A Diabetic’s Guide to Sweeteners: the best sweetener to choose

What is the best sweetener for people with diabetes? Great question. It comes down to personal choice, so it’s important to be informed. Below, we outline all the different kinds of artificial sweeteners and sugar substitutes. Here’s all you need to know about sweeteners.

Understanding artificial sweeteners and sugar substitutes

We know that sugar can be an addiction (studies have shown). That means it’s not always easy to cut out sugar entirely. Especially if you ‘fall off the wagon’ and binge on it: that can be really dangerous for your blood sugar. A more balanced approach is to slowly change your tastebuds so that you don’t needs as much sweet food. And a sensible way to do that, for people with diabetes, is by using sweeteners or sugar substitutes, as they don’t spike blood sugar the way sugar does.

There is a lot of confusion around sweeteners, as we saw when we opened up the discussion on Diabetic South Africans. For starters, let’s understand what sweeteners are.

Nutritive sweeteners

Nutritive sweeteners are sugar, or variations on sugar. These will definitely spike your blood sugar. “There is no advantage to people with diabetes in using one type of sugar over another, such as honey instead of sugar,” explains Leanne Kiezer, the dietitian at Pick n Pay.

Nutritive sweeteners are called a variety of things, but you should avoid all of them if possible:

• honey
• brown sugar
• white sugar
• glucose
• sucrose
• maltose
• fructose
• high fructose corn syrup
• agave syrup
• dextrose
• molasses
• maltodextrin

Sugar alcohols

Despite the name, sugar alcohols do not contain alcohol. They are a group of carbohydrates called “polyols”. They are lower in calories than regular sugar, and have a minimal effect on blood sugar, so products containing these foods are often called ‘sugar-free’ (but remember to check the other ingredients in ‘sugar-free’ foods, like carbohydrates.) Excessive intake of some of these (like xylitol) can have a laxative effect.

These sweeteners are called:

• erythritol
• isomalt
• maltitol
• mannitol
• lactitol
• sorbitol
• xylitol

Erythritol occurs naturally in foods like grapes, melons and honey and in fermented foods such as cheese and wine. It has a very low glycemic index and doesn’t raise blood sugar. 90% of it is absorbed in the small intestine when digested, which means it doesn’t have the same laxative effect as other sugar alcohols. It is also tooth friendly and doesn’t contribute towards tooth decay.

Xylitol is a chemically made sugar alcohol. It is a common ingredient in sugar-free chewing gums, mints, diabetes-friendly foods and even toothpaste. Xylitol can have a laxative effect (causing diarrhoea) if too much of it is eaten – some people report this even if they don’t eat too much of it. It is also toxic for sugarbirds and dogs.

Non-nutritive sweeteners

Most non-nutritive sweeteners are what we commonly call artificial sweeteners. Non-nutritive sweeteners offer the sweetness of sugar, but without the calories. They are intensely sweet – much sweeter than sugar – so only tiny amounts are needed for the same taste. They don’t affect blood sugar levels. Stevia is the only plant-based, naturally occurring non-nutritive sweetener, the others contain chemicals (listed below).

Stevia (Stevia Rebaudiana Bertoni) is a small herbal plant from the sunflower family with origins from Paraguay. Stevia extract is naturally sweet. It is dried into a powder and used as a high intensity non-nutritive sweetener: about 300 times sweeter than sugar, with no kilojoules per gram. Stevia has no glycemic index and therefore does not raise the blood glucose level. It also doesn’t contribute to tooth decay.

Common artificial sweeteners include:

• aspartame
• saccharin
• sucralose
• acesulfame-K
• cyclamate

Aspartame is approximately 200 times sweeter than table sugar so only a tiny amount is needed. The sweetness of aspartame lasts longer than that of sucrose, so it is often blended with other artificial sweeteners such as Acesulfame-K to produce an overall taste more like that of sugar. Aspartame has been in the news a lot in recent years, especially in relation to whether or not it causes cancer. But according to the National Cancer Institute there is no scientific evidence that aspartame causes cancer or other serious health problems.

Acesulfame K is non-caloric (has no calories) and is 200 times sweeter than sucrose. Like saccharin, it has a bitter aftertaste, especially at high concentrations. It is often blended with aspartame.

Saccharin is a non-caloric artificial sweetener. It is about 300–400 times as sweet as  sugar but has a bitter or metallic aftertaste.

Common South African sweeteners and their ingredients

After a thorough analysis of the various sweeteners and sugar substitutes on the market, we believe there’s a clear winner in terms of ingredients. So many South African sweeteners are full of artificial ingredients and chemicals, and leave a horrible, bitter aftertaste. We’ve found a plant-based, clean product with no aftertaste that still delivers on sweetness. Take a look at the common sweeteners available in South Africa and let us know which is your favourite, and why:

SWEETLY
Looks, smells and tastes just like sugar. This entirely plant-based sugar substitute has just been released by NOMU and is made of erythritol (non-nutritive sweetener), fibre (inulin), steviol glycosides (stevia extract) and flavouring so that it tastes just like sugar.

Equal / EquiSweet / Canderel
Made from aspartame.

Hermestas / Natreen
Made from saccharin.

Splenda / Canderel® with sucralose / Selati sucralose
Made from sucralose.

Hulett’s Sugalite / Selati / Equal
Made from Acesulfame-K.

Sweet ’n Low
Made from Cyclamate.

Canderel green with stevia / Equisweet stevia
Made from stevia (the most natural of the artificial sweeteners).

So… Which sweetener to choose?

As we said at the beginning of this guide, first prize is definitely cutting out everything sweet. But for many people with diabetes, that’s not possible and will result in ‘cheating’ by eating sugary foods that result in high blood sugar. A safer route is to find an artificial sweetener that tastes good, doesn’t spike your blood sugar and can be used in moderation.

“When choosing sugar substitutes, get informed and look beyond the hype. While artificial sweeteners may help with diabetes and weight management, they aren’t a magic bullet and should only be used in moderation. As a guideline, use no more than 3 to 6 sachets or tablets of sweeteners a day, and limit diet cold drinks to a maximum of one 250ml glass a day.”

Leanne Kiezer, registered dietitian

Final thoughts…

At Sweet Life, we believe in a moderate diet. Remember that diabetes is a chronic condition, which means you have to find a diet that is sustainable for the rest of your life… Not one that you can only keep up for a few weeks or months. The most important thing is to be informed and make conscious choices that you feel are best for your health. Life can be sweet with diabetes!

Photos from Unsplash