Author: Drake Christie
As someone with Type 1 Diabetes, ensuring that my diet is balanced is a key part of managing my health. In general, I try to reduce my consumption of simple sugars that spike my blood sugar and require me to administer more insulin. In my experience, large doses seem to cause insulin to pool at the site of administration, which slows my insulin absorption. As a result, my blood sugar will quickly spike and stay high for longer causing me to feel fatigued, thirsty and have a headache. The prevalence of this issue is only made worse by my sweet tooth and love for desserts. So, do I just have to consume sweets in moderation? Do I only have sweets when my blood sugar is low? Is there any other solution?
One potential option that is widely available nowadays, are sugar substitutes. Use of these sugar substitutes has been increasing in recent times due to demand for low calorie foods and healthier diets that reduce sugar consumption. This demand coupled with the cheap cost of artificial sweeteners had encouraged an increased usage of sugar substitutes in more of our food products (Tandel, 2011). These low-calorie food and beverage products are often void of absorbable carbohydrates altogether. Therefore, these products marketed as “diet” or “diabetic friendly” present a way for diabetics such as me, and others looking to avoid sugar consumption to get our sweet fix without the consequences of sugar. Unfortunately, some research has indicated that these sugar substitutes may have their own health risks and that they may not be much better than the sugar they are replacing (Tandel, 2011).
What are sugar substitutes?
Sugar substitutes are additives that taste sweet and thus perform the role of typical simple sugars, but they typically also have fewer calories (Sharma et al., 2016). Their sweet taste is maintained by acting on and activating the same lingual taste bud receptors as regular sucrose. Therefore, the sugar substitutes are indistinguishable in terms of sweet taste as they activate the same sweet taste receptors such as T1R family or -gustducin receptors (Brown et al., 2010). These sugar substitutes can be natural and obtained from plants such as Stevia and Xylitol or they can be artificial such as Aspartame and Sucralose. These sugar substitutes are effective at reducing the calories and carbohydrates of foods that they are used in through a variety of mechanisms. Caloric sugar substitutes are sweeteners that have similar physical characteristics to regular sugar but much less can be used to obtain the same sweetness (Sharma et al., 2016). Less can be used to achieve the same sweet taste as these compounds can have much higher affinity for the taste receptors or they may improve activation of the receptor more than sucrose (Brown et al., 2010). Using less of one of these types of sweeteners allows you to have lower calories and carbohydrates while maintaining the same sweetness of food and beverages. Non-caloric sugar substitutes on the other hand provide sweetness but they provide very little to no calories and cut down the carbohydrates in products that they are used in (Sharma et al., 2016). These non-caloric sugar substitutes include the commonly used Aspartame that is found in many products such as diet pop, as well as the common sweetener Stevia. Aspartame for example, has a different chemical structure and composition than regular sucrose. It is a dipeptide which when absorbed and metabolized contributes an insignificant number of calories to food or beverages while maintaining sweetness (Yilmaz and Uçar, 2014).
Potential benefits of sugar substitutes:
There are certainly many attractive upsides that sugar substitutes offer and that contribute to its widespread use in food and beverages. A primary reason for the increased desire for sugar substitutes is their effectiveness at reducing the calories of traditionally energy dense foods or drinks. Individuals looking to lose weight by decreasing their consumption can now swap out their sugary Coke for a Diet Coke with 0 calories while still having a sweet tasting beverage. The use of sugar substitutes also contributes to better dental health than consumption of regular sucrose. Sugar substitutes are not able to be used by bacteria during fermentation, a process where sugars and starches are broken down to produce energy for bacteria. Unfortunately, fermentation also produces acid as a by-product, this acid damages our teeth leading to cavities (Sharma et al., 2016). Therefore, the inability of bacteria to use sugar substitutes for fermentation has encouraged the use of sugar substitutes for prevention of cavities. Finally, sugar substitutes offer the benefit of improving blood sugar control in diabetics. For type 2 diabetics sugar substitutes can help reduce worsening of conditions by preventing hyperglycemia and reducing their caloric intake. Similarly, for type 1 diabetics sugar substitutes also prevent spiking of blood sugar and hyperglycemia. In this sense, these sugar substitutes make normally high sucrose foods and beverages such as syrup, pop, and candies more accessible to diabetics. It’s certainly nice for me as a diabetic to be able to have low sugar syrup containing a sugar substitute without having to worry about spiking my blood sugar and feeling the consequences afterwards.
Potential consequences of sugar substitutes:
Unfortunately, sugar substitutes are not without their downsides. Due to the recent popularity of sugar substitutes more and more research is being conducted on their effects. There is now research that indicates that some sugar substitutes may not be so effective at helping control diabetes and that they are even associated with increased risk of type 2 diabetes (Purohit and Mishra, 2018). It is worth mentioning that some similar studies regarding sugar substitutes and the effect on weight gain or diabetes have had somewhat conflicting results (Purohit and Mishra, 2018). This reinforces the idea that more research needs to be done regarding the benefits and consequences of sugar substitutes. Artificial sweeteners have also been shown to contribute to weight gain, brain tumours and bladder cancer in animals; this carcinogenicity has also been noticed in humans (Tandel, 2011). For these reasons the constant use of sugar substitutes may not be as great of a solution as we once thought.
Overall, sugar substitutes may not be the perfect and sweet solution that we’d hoped for, although more research needs to be done to verify their effects. When consumed in moderation and infrequently sugar substitutes may not be very detrimental, and they have approved for use in food and beverages by Health Canada. Currently in Canada Aspartame, Saccharin, Sugar alcohols (Polyols), and Stevia are approved for consumption. It should be noted that staying healthy and having a balanced diet requires that we consider all that we ingest. Consuming both sucrose and some sugar substitutes in moderation combined with exercise is probably the best way for diabetics and non-diabetics to ensure a healthy lifestyle. Only time and more investigation will prove whether sugar substitutes can truly provide us with a safe alternative for our beloved sucrose.