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If you want to optimize your type 2 diabetes or prediabetes health, understanding which sweeteners or sugar substitutes are safe and effective is crucial.
With over 50 different types of sugars and sweeteners available, navigating through the options can be confusing, especially with all the conflicting information out there.
By listening to this podcast or reading through the information below, your confusion will be put to an end.
We share research-backed benefits or downfalls to the sweeteners and sugar substitutes available, covering everything from traditional sugars like white sugar, brown sugar, honey, and syrups, through to modern substitutes such as stevia, monk fruit, erythritol, aspartame, and sucralose.
LISTEN TO THE PODCAST
PODCAST CHAPTERS
2:50 Sugar is as addictive and provides zero nutritional value
4:42 Carbs in natural sugars compared
8:06 Adverse effects of artificial sweeteners
11:13 Pros and cons of sugar alcohols
15:57 Research and benefits of naturally-derived sugar substitutes
22:52 Reading food labels and making a sweetener choice
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Why Cut Out Sugar?
Sugar provides zero nutrition
The main reason for cutting out sugar is that sugar provides zero nutritional value!
One reason why we eat is to provide fuel to our body in the way of nutrition, vitamins, minerals and so forth. Sugar doesn’t contain any of these things. So although we might like the taste of it, it’s deplete of anything valuable as far as nutrition goes.
Sugar negatively impacts our health
Here are a few more reasons to cut sugar out:
- Sugar is also easy to over consume
- Sugar is a refined product
- Sugar contains too many (empty) calories – no nutritional value = empty calories
- The fructose component of sugar is problematic – fructose gets metabolized entirely by the liver and converted directly into fat (not a pretty picture)
- Sugar does result in sharp rises to blood sugar levels
- We don’t really need sugar
To emphasize, cutting down on sugar is one key step to improving your health!
Sugar offers no vitamins, minerals, or beneficial nutrients – it’s just empty carbs and calories that contribute to weight gain, fatty liver, poor blood sugar control, and various health conditions.
Reducing sugar intake is not just about controlling blood sugar levels; it’s also about protecting your liver and overall metabolic health – that’s very important!
Sugar is highly addictive
Unfortunately the ‘white poison’ as some call it, is highly addictive.
In fact, Dr Eric Stice, neuro-scientist, has done studies on the brain showing that the same ‘addiction’ receptors are activated when we consume sugar as they are if we consume cocaine.
Quite shocking but true!
So you know, you could try to limit sugar but that’s hard to do, and there’s a reason why – those parts of the brain Dr Eric Stice discovered – they get stimulated, along with various hormones. And when that stimulation occurs, we want more of the sweet stuff.
Then, we might find ourselves in a viscous sugar cycle!
The Hidden Names of Sugar
When it comes to choices, white sugar is definitely the worst type of sugar. This includes castor sugar and icing sugar as these are all highly refined. The whiter it is, the worse it is.
Following closely behind white sugar is brown sugar and raw sugar. Though they are brown or ‘raw’ they are still processed and refined, although containing a little more molasses that changes the flavor.
Sugar is what we find in most processed and packaged food products, and can sometimes be hidden by names like maltodextrin. But it’s not always labelled as sugar, as there are over 50 names for sugars and sugar substitutes.
Sugar Nutrition Facts Compared
Let’s take a closer look at the nutrition facts of all the sugar and sugar substitute choices.
For 1 Tablespoon of each item
White sugar – 48 cal, 12.6 g carbs/sugar, 0 nutrients, GI: 54-84.
Brown sugar – 51 cal, 13.5 g carbs/sugar, 3 mg sodium, 18 mg potassium, 0 nutrients, GI: 54-84 .
Raw sugar – 45 cal, 12 g carbs/sugar, 0 nutrients, GI: 54-84.
Coconut sugar – 45 cal, 12 g carbs/sugar, 0 nutrients, GI: 35.
Rapadura sugar – 45 cal, 12 g carb/sugar, 5.7 g iron, 3.6 g vitamin C, GI: 65.
Molasses – 58 cal, 15 g carb/sugar, 7 mg sodium, 41 mg calcium, 0.94 mg iron, 293 mg potassium, 0.134 mg niacin, GI: 55.
