Q. I’m diabetic. Should I use artificial sweeteners, such as Splenda or NutraSweet, instead of sugar?
A. As you know, when you eat sugar (or simple carbohydrates), your blood glucose levels rise, and your pancreas releases insulin to usher the sugar into cells. As a diabetic, however, you either don’t produce enough insulin or your cells don’t respond to the insulin (or both), and your blood glucose levels remain sky high. So eating too many carbohydrates will lead to an excessive rise in blood glucose that can cause serious health problems if left unchecked. These diabetes-related complications include increased risk for kidney failure, stroke, blindness, heart disease, and nerve damage.
Because of these risks, many people argue that artificial sweeteners are safer than sugar for diabetics since they contain no calories and have not been shown to raise blood-glucose levels. However, artificial sweeteners pose dangers of their own. Several studies have linked Aspartame (NutraSweet), acesulfame K (Sunette or Sweet One), and saccharin (Sweet’N Low) to increased cancer risk. Much of this research was conducted on animals and in doses significantly higher than an individual would consume, so the jury’s still out on whether the results apply to humans. Aspartame also has been implicated as an excitotoxin, a compound that overexcites neurons, leading to cell death.
As for sucralose (Splenda), it’s synthesized by reacting sugar with chlorine. While some say sucralose doesn’t break down in the body, and few studies have shown negative health effects, it may still pose problems. Because sucralose degrades slowly, scientists don’t know yet whether the amounts found in waste-water harm the environment. The real question with all these sweeteners is: What health risks arise from continual, long-term use? We just don’t know.
What’s more, artificial sweeteners raise insulin levels—even without your blood-glucose levels rising. Scientists theorize that the sweet taste fools your body into thinking you’re eating sugar, and in preparation, it releases insulin. This can lead to complications like hypoglycemia (when blood glucose drops too low) and altered hormone metabolism.
Whether or not you put stock in the research censuring artificial sweeteners, one thing’s for sure: They do not provide any nutritional value, and we can only hope they do no harm. Managing blood sugar levels is critically important, but you can achieve that in many other ways. My advice: Eat fewer processed treats, which rapidly raise blood sugar, and instead consume more naturally sweet whole foods, such as nutrient-rich fresh fruit and sweet vegetables like red bell peppers, sweet potatoes, sugar snap peas, and baby carrots. They contain less sugar than processed foods, and the fiber in them helps your body absorb the sugar they do contain more slowly, so your blood glucose doesn’t spike. Sweeteners such as honey, agave nectar, molasses, and fruit juice are lower-glycemic than sugar, too, and provide vitamins and minerals. You can also use spices for sweetness—for example, cinnamon and nutmeg, both high in antioxidants.
Several natural low- or no-calorie sweeteners exist as well, with mixed safety records. These include:
Stevia. The nonprofit Center for Science in the Public Interest recommends avoiding it because tests show it may harm reproductive organs. But other studies have shown it to be an antioxidant that possibly protects against DNA damage. Until scientists have more conclusive results, you may want to avoid or limit your intake of stevia.
Xylitol and erythritol. Both appear to be quite safe, although large amounts can have a laxative effect.
Inulin. Known by its brand name “Just Like Sugar,” inulin comes from plants and is a safe, sweet prebiotic that feeds your healthy gut bacteria.
The bottom line: A little sugar once in awhile is safe for diabetics, as long as it’s factored into your total carbohydrate allowance for each meal. Just manage your portions, and pay attention to what you’re eating. A little sweetness goes a long way when consumed consciously.
Three Nutrients to Help You Along
1. Cinnamon contains substances that lower fasting blood glucose levels, cholesterol, and triglycerides in type-2 diabetics. Consume one teaspoon a day for maximum benefit, or take a supplement containing 125 mg of water-extracted cinnamon bark twice daily.
2. Soluble fiber can reduce post-meal glucose levels by up to 20 percent. Foods rich in soluble fiber include dried beans, winter squash, dried figs, plums and apricots, and ground flaxseeds.
3. Alpha-lipoic acid, found in spinach, carrots, broccoli, potatoes, sweet potatoes, yeast, liver, and tomatoes, as well as in supplement form, has been shown to help increase insulin sensitivity, improve glucose uptake and metabolism by skeletal muscles, and reverse symptoms of peripheral neuropathy. Shoot for three servings of alpha-lipoic-rich foods a day.
Lisa Lanzano, RD, of Boulder Co.