving of the food.

What else can I learn from food labels?

Foods labeled as sugar-free, no sugar added, reduced sugar, and dietetic still contain carbohydrate. To check the amount of sugars (listed as "Sugars" under "Total Carbohydrate") in the Nutrition Facts Label, keep in mind that it includes both added sugars and naturally occurring sugars, such as the natural sugar in raisins. It is more helpful to check the total carbohydrate because it gives a better picture of all the carbohydrate in a single food.

Reduced Calorie Sweeteners – Sugar Alcohols

Sugar alcohols are one type of reduced-calorie sweetener and are used in sugar-free candies, chewing gum, and desserts. They provide about half the calories of sugars and other carbohydrates. Isomalt, maltitol, mannitol, sorbitol, and xylitol are examples of sugar alcohols. Even though they are called sugar alcohols, they do not contain alcohol. Sometimes sugar alcohols can cause diarrhea, especially in children. Many people think that foods with sugar alcohols are "free foods." This is not true!

Tips for Carb Counting and Sugar Alcohols

Sugar alcohols don't raise blood glucose as much as the same amount of other carbohydrates. To figure out the amount of other carbohydrate you should count for a food with sugar alcohols, follow these tips:

• Subtract half of the sugar alcohol grams from the total carbohydrate
• Count the remaining grams

For Example:

Serving Size: 1 bar
Total carbohydrate 15 grams — Sugar alcohol 6 grams
One bar counts as 12 grams carbohydrate (15 – 3 = 12)

Low Calorie Sweeteners

Don't throw away your low-calorie sweeteners just because sugar is safer than you thought. Low-calorie sweeteners are "free foods." They make food taste sweet, and have no calories and do not raise blood glucose levels. They do not count as a carbohydrate, a fat, or any other exchange. They can be added to your meal plan instead of substituted.

The Food & Drug Administration (FDA) has approved the use of these low-calorie sweeteners. The American Diabetes Association accepts the FDA's conclusion that these sweeteners are safe and can be part of a healthy diet.

Saccharin (Sweet N Low, Sugar Twin)
Saccharin can be used in both hot and cold foods to make them sweeter. You may recall that some studies giving very large quantities of saccharine to rats raised concerns that saccharin could cause cancer, but many studies and years of use have shown saccharin to be safe in the quantities used by consumers.

Aspartame (NutraSweet, Equal)
Aspartame is another low-calorie sweetener. Because high temperatures can decrease its sweetness, check the manufacturer's Web site or call their toll-free number for guidelines when using aspartame in recipes.

Acesulfame potassium (Sweet One, Swiss Sweet, Sunett)
Another low-calorie sweetener on the market is acesulfame potassium, also called acesulfame-K. This sweetener is heat stable and can be used in baking and cooking.

Sucralose (SPLENDA)
Sucralose is the newest low-calorie sweetener on the market. Sucralose is not affected by heat and retains its sweetness in hot beverages, baked goods, and processed foods.

If you like to cook, you know that sugar does more in hot foods, especially baked goods like cookies and cakes, than just add sweetness. It also affects the way the foods cook and the final texture. Substituting a low-calorie sweetener may affect the texture and taste. Many people use a combination of sugar and a low-calorie sweetener to reduce overall calories and sugar while still producing acceptable results.

All of these low-calorie sweeteners may help people who are overweight or have diabetes to reduce calories and stick to a healthy meal plan. In addition, these sweeteners are useful for reducing calories and carbohydrates when used instead of sugar in coffee, tea, cereal, and on fruit.

Are low-calorie sweeteners safe?

The low-calorie sweeteners in the United States all underwent extensive testing before they were approved. Results showed that low-calorie sweeteners are safe for everyone, including children and pregnant women. However, people with a rare condition called phenylketonuria (PKU) should limit their intake of aspartame, one type of low-calorie sweetener.

What are the advantages and disadvantages of reduced-calorie or low-calorie sweeteners?

Foods with low- or reduced-calorie sweeteners can have fewer calories than foods made with sugar and other caloric sweeteners. That can help if you're trying to lose weight or even prevent weight gain. However, some sugar-free foods or products that use low-calorie sweeteners actually have more calories than, and may have more fat than, the sugar sweetened versions.

When you're considering foods with low- or reduced-calorie sweeteners, always check the Nutrition Facts on the label. By comparing the calories in the sugar-free version to the regular version, you'll see whether you're really getting fewer calories. You'll also want to compare the fat content of the labels. Some people choose the regular version of a food and cut back on the serving size instead of buying the sugar-free version. Consider price as well. Sometimes sugar-free versions cost more.

Low-calorie sweeteners are useful for adding extra flavor or sweetness to your food, with few if any extra calories. You can experiment with your own recipes to include reduced- and low-calorie sweeteners.