Controlling Sugar in the Diabetic Diet
If you have diabetes or pre-diabetes, what sugar or sugar substitute is best for blood sugar? Contrary to popular belief, those with diabetes can still eat sugar. The hardest thing for their body to do, is properly absorb simple carbohydrates, while maintaining stable blood sugar levels. So, their worst nightmare can be this:
So, with pre-diabetes or diabetes, a small amount of real, naturally-occurring sugar is best (like whole fruits). Of course, eating less-processed sugar, like we discussed, is can be a minimally-eaten option too. However, for diabetics, supplementing with sugar substitutes helps control carb intake and blood sugar levels, and gives you more meal planning freedom. Keep in mind, these sweeteners are the most studied food additive and many still remain very controversial, because of health risk findings in rats and mice. Also, the source and amount of calories they contain can vary, and is the biggest thing diabetics should pay attention to during insulin management.
According to Melissa Mullins, a certified diabetes educator at Johnston Memorial Hospital in Abingdon, VA, there are two types of sugar substitutes, nutritive and non-nutritive. Non-nutritive, are usually high-intensity sweeteners, that don't affect blood sugar or add calories when consumed. This makes them excellent baking and general sweetener options for diabetics or those with diabetic risk. There are currently 8 FDA-approved non-nutritive sweeteners. However, many simply replace sugar with chemicals, don't satisfy the sugar cravings, thus increasing the cravings and their negative effects. Artificial sweeteners are also connected with increased weight gain, doubled risk of metabolic disease, and continued risk of diabetes and heart diseases. Despite the negatives, the US availability and consumption of these artificial sweeteners steadily increases. In a 2007 and 2008 study, 1/3 of adults and 15% of children age 2-17 reported consuming these products.
The first of these sweeteners is the yellow-packeted Splenda, which is the artificial sweetener, sucralose. This sweetener is 600x more concentrated than sugar and doesn't affect blood sugar. It also usually just passes through your digestive system with minimal absorption.
Another artificial non-nutritive sweetener, saccharin, comes in the pink-packeted Sweet-N-Low. Once again, it is 300-500x more concentrated than sugar, even though it doesn't affect blood sugar. However, studies have found that consuming these types of non-nutritive sweeteners leads to weight gain. This result from excess additional calorie consumption, as the body seeks to get the calorie satiation that normally comes with sweetness.
The other common non-nutritive, artificial sweetener is aspartame, 200x more concentrated than sugar, which is branded as Equal or NutraSweet. The sweetener Advantame is also made from aspartame. However, despite FDA approval, neither are actually zero calorie and there are many conflicting studies on the safety and health affects of consumption. Also, there is a rare allergy to certain compounds in this sweetener too.
As far as natural non-nutritive sweeteners, we also have stevia, an FDA-approved leaf extract from a native Central and South American plant. Common brands like A Sweet Leaf, Truvia and Pure Via contain stevia, are zero calories, and have very little impact, if any, on insulin and blood sugar. Thus, despite reports of headaches and gastro-intestinal issues, after overconsumption, stevia is great for diabetics.
The other 3 approved sweeteners are, acesulfame K (found in Sunett and Sweet One), natural monk fruit extract (Monk Fruit in the Raw, Nectresse, PureFruit, PureLo), and neotame. Monk fruit comes from a small, Asian melon, which looks like a kiwi, and has a licorice aftertaste. Neotame is made from aspartame, but can be eaten by those with aspartame allergy (phenylketonuria). Most of these sweeteners are commonly found in "sugar-free" or "diet" food items. However, the artificial, non-caloric sweeteners can contribute to weight gain, and many contain, the starch, maltodextrin to add volume.
Finally, we have nutritive sweeteners, such as honey, raw sugar, maple syrup, agave, etc, which contain calories. These type of sweeteners come from natural, usually unprocessed, sources and are usually sold on their own, to be added at your discretion. Of course, whether organic or not, they still contain calories, often more than sugar itself. Each one contains about 14 calories per teaspoon, and 5 grams of carbohydrates. Beware though, because advertising "natural" is not defined or regulated by the FDA, and labels should still be read.
Some barely nutritive sweeteners include sugar alcohols aka polyols, such as mannitol, xylitol, erythritol, and sorbitol. These are low-glycemic, and their calories and carbohydrates come from the fruit and vegetable fibers they're extracted from. Most of these aren't fully absorbed by the body, but they may still affect blood sugar levels and may cause digestive issues, if over 10-15 grams are consumed daily. A 12-week study actually found that regular consumption of sugar alcohols helped to lower average blood glucose levels. As such, another great option for diabetics, as long as the remaining calories and carbohydrates in your food are low. You can calculate this by subtracting half the amount of sugar alcohols by the total number of carbohydrates.
Remember, just because something is sugar-free, doesn't mean it's calorie- and carbohydrate-free. You need to understand which sweeteners will impact blood sugar and factor it into your meal plan. Many studies hypothesis that low- or no-calorie sweeteners chemically alter the body's natural adjustments for metabolism of glucose. In a study on rats and mice, these sweeteners had a lowered effect on the brains' pleasure activation, causing overconsumption and weight gain. So don't make foods sweeter than they need to be or make diet items a large part of your diet, and always make it a habit to read the labels on your food.
In conclusion, the best thing anyone can do for blood sugar is to avoid adding any sugar to their food. Focus on maintaining a diet of wholesome foods, whole grains, and fresh fruits and vegetables. For that sweet tooth, add natural sweetness, with unsweetened almond milk or fresh fruits. As Katie Boardman says, "Moderation is key no matter which sweetener you choose..." ;) That goes for non-diabetics too! Another healthy option for anyone, to help manage blood sugar, is Jah Manna's NotBread, with vegan and protein flavors. Its naturally low-glycemic, gluten-free, grain-free, hypoallergenic, and a prebiotic. Happy sugar-free munching!
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