Blackstrap molasses – 47 cal, 12 g carb/sugar, 172 mg calcium, 3.5 mg iron, 43 mg magnesium, 8 mg phosphorus, 498 mg potassium, 11 mg sodium, 3.6 mcg selenium, 0.216 mg niacin, GI: 55.
Raw honey – 70 cal, 17 g carb/sugar, 11 mg potassium, antibacterial and antiviral, GI: 50.
Brown rice syrup – 21 cal, 15 g carb/sugar, 4.8 mg calcium, 49.4 mg magnesium, 1.9 mg manganese, 14.8 mg phosphorus, 2.8 mg Vit B6, GI: 25.
Maple syrup – 52 cal, 13-14 g carb/sugar, 4 mg phosphorus, 42 mg potassium, 2 mg sodium, 1 g calcium, GI: 54.
As you can see from the list above, most forms of sugar have roughly the same amount of carbs/sugar per serving. The only real difference is the amount of nutrients that can be found in them.
Sugar Substitutes Nutrition Facts Compared
Allulose – 0 cal, 16 carbs/sugar, 0 nutrients, GI: 0.
Sucralose (Splenda) – (1 g packet) 3 cal, 1 g carbs/sugar, 0 nutrients. GI: 0.
Artificial sweeteners – 0 cal, 0 carbs/sugar, 0 nutrients. Artifical sweeteners include aspartame (aka Equal and Nutrasweet), saccharin (aka Sweet N Low), and acesulfame K (aka Sweet One), GI: 0.
Sugar Alcohols – erythritol and xylitol -‘tols’ – 0 cal, 0 carbs/sugar, 0 nutrients, GI: 1.
Stevia – 0 cal, 0 carbs/sugar, 0 nutrients, GI: 0.
Monk fruit – 0 cal, 0 carbs/sugar, 0 nutrients, GI: 0.
So What Is The Best Sweetener For Diabetics?
Natural Sugars
White sugar, brown sugar, honey, maple syrup, and more. These sugars, although different in appearance and flavor, generally have similar effects on your blood sugar levels and overall health and will lead to a blood sugar spike.
KEY POINT: If you are going to choose a “natural” form of sugar, it is better to choose something like rice syrup, molasses, honey or maple syrup, which at least provide some nutrients and are lower glycemic index.
Although manuka honey is the best form of honey in the world (with medicinal properties), it is still honey – high in fructose/sugar that can increase blood glucose and A1c, not help it.
In small doses, manuka honey is definitely a better option. But avoiding sugar and syrups (most of the time), even natural ones – honey, molasses, maple syrup – is going to be better for your health overall.
What About Agave Syrup?
This question comes up a bit so we better add agave to the list.
Agave was hyped up for several years as a safe option for people with diabetes because it’s “low GI.” While that may be the case, it doesn’t make it good.
Interestingly, when researchers discovered high fructose corn syrup, they also thought they’d found the halo for an obesity and a possible diabetes cure (because fructose gets processed by the liver and does not require much insulin).
Well, it turns out they didn’t have their handle on the whole story because fructose is said to be the CAUSE of much of our obesity and diabetes issues – many researchers agree.
How does this relate to agave? Agave is 80-90% fructose, which is a lot!
Fructose is 100% metabolized by the liver, this then leads to fatty liver, which then leads to insulin resistance and contributes to the development of diabetes. Not to mention fructose gets stored as fat at 3 times the rate of sucrose – talk about bring on obesity!
And, like most other “natural” sugars, agave still contains approximately the same amount of carbs – 20 grams per tablespoon.
KEY POINT: Overall, agave syrup is not a recommended choice.
Artificial Sweeteners: Aspartame, Saccharin, and Sucralose
- Saccharin – Brand names: Sweet’N Low, Sugar Twin, Necta Sweet.
- Aspartame – Brand names: Equal, Nutrasweet, Natra Taste.
- Acesulfame-K – Brands: Sunette, Sweet One, Swiss Sweet.
- Sucralose – Brand name: Splenda
Interestingly, aspartame and many of the ‘old hat’ artificial sweeteners were first implemented to help the obesity problem. In came diet coke and Coke Zero a whole range of ‘diet’ products and foods. Years later, research now shows that these may contribute to weight gain in many people – not weight loss as you’d expect.
So, although artificial sweeteners have been used for decades, they come with potential risks.
