How Sweet It Is: A Look at
Sugars and Sweeteners
SHERRI SHAFER, R.D., Certified Diabetes Educator
How
Sweet It Is: A Look at Sugars and Sweeteners
The use of sugar, sweeteners,
and sugar substitutes has often been a topic of hot debate.
Until recently, using sugar has been discouraged in diabetic
meal planning. Current scientific studies have not supported
the necessity of completely abstaining from sugar, and now it’s
becoming widely accepted that sugar may be used in moderation
without causing deterioration in blood sugar control. Countless
studies have investigated the safety profiles of artificial
sweeteners.
Misinformation is rampant regarding
the safety and acceptability of using both sugar and artificial
sweeteners. A fair amount of alarmist propaganda is out there,
mixed in with medical facts. Listen with a critical ear. Try
to review the scientific studies, not the hearsay. Consider
the source of the information. In the end, the decision of what
to use is up to you.
Sugar
Historically, people with diabetes
were advised to completely avoid eating sugar, in hopes that
this would control their blood sugar. More recently, it’s
become clear that strict avoidance of dietary sugar is unnecessary.
Studies have shown that when sugar is eaten in reasonable amounts
and in the context of a healthful diet, blood sugar control
is not jeopardized. Keep in mind that all carbohydrates (except
fiber) are digested and then absorbed as sugar into the bloodstream.
Blacklisting one form of carbohydrate will not cure diabetes.
What’s more important is eating a reasonable amount of
total carbohydrate. How much carbohydrate you eat and how
it is spaced throughout the day are much more influential on
the blood sugar than the specific type of carbohydrate you choose.
Although you may include refined sugar in the diet, it’s
wise to moderate the amount of sugar that you consume. Sugary
foods are often low in nutritional value, high in fat or calories,
or all three.
There are naturally occurring
sugars, as well as added sugars. Fruit and milk both have natural
forms of sugar (fructose and lactose, respectively). Naturally
occurring sugars and added sugars affect the blood sugar similarly.
Lightning won’t strike you down for eating the occasional
cookie, but the diet police (well-intentioned family, friends,
and strangers) may swarm around you, scolding that people with
diabetes can’t eat sugar. Everyone has been so conditioned
to believe that sugar is evil that it’s been hard to dispel
this myth.
Some sugar-sweetened items do
tend to raise the blood sugar quickly. For example, it doesn’t
take long to digest liquids, so the sugar from regular sodas
and sugary drinks can enter the bloodstream rapidly. A 12-ounce
can of soda (45 grams carbohydrate) is roughly equal to 9 teaspoons
of sugar. Fruit juice has almost the same amount of sugar; it’s
just a different type of sugar. Use caution with both regular
soda and fruit juice. You may find that your blood sugar is
easier to control if you use diet drinks instead. Also, be aware
that goopy, frosted goodies can have a large amount of carbohydrate
concentrated in a relatively small portion.
Other Calorie-Containing Sweeteners
Honey, maple syrup, pancake
syrup, malt syrup, corn syrup, Karo syrup, corn sweeteners,
molasses, jelly, jam, and marmalade are all concentrated forms
of sweeteners. There’s no advantage or disadvantage to
using any one of these over another. They’ll all affect
the blood sugar similarly. They each contribute approximately
15 grams of carbohydrate per tablespoon, which is about the
same as white sugar.
Fructose
Powdered fructose may have some
advantage over white sugar because it produces a smaller rise
in blood sugar than the same amount of white sugar. Since fructose
tastes sweeter than sugar, less can be used. Fructose can be
used in baking.
Fructose doesn’t require
digestion in the intestines. It gets absorbed into the bloodstream
as fructose, not glucose. Fructose is then transported to the
liver, where it’s converted to glucose and stored as glycogen
for later use. It’s released into the bloodstream as needed.
Studies have shown that when
a very large intake of fructose was eaten (20 percent of total
calories), the LDL cholesterol went up. Don’t give up
fruit if you have high cholesterol, though. Just use moderation
in the amount of fructose-sweetened products you use.
