The best sweeteners for people with diabetes

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Stevia is a natural sweetener that comes from the Stevia rebaudiana plant. To make it, manufacturers extract chemical compounds called steviol glycosides from the leaves of the plant.

This highly processed and purified product is around 300 times sweeter than table sugar, which means a person needs to use only a small amount to sweeten food.

Stevia has several pros and cons that people with diabetes need to consider. It is calorie-free and does not raise blood sugar levels. However, it is often more expensive than other sugar substitutes.

Stevia also has a bitter aftertaste that many people may find unpleasant. For this reason, some manufacturers add other sugars and ingredients to balance the taste. This can make stevia products less suitable for those with diabetes. Additionally, some people report nausea, bloating, and an upset stomach after consuming it.

The Food and Drug Administration (FDA) classifies sweeteners made from high purity steviol glycosides as “generally recognized as safe” (GRAS). But the FDA does not consider stevia leaf or crude stevia extracts safe. Therefore, it is illegal to sell these products or import them into the United States.

According to the FDA, the acceptable daily intake (ADI) of stevia is 4 milligrams per kilogram (mg/kg) of a person’s body weight. So, a person who weighs 60 kg, or 132 pounds (lb), can safely consume 9 packets of the tabletop sweetener version of stevia per day.

Tagatose is a form of fructose that is around 90% sweeter than sucrose. It exists in small amounts in some fruits, such as apples, oranges, and pineapples. However, manufacturers usually extract it from milk and may use it in food production as a low calorie sweetener, texturizer, or stabilizer.

The FDA classifies tagatose as GRAS, and scientists are interested in its potential to help manage type 2 diabetes.

Some studies indicate that tagatose has a low glycemic index (GI). GI is a ranking system that measures the speed at which foods increase a person’s blood sugar levels.

Tagatose may be particularly beneficial for people with diabetes who are following a low GI diet. However, this sugar substitute is more expensive than other low calorie sweeteners and may be harder to find in stores.

Sucralose is an artificial sweetener that is about 600 times sweeter than table sugar but contains very few calories. It is one of the most popular artificial sweeteners and is widely available under the brand name Splenda.

Manufacturers add sucralose to sweeten a range of products, from chewing gum to baked goods. It is heat-stable and is a popular choice for sugar-free baking and for sweetening hot drinks. This is because, unlike other artificial sweeteners, sucralose retains its flavor at high temperatures.

The FDA has approved sucralose as a general-purpose sweetener and set an ADI of 5 mg/kg of body weight. For example, a person weighing 60 kg (132 lb) can safely consume up to 23 packets of the tabletop sweetener version of sucralose in a day.

However, some studies have raised health concerns. A 2016 study found that male mice who consumed sucralose were more likely to develop malignant tumors.

Animal studies do not necessarily indicate that a substance poses a significant risk to humans, but nevertheless, more research on sucralose’s effect on humans is necessary to determine its safety.

Aspartame is a popular synthetic sweetener that is around 200 times sweeter than sugar. It has been on the market in the U.S. since the 1980s and is available in grocery stores under the brand names Nutrasweet and Equal.

Manufacturers add aspartame to a wide variety of food products, including diet soda. However, unlike sucralose, aspartame is not a good sugar substitute for baking because it breaks down at high temperatures. People generally use it only as a tabletop sweetener.

The FDA considers aspartame safe at an ADI of 50 mg/kg of body weight. A person who weighs 60 kg (132 lb) could consume up to 75 packets of aspartame sweetener per day. However, aspartame is not safe for people with a rare genetic disorder called phenylketonuria.

Learn more about whether aspartame has health risks.

Acesulfame potassium, also known as acesulfame K or Ace-K, is an artificial sweetener that is around 200 times sweeter than table sugar. Manufacturers often combine it with other sweeteners to reduce its bitter aftertaste.

The FDA has approved acesulfame potassium as a low calorie sweetener and states that the results of more than 90 studies support its safety. According to the FDA, the ADI for acesulfame potassium is 15 mg/kg of body weight.

This is equivalent to a person weighing 60 kg (132 lb) consuming 23 packets of a tabletop sweetener version of this ingredient per day.

A 2017 study in mice suggests a possible association between acesulfame potassium and weight gain, but further research in humans is necessary to explore this link.

Saccharin is widely available under brand names such as Sweet Twin, Sweet’N Low, and Necta Sweet. It contains zero calories and is 200–700 times sweeter than table sugar.

