Today, diabetes is one of the most common chronic diseases and a leading cause of death globally. It affects approximately 422 million people in the developed and developing worlds. Currently, China has the highest population of people with diabetes. India is in second place, with about 77 million people with diabetes. The United States ranks third with 37.3 million diagnosed and undiagnosed cases. Another 96 million in the USA have prediabetes.
Evidence shows that added sugar is a significant contributor to the current diabetes pandemic. People enjoy sugary treats or foods that lead to a significant spike in blood sugar levels. However, excessive intake of these foods or drinks can, directly and indirectly, cause diabetes.
Taking sugar-sweetened foods and beverages increases blood sugar levels. It negatively affects glycemic control and overall health outcomes. As a result, there is an intense debate about whether diabetic people can safely take artificial sweeteners as a sugar substitute.
What is the Difference Between Sugar and Artificial Sweeteners?
Generally, sugar and artificial sweeteners add a sweet taste. However, they are very different in composition, production, and total calories.
Sugar usually contains calories and supplies them to the body when consumed. In contrast, artificial sweeteners do not have or provide any calories to the body. This characteristic makes them suitable for making sugar-free foods. For instance, artificial sweeteners are a critical diet soda ingredient. The manufacturers often use aspartame as a substitute for added sugars.
Artificial sweeteners are also produced in the lab and have no nutritive value. Hence, they are known as non-nutritive sweeteners. By contrast, sugars are naturally occurring carbohydrates such as sucrose (table sugar), glucose, and fructose. They have nutritive value and are categorized as nutritive sweeteners.
In addition, artificial sweeteners taste sweeter than regular or table sugar. According to existing evidence, they are several hundred times sweeter than sucrose, making them an ideal sugar substitute.
Are Artificial Sweeteners Safe for Diabetic People?
People with diabetes risk developing hyperglycemia (high blood glucose) if they do not limit their sugar intake. Hyperglycemia can cause irreversible and life-threatening complications. Therefore, diabetic persons who want to enjoy sweet-tasting foods or drinks only have artificial sweeteners as a sugar substitute.
Artificial sweeteners remain the best option for these people because they do not have calories and will not cause a spike in blood glucose, as seen with sugars. This characteristic has caused the FDA and other regulatory agencies to approve them as generally safe.
Artificial sweeteners and weight gain
However, studies have shown that artificial sweeteners might have harmful effects. They might lead to weight gain because they increase appetite or the urge to consume calories to compensate for the energy deficit created when you take them in a food or drink.
Generally, artificial sweeteners trick the body into producing more insulin in response to an expected blood sugar spike that never comes because they have no calories. This physiologic response can increase cravings for sugary foods or drinks, contributing to weight gain.
Some researchers also found that artificial sweeteners can curb weight gain. At the same time, most clinical studies have established that artificial sweeteners have no significant impact on body weight. The discrepancies in the findings may reflect the variation in the metabolism of different artificial sweeteners. Thus, this signals the need to treat each artificial sweetener as unique instead of generalizing research findings.
Artificial sweeteners and cancer
Despite the evidence suggesting artificial sweeteners may not significantly affect body weight and blood sugar regulation, there is concern that they might cause cancer. Studies have, in the past, shown that these sweet-tasting substances might augment the risk of lymphoma, carcinoma, leukemia, and bladder cancer.
This safety issue resulted in an FDA ban on cyclamate and saccharin. However, Congress reversed this ban and approved a moratorium pending further safety studies. Today, saccharin is no longer on the list of potentially hazardous chemicals in the United States. Its usage continues to date, even though some countries banned it based on the evidence presented at the time. Other countries also utilize cyclamate, citing weak evidence proving its carcinogenic activity.
Should diabetic people take artificial sweeteners?
People with diabetes can safely take artificial sweeteners instead of sugar as long as their consumption is within the acceptable daily intake. As a result, this option can help cut sugar or carbohydrate intake in this population. A dietician can aid in developing an individualized diet plan incorporating artificial sweeteners.
Caution is also critical in light of new evidence indicating that long-term use of these substances can harm diabetic persons. Thus, taking them in moderation is a safer step for this population. This way, it can confer the expected benefits without introducing new health risks.