Aspartame has been linked to headaches, depression, and even more severe health issues in some studies. The International Agency for Research on Cancer (IARC) recently classified it as a potential carcinogen.
Saccharin, once banned due to cancer concerns, remains controversial despite being deemed safe for consumption.
Sucralose, while considered safer, has more recently been found to negatively affect gut bacteria and disrupt glucose metabolism.
KEY POINT: If you need to use an artificial sweetener, sucralose is the better choice over aspartame, Ace-K or saccharin.
Sugar Alcohols: Erythritol and Xylitol
- Erythritol
- Xylitol
- Mannitol
- Sorbitol
The ‘tols’ are sugar alcohols – not really sugar or alcohol but named that way, provide sweetness with fewer calories and less impact on blood sugar.
The ‘tols’ are claimed to be natural because sugar alcohols are naturally occurring in lots of fruits and veggies. However, these ‘tols’ are usually processed from pure glucose and sucrose taken from wheat and/or cornstarch. The end result is a zero calorie sweetener that does not affect blood sugar levels (in most people).
Erythritol, is the most frequently used and available of the ‘tols’, as it does not cause the digestive issues that other sugar alcohols might. Erythritol is absorbed into the bloodstream and excreted unchanged in the urine, making it a safe option.
Xylitol, while similar to erythritol, can cause digestive discomfort in higher doses and can be toxic to pets. Therefore, it should be used with caution if you have animals around the house.
KEY POINT: The ‘tols’ are generally a safe option for people with diabetes and prediabetes to choose. Erythritol is the most frequently used and best tolerated sugar alcohol, and is safe to use.
Natural Sweeteners: Stevia and Monk Fruit
Stevia, derived from a South American herb, is available in both liquid and powder forms. It has no calories, no carbs, and does not raise blood sugar levels. Research has shown that stevia can help regulate appetite and improve insulin sensitivity. It’s also known for its potential anti-inflammatory and antioxidant properties.
Monk fruit, another great option, is 300 to 400 times sweeter than sugar and also has zero calories and carbs. It contains mogrosides, which have been shown to inhibit the formation of harmful compounds in the body. Though there’s less research on monk fruit compared to stevia, it appears to be a safe and effective sweetener.
KEY POINT: Stevia and monk fruit are excellent choices.
Allulose: A Newer Contender
Allulose is a newer sweetener that shows promising benefits for people with diabetes.
It’s a rare sugar with almost zero calories and has been found to lower postprandial (after meal) blood sugar levels. Studies have shown that allulose may even improve insulin resistance and liver inflammation.
KEY POINT: Allulose is an excellent choice.
Conclusion: Best Sweetener for Diabetes?
Certainly minimize sugars, as these will impact blood sugar directly.
As for the sweeteners that have little, if any impact on blood sugar, we prefer using stevia, monk fruit, erythritol and allulose over all other sweeteners and it’s what we generally recommend to most people.
These recommendations are grounded in research that supports the benefits of these sweeteners for diabetes health.
In saying that, at the end of the day it’s going to be a personal choice. Some people hate the taste of stevia, for example. So move up the ladder and try the ‘tols’ or a stevia/allulose combo.
If anything, try to avoid the nasty ones mentioned first – Aspartame, Saccharin, and Acesulfame-K, the artificial sweeteners.
It’s also good practice to try to move away from eating too many sweets overall and focus on eating more vegetables because they are much better for your health and help to reduce cravings too!
What sweetener do you use? Or maybe now you’ve read this you’ll change it?
TRANSCRIPT
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Dr. Jedha, Host
Hello there, and welcome to episode 49. There are numerous types of sugars and sugar substitutes used in food products, including natural sugars like white sugar, brown sugar, and honey; different syrups like maple syrup, corn syrup, agave and rice syrup; other types of sugar like coconut sugar, or palm sugar; natural sweeteners like stevia, monk fruit extract, and erythritol; and artificial sweeteners like aspartame, saccharin, and sucralose. Yes, it can all get a bit confusing when there are over 50 different types of sugars and sugar substitutes available. Of course, some we see more in food products like maltodextrin or high fructose corn syrup, others are readily available to us such as white or brown sugar or stevia and erythritol.