Sugar Alcohol
Mannitol, maltitol, lactitol,
xylitol, sorbitol, hydrogenated starch hydrolysate, and isomalt
are all sugar alcohols. Sugar alcohols don’t contain sugar
or alcohol, but they are a type of carbohydrate. Sugar alcohols
don’t impact the blood sugar as much as regular sugars,
but they do still eventually produce some glucose in the blood.
Since sugar alcohols aren’t technically a form of sugar,
products sweetened with sugar alcohols can boast that they are
“sugar-free.” That doesn’t necessarily mean
the product is “carbohydrate-free” or “low
calorie.” Most chocolates that are sweetened with sugar
alcohols have just as much fat, calories, and total carbohydrate
as regular chocolate candies. However, sugar alcohols don’t
promote tooth decay.
Sugar alcohols may have a laxative
effect, causing gas, bloating, and diarrhea. Tolerance varies
from one individual to the next but is usually related to the
amount of sugar alcohol consumed.
Artificial Sweeteners
The FDA has approved the following
artificial sweeteners for use in the United States. The acceptable
daily intake (ADIs) has a built-in 100-fold safety factor. The
amounts that people actually consume are well below what has
been determined to be safe.
Aspartame is sold under the
brand names Equal, NutraSweet, SweetMate, and NatraTaste. The
FDA approved aspartame in 1981. It is 180 times sweeter than
sugar. If heated at extreme temperatures, aspartame loses its
sweetness; therefore, it is not acceptable for use in most cooked
or baked goods.
Aspartame is made of
two amino acids: phenylalanine and aspartic acid. Amino acids
are the natural building blocks of proteins. When aspartame
is digested into its amino acid components, the body cannot
distinguish whether those amino acids came from aspartame or
from dietary proteins like chicken, milk, or eggs.
Small amounts of methanol are
produced as a by-product from digesting aspartame. Methanol
is a by-product that is also produced from digesting the regular
foods that we eat. Natural juices, including fruit juice and
tomato juice, produce three to six times more methanol than
an equal portion of aspartame-sweetened soft drink.
There has been a lot of finger
pointing in the direction of aspartame, but claims that it is
harmful haven’t been substantiated. Whether to use aspartame
or not is a matter of personal choice.
Patients with a very rare metabolic
disease called PKU (phenylketonuria) should not use aspartame
because they need to limit all sources of phenylalanine.
Acesulfame K is sold
under the brand names Sunett, Swiss Sweet, and Sweet One. Gaining
FDA approval in 1988, acesulfame K is 200 times sweeter than
sugar. It is heat stable and can be used in baking.
Sucralose is sold under
the brand name Splenda. The FDA approved Sucralose in 1998.
It’s actually made out of sugar but has been modified
so that it doesn’t affect the blood sugar or provide any
calories. It’s 600 times sweeter than sugar. It’s
stable at high temperatures and can be used in baked goods.
Like the other artificial sweeteners, sucralose doesn’t
promote tooth decay.
Saccharin is sold under
the brand name Sweet ’N Low. Saccharin has been around
since 1879. It’s approximately 300 times sweeter than
sugar. It’s stable when heated, so can be used in baking.
In the 1970s its safety came under question, as some studies
showed that rats that were fed large amounts of saccharin developed
bladder tumors. Saccharin has been scrutinized and studied over
the past several decades and has now been determined to pose
no cancer risks to humans. In May 2000, saccharin was removed
from the government’s list of carcinogens (cancer-causing
substances). The label warning that appears on saccharin will
likely soon be dropped.
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SHERRI
SHAFER received her BS in Nutrition and Dietetics from the University
of California at Berkeley. She has been a Dietitian at UCSF
Medical Center for 10 years. Sherri specializes in medical nutrition
therapy counseling for individuals in adult and pediatric diabetes
clinics, and is an Instructor for classes on diabetes self management
for Type 1 and Type 2 diabetes. She has just completed her first
book, Diabetes Type 2 Complete Food Management Program from
Prima Publishing.
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