Is it better or worse for diabetes and weight loss? An expert explains – Alternet.org

While walking through grocery stores, it's easy to be overwhelmed by the many brands and health claims made by dozens of sugar substitutes. This can be particularly confusing for diabetics or pre-diabetics who need to control their blood sugar and control their weight.

With the growing epidemic of diabetes and obesity, the consumption of added sugars in foods is raising awareness. The latest edition of the American Dietetic Guidelines for Americans recommends limiting added sugars to less than 10% of calories consumed, or about 270 calories per day.

Indeed, "added sugars" add a sweetness or flavor but add very little nutritional value. Because of this trend, the food industry has embarked on a quest to find or develop the perfect substitute for sugar – with the same taste and no calories to gain weight.

As a pharmacist also certified in Advanced Diabetes Management, I discuss daily with patients about blood glucose levels and ways to help them manage their diabetes. They often ask me if the perfect sugar substitute has been found. The short answer is no. Here is the long answer.

Sugar alcohols

Sugar substitutes can be clbadified into two main groups: sugar alcohols and high intensity sweeteners. Sugar alcohols include sorbitol, xylitol, lactitol, mannitol, erythritol and maltitol. High Intensity Sweeteners include Saccharin, Aspartame, Acesulfame Potbadium (Ace-K), Sucralose, Neotame, Advantame, Stevia and Fruit Extract of Siringia grosvenorii Swingle (SGFE).

Sugar alcohols are often found in toothpaste, chewing gum and some "sugar-free" foods. These are carbohydrates whose chemical structure resembles sugar, but also the components that make it an alcohol. They are about 25-100% sweeter than sugar and have a similar taste. But here's the trap: they are not without calories. Most have between 1.5 and two calories per gram. Now compare the number of calories to sugar, also called sucrose, which contains four calories per gram, twice as much.

Although sugar alcohols contain fewer calories, they will still increase the patient's blood glucose, especially in case of excessive consumption. Compared to sugar, the effect is however less spectacular. This is due to the way these molecules are processed in the body. We measure this using the glycemic index.

The glycemic index is a reference to the speed with which a food is broken down and absorbed. The higher the number, the faster the food breaks down and the faster the sugar gets into the bloodstream. Sucrose has a glycemic index of 65; while sugar alcohols, such as xylitol, have a glycemic index of about seven. This means that sugar alcohols are more difficult to digest and result in a slower and slower increase in blood glucose after meals – which is usually better for people with diabetes. Since sugar alcohols are more difficult to degrade, some remain in the intestine and if a person consumes too much, it may suffer from digestive disorders such as gas, cramps and diarrhea.

Here is the other disadvantage of foods containing sugar alcohols: they often contain larger amounts of fat or salt to make up for the lower sugar content.

Artificial sweeteners

High Intensity Sweeteners are low or no sugar substitutes for sugar. They are made from a variety of sources and are 100 to 20,000 times sweeter than sugar. Some leave behind a bitter or metallic taste. Two new substitutes – stevia and SGFE – come from plants and are sometimes called "natural" substitutes.

According to the guidelines of the American Diabetes Association 2019, the use of high intensity sweeteners can reduce the intake of calories and carbohydrates. However, you can not replace these "free" calories with calories from other food sources. You will lose or lose the benefits of controlling blood glucose and losing weight.

Researchers have found this in some of the studies on high intensity sweeteners. Some tests show no difference or even a possible increase in weight. But in other studies where food consumption is better regulated and patients do not replace these free calories with other high-calorie foods, weight loss is maintained.

The delivery

All sugar substitutes are labeled as food additives and are regulated by the US Food and Drug Administration. According to the latest trend, some sugar substitutes have been labeled "plant-derived" or "natural". This does not necessarily mean that they are safer or more effective at controlling blood sugar or losing weight. If it is used in excess, side effects such as bloating or diarrhea may still result.

Researchers have raised several concerns regarding high intensity sweeteners – saccharin and aspartame – and cancer. To date, the National Cancer Institute has concluded that it is unclear whether any of the high-intensity sweeteners are badociated with an increased risk of cancer.

As a pharmacist specializing in advanced diabetes, I talk to patients every day about how to control their blood glucose and diabetes. There are three main ways to do this: medications, increased activity, and a diet. The last two are probably more important in the long run.

If the diet and activity level never change, it is very difficult to help patients reduce their blood sugar. Medications after the medications will probably need to be added. With that comes the potential for side effects. So if I can persuade patients to make changes to their diet, for example by switching to a drink with a sugar substitute, it will be very helpful to control the blood sugar and the dose of medication.

Diabetes management should focus on reducing the consumption of beverages and sweetened foods. If you can replace any of these sugar-sweetened products with a food containing a high-intensity sugar substitute, it's better. But the best is to consume foods and drinks that are little processed and without added sugars.

Jamie Pitlick, Associate Professor of Pharmacy Practice, Drake University