DIABETESAre sugar alternatives good for me?

Are sugar alternatives good for me?

All you need to know about low calorie sweeteners

by Vicky Pyrogianni, MSc, RDN* Consultant, Nutrition Science Director to the International Sweeteners Association (ISA)

Science says that our liking for sweet taste is innate and that we are born with a natural preference for sweetness. That is why cutting out sweet taste altogether from our diet is unrealistic. This might be even harder for some people with diabetes due to the frequently observed reduced sweet taste sensation that may make it difficult for them to follow dietary recommendations.

Current guidelines do not call for a total ban of sugar use in the diet of people with diabetes; however, keeping its intake low, between 5-10% of total energy intake, is a key recommendation.

Fruit intake may partly cover our desire for sweetness in the diet. Another way of reducing sugar consumption is by replacing some of it in foods and drinks with low calorie sweeteners. Low calorie sweeteners allow people to enjoy sweet-tasting foods and drinks that have fewer or no calories and less, if any at all, sugar; hence, they may help satisfy our natural desire for sweetness. Additionally, low calorie sweeteners offer people with diabetes an important alternative to sugar as they do not affect blood glucose levels.

What are low calorie sweeteners?

Low calorie sweeteners are food ingredients that taste sweet but have zero, or virtually zero, calories and no sugars. They are used in foods, drinks and table-top sweeteners as sugar alternatives and they do not raise glucose levels in the blood, which makes low calorie sweeteners a preferable choice over sugar for people with diabetes who need to manage their carbohydrate intake.

How do we know that low calorie sweeteners are safe?

Low calorie sweeteners are amongst the most thoroughly researched ingredients in the  world. The safety of approved low calorie sweeteners has been repeatedly confirmed by safety bodies globally. These authorities include the FDA (Food and Drug Administration) in the US and EFSA (European Food Safety Authority) in Europe, and the Joint Food and Agriculture Organisation (FAO)/World Health Organization (WHO) Expert Committee on Food Additives (JECFA) at international level. Before approving low calorie sweeteners for use on the market, these bodies have extensively evaluated all kinds of studies examining potential side effects, and on the basis of the wealth of data available, they have confirmed that low calorie sweeteners are safe.

Can low calorie sweeteners help in glucose control?

Low calorie sweeteners do not raise nor otherwise affect glucose or insulin levels in the blood. So, contrary to sugars, they do not cause a spike in blood glucose after their consumption. That is why low calorie sweeteners can be a significant aid to people with  diabetes who need to manage their carbohydrate intake, an important aspect of diabetes management, while still enjoying sweet-tasting foods and drinks with fewer or no calories.

This benefit of low calorie sweeteners is widely recognised by scientific and healthrelated organisations around the world. For example, the Diabetes UK evidence-based nutrition uidelines for the prevention and management of diabetes state that low calorie sweeteners are safe and may be recommended in diabetes. Also, a recent Diabetes UK position statement on the use of low or no calorie sweeteners concludes that low calorie sweeteners can be used as part of a strategy for the management of weight and diabetes. EFSA also previously concluded that consumption of low calorie sweeteners leads to lower post-prandial blood glucose concentrations if consumed instead of sugars. This is an authorised health claim in the EU Register of nutrition and health claims.

Additionally, replacing sugar-sweetened products with low calorie sweetened foods or drinks can help reduce energy (calorie) intake. By decreasing the overall intake of calories from the diet, people with diabetes can control their body weight more effectively, as long as substitution does not lead to later caloric compensation. So, using low calorie sweeteners in place of sugars and as part of a calorie-controlled, healthy diet and a healthy lifestyle can help persons with diabetes in their effort to lose weight, when recommended, because excess body weight is a known risk factor for both the development and exacerbation of type 2 diabetes.

It is important to clarify that low calorie sweeteners can be a useful dietary tool in helping people with diabetes reduce excess sugar consumption and manage carbohydrate intake in the context of an overall high-quality diet, but there should be no expectation that they, by themselves, would cause weight loss or decrease blood glucose levels.

Calorie and sugar savings by switching to low calorie sweeteners

Low calorie sweeteners are used to replace sugar in a variety of foods and drinks, including soft drinks, table-top sweeteners, chewing gums, confectionery, yoghurts, ice creams and desserts. In practice, by being hundreds of times sweeter than sugar, low calorie sweeteners are used in very small amounts to confer the desired level of sweetness to foods and drinks, while contributing very little or no energy at all to the final product. This offers one major advantage:  providing sweet taste whilst eliminating or substantially reducing the calories and sugars in a food or drink. A few examples of calorie and sugar savings by substituting a sugar-sweetened product with its low calorie sweetened alternative are:

• By replacing 1 teaspoon of table sugar with table-top sweetener you may “save” 4-5g of sugar and 16-20 calories;
• By replacing 1 glass (250ml) of sugarsweetened cola-type soft drink with its diet/ light/ zero alternative you may “save” approximately 25g of sugar and 100 calories;
• By replacing 1 portion (200g) of low-fat fruit yogurt containing sugar with a version sweetened with low calorie sweeteners you may ‘save’ about 10g of sugar and approximately 40-50 calories;
• By replacing 1 scoop (100g) of vanilla ice cream containing sugar with an ice cream sweetened with low calorie sweeteners you may ‘save’ about 10-15g of sugar and approximately 50 calories.

Don’t forget to always check food labels, as other ingredients included in some of these products, such as milk sugars in yogurt and ice cream or starch in some desserts, still affect your blood glucose levels. Products sweetened with low calorie sweeteners can be used to help curb cravings for something sweet without risking a spike in blood glucose levels, provided that other ingredients in the food or drink don’t influence blood glucose either.

A helpful tool to an overall healthy diet

When it comes to what we eat, looking at the diet quality as a whole rather than focusing on individual ingredients or single swaps is the right approach. As with every single food ingredient, low calorie sweetened foods and drinks should be consumed alongside an overall healthy diet. Studies from around the world as well as in the United Kingdom show that people consuming low calorie sweetened products have lower intake of sugars and follow a higher quality diet overall.

Enjoying the food we eat is certainly key, and reducing sugar intake may sometimes go against it. So, an overall healthy and balanced diet, fitted for the individual needs of a person with diabetes, may safely include low calorie sweeteners and foods and drinks containing them to replace some of the sugar in the diet while still keeping the enjoyment of sweet taste.




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