Neva Cochran, MS, RDN, LD –
Setting the Stage
Replacing sugar with low and no calorie sweeteners (LNCS) is a practical way to reduce carbohydrate intake to potentially help those with diabetes better manage blood glucose levels and facilitate weight loss. (1) It also creates more flexibility in the diet to accommodate personal preferences and satisfy sweet cravings.
There are claims circulating that LNCS can actually raise blood glucose levels and promote diabetes. However, these claims are based on studies in rats and mice. Although these studies suggest low-calorie sweeteners may alter intestinal microbes that lead to glucose intolerance and an increased risk of Type 2 diabetes, rodents are not humans and the research is too preliminary to change current recommendations on sweetener use in people with diabetes.
State of the Science
On the other hand, a review of the research finds substantial support for the use of LNCS in the management of diabetes. Consider the results of the seven studies published over the last thirty-two years summarized here.
- A 12-week study in 47 normoglycemic males consuming approximately 333 mg encapsulated sucralose or placebo 3 times/day at meals found no effect on blood glucose control. All glucose, insulin, C-peptide and HbA1c levels throughout the study were within normal range with no statistically significant differences between sucralose and placebo groups. (2)
- A meta-analysis of 29 randomized controlled trials with 741 total participants evaluated the glycemic impact of aspartame, saccharin, steviosides and sucralose. LNCS consumption did not increase blood glucose levels, and glucose gradually declined following LNCS consumption. There was no difference in glycemic impact by type of sweetener. And the changes in blood glucose levels in those with type 2 diabetes were lower at 1–29 minutes, 150–179 minutes and 180–210 minutes after LNCS consumption compared to those without diabetes. (3)
- Researchers assessed the effect of daily aspartame ingestion on glycemia at levels of 0, 350 or 1050 mg aspartame per day consumed in beverages with 100 subjects for 12 weeks. Results demonstrated no group differences for blood glucose at baseline or week 12. (4)
- A Japanese study evaluated aspartame’s effect on blood glucose administered orally to normal controls and 22 patients with untreated diabetes and seven controls without diabetes. Administering of a single dose of 500 mg. aspartame (equivalent to 100 grams of glucose in sweetness) did not increase blood glucose. Instead, a small but significant decrease in blood glucose was noticed 2 or 3 hours after administration. The decrease in blood glucose was found to be smallest in the control and became greater as the diabetes increased in severity. (5)
- Another study was conducted by the same Japanese researchers above. In 9 hospitalized patients with diabetes under steady-state glycemic control, the researchers determined the effects of eating 125 mg aspartame (equal in sweetness to 1.5 – 2.5 Tbs. sugar) in no-calorie gelatin daily for 2 weeks. Fasting, 1-hour and 2-hour postprandial blood glucose levels were unaffected. (5)
- In a multicenter double-blind study, subjects with type 2 diabetes received either placebo (cellulose) capsules or 667 mg of encapsulated sucralose) daily for 13-weeks (7.5 mg/kg/day, approximately three times the estimated maximum intake). There were no significant differences between the sucralose and placebo groups for HbA1c, fasting plasma glucose or fasting serum C-peptide changes from baseline. (6)
- Finally, in a systematic review of the nutritional benefits and risks of LNCS, the authors concluded that the vast majority of studies do not show any acute effects of LNCS intake on blood glucose or insulin concentrations measured on an empty stomach or after a test meal, in subjects with or without diabetes. (7)
Applications for Practice
In their Standards of Medical Care in Diabetes (8), the American Diabetes Association states that LNCS may be an acceptable substitute for nutritive sweeteners for people with diabetes who are accustomed to sugar-sweetened products when consumed in moderation noting that these sweeteners do not appear to have a significant effect on glycemic control.
In conclusion, this review of the evidence in humans does not support the assertion that LNCS promote glycemia and the development of diabetes. It is reassuring to know that low and no calorie sweetened foods and beverages are another tool people can use as part of a nutrient-rich eating plan to help them manage diabetes and promote overall health.
- ”The Role of Low-calorie Sweeteners in Diabetes” US Endocrinology 9:13-15, 2013
- “A 12-week randomized clinical trial investigating the potential for sucralose to affect glucose homeostasis” Regul Toxicol Pharmacol 88:22-33, 2017
- “Glycemic impact of non-nutritive sweeteners: a systematic review and meta-analysis of randomized controlled trials” Eur J Clin Nutr 72:796, 2018
- “Aspartame Consumption for 12 Weeks Does Not Affect Glycemia, Appetite, or Body Weight of Healthy, Lean Adults in a Randomized Controlled Trial” J Nutr 148:650, 2018
- “Glucose tolerance, blood lipid, insulin and glucagon concentration after single or continuous administration of aspartame in diabetics” Diabetes Res Clin Pract 2:23,1986
- “Lack of effect of sucralose on glucose homeostasis in subjects with type 2 diabetes” J Am Diet Assoc 103:1607, 2003
- “Review of the nutritional benefits and risks related to intense sweeteners” Arch Public Health 73:41, 2015
- “Lifestyle Management: Standards of Medical Care in Diabetes – 2018” Diabetes Care 41(Suppl. 1):S38–S50, 2018
Neva Cochran, MS, RDN, LD is a registered dietitian nutritionist based in Dallas. She serves as a nutrition communications consultant to a variety of food and nutrition organizations, including the Calorie Control Council. She is passionate about promoting fact-based food and nutrition information to help people enjoy nutritious eating. Follow her on Twitter @NevaRDLD and check out her blog at www.NevaCochranRD.com.