According to the FDA, people expressed safety concerns about saccharin in the 1970s after research found a link between saccharin and bladder cancer in laboratory rats.

However, more than 30 human studies now support saccharin’s safety, and the National Institutes of Health no longer consider this sweetener to have the potential to cause cancer.

The FDA has determined the ADI of saccharin to be 15 mg/kg of body weight, which means that a person weighing 60 kg (132 lb) can consume up to 45 packets of a tabletop sweetener version per day.

Neotame is a low calorie artificial sweetener that is about 7,000–13,000 times sweeter than table sugar. It can tolerate high temperatures and is therefore suitable for baking.

The FDA approved neotame in 2002 as a general-purpose sweetener and flavor enhancer for all foods except meat and poultry. According to the FDA, more than 113 animal and human studies support neotame’s safety. The FDA has set an ADI for neotame of 0.3 mg/kg of body weight.

This is equivalent to a person weighing 60 kg (132 lb) consuming 23 packets of a tabletop sweetener version of neotame per day.

Monk fruit, which is also known as Lo Han Guo or Swingle fruit, is a small, round fruit that grows in Southeast Asia. There, people have used it for centuries in traditional Chinese medicine as a digestive aid.

Some manufacturers make a zero-calorie, carbohydrate-free sweetener from dried monk fruit. It is around 250 times sweeter than table sugar and does not affect a person’s blood sugar levels.

People can add monk fruit sweetener to many foods and drinks. It is stable at high temperatures but is not suitable as a sugar alternative in baked goods that need sugar for texture and structure.

The FDA approved monk fruit extract as a food additive in 2010. It recognizes monk fruit as safe for everyone, including pregnant people and children, and has permitted the use of monk fruit in foods and beverages. However, it has not set an ADI for monk fruit.

Allulose is a low calorie sugar that occurs naturally in some fruits and vegetables, such as figs, raisins, and jackfruit. It is around 70% as sweet as table sugar but has only 10% of the calories. It does not increase blood sugar or feed the dental bacteria that cause cavities.

The FDA has classified allulose as GRAS but has not set an ADI.

Unlike some other artificial sweeteners, allulose is suitable for baking and acts like sugar.

Agave nectar or syrup comes from agave plants. Although brands often market it as a healthy alternative to sugar, it is not suitable for people with diabetes because of its sugar content.

Agave nectar contains fructose, or fruit sugar. Fructose breaks down more slowly than sucrose, meaning that it is less likely to cause sudden spikes in blood sugar. For this reason, agave syrup has a low GI rating.

However, GI is not the only consideration for people with diabetes. The ADA lists agave nectar as an example of an “added sugar” that people with diabetes need to watch for on food labels, along with corn syrup, honey, and table sugar. Consuming large amounts of added sugars may contribute to prediabetes, type 2 diabetes, and obesity.

When deciding which low calorie sweetener to use, a person may wish to consider:

• Intended use: Many sugar substitutes do not withstand high temperatures, so they would make poor choices for baking.
• Necessity: Sometimes, it is possible to flavor a dish with whole food ingredients instead of sweeteners. This option also adds vitamins and minerals to meals. For example, people can infuse water with mint and citrus fruits or add whole blueberries or raspberries to their breakfast.
• Cost and availability: Some sugar substitutes are expensive, whereas others have a cost closer to that of table sugar. Additionally, some sugar substitutes are more widely available than others.
• Taste: Some sugar substitutes, such as stevia, have a bitter aftertaste that many people may find unpleasant.
• Natural versus artificial: Some people prefer using natural sweeteners, such as stevia, rather than artificial sugar substitutes. However, as with agave nectar, “natural” does not always mean better.

Learn more about the foods to eat and avoid for type 2 diabetes.

Many people with diabetes need to avoid or limit sugary foods. Low calorie sweeteners can allow those with the condition to enjoy an occasional sweet treat without affecting their blood sugar levels.

Each sweetener has advantages and disadvantages. For example, tagatose may be actively helpful for those with type 2 diabetes. However, research into this is ongoing. So far, there is no evidence that switching to low calorie sweeteners helps manage diabetes in the long term.

It is best for people with diabetes to consume sweeteners in moderation as part of a balanced and diabetes-appropriate diet. People can consult a doctor or dietitian for advice on the best diet for them.