So today, we’re tackling this topic that’s on lots of people’s minds: safe diabetes sweeteners and sugar substitutes. And in our usual fashion, it’s evidence over opinion here. We’ll be investigating what the research has to say on all these sugars and sweeteners.
You can head down to our website at Type2DiabetesTalk.com to review some of the info we cover today. And if you’re one of our members, you can find a newly updated and detailed sugar substitutes guide inside the members site. Find that in the ‘Food Guides’ or alongside episode 46.
2:50
You know, we all love sweets from time to time; it’s just human nature. Unfortunately though, sugar is easy to over consume and in today’s modern world, sugar is found in the majority of food products. That doesn’t help with sugars’ highly addictive appeal. In fact, Dr. Eric Stice, a neuro-scientist, has done studies showing that the same addiction receptors are activated when we consume sugar as when we consume cocaine. It’s shocking but true, which explains why it’s so hard to moderate sugar intake.
Although we might like sugar, for the most part, sugar is best to cut out of our diet as much as possible. Why? The main reason is that sugar provides zero nutritional value. Sugar has no vitamins, minerals, or beneficial nutrients. It’s just empty calories, and lots of evidence shows us that added sugar contributes to weight gain, fatty liver and the development of various health conditions. Obviously with any of us, sugar leads to sharp rises in blood sugar levels, and in diabetes, this is clearly an issue. But sugar also triggers systemic inflammation, changes gut bacteria, among other things. Again, sugar provides zero nutritional value. So, reducing sugar intake isn’t just about controlling blood sugar levels; it’s also about protecting your liver and overall metabolic health.
4:42
When we compare different sugars, white sugar is obviously the worst, being highly refined. But brown or raw sugar are still made up of the same, they just maintain some of the natural molasses that gives them the brown coloring and a different flavor. Whether it’s white, raw or brown, these all contain roughly 12 to 13 grams carbs per tablespoon and 45-50 calories. Honey, molasses and maple syrup, although natural, all contain roughly 13-17 grams carbs per tablespoon and 45-70 calories. Similarly, manuka honey, although known for its medicinal properties, still contains 17 grams carbs per tablespoon and around 50 calories.
These days we have many sweeteners available that are substitutes for sugar, and many of them have zero carbs and zero calories. So, what’s the best option for blood sugar levels and health?
Let’s start with whether it might be okay to have small amounts of natural sugars like raw sugar, honey, coconut sugar, brown rice syrup, etc. You might also consider certain factors like coconut sugar has a lower glycemic index than regular sugar, however, it still contains the same amount of carbs, 12g and calories, 45. Brown rice syrup may seem like better option because again, it has a lower glycemic index and less calories, around 25 per tablespoon, but again, the carbs are around 15g per tablespoon.
If you were to choose foods or include these natural sugars or sweeteners, moderation is certainly key as you’d have to be aware of their impact on blood sugar levels, that’s really going to be your biggest concern. And clearly, it’s going to be little benefit for your health if you’re eating too many sweet treats containing sugar, honey or maple syrup. Does that make them completely off limits?
Well, no. We don’t like to say you ‘can’t’ have anything or ‘should’ take one pathway only, because it’s always a matter of choices. And also consistency is more important than perfection, so if you were at a birthday celebration and you wanted to enjoy a piece of cake with your grandson, then go for it.
So if the option isn’t sugar itself, you might be basing your decision on the wide range of sweeteners available – artificial sweeteners, stevia, monk fruit or sugar alcohols, these may seem ideal because they provide zero calories and zero carbs. But, there’s a bit more to the story here too, so let’s dive in and explore them in more detail.
8:06
Let’s look closer at some of the artificial sweeteners like aspartame, saccharin, and ace-K. These were the only types of sugar substitutes that used to be available. They were initially brought onto the market as a zero carb, zero calorie with the thought they would help consumers deal with obesity. Fast forward until now and unfortunately, some research shows they may contribute to weight gain and other health issues. Aspartame, for instance, has had lots of FDA complaints and has been linked to headaches, depression, and even more severe health issues in some studies. In 2023 there were reviews done over aspartame safety and overall the conclusion was there is limited data, there just haven’t been enough studies to show the health effects. Being that these products have been on the market so long we’d expect more safety data would have been explored, but that’s not the case. However, the International Agency for Research on Cancer (IARC) has more recently classified aspartame as a potential carcinogen to humans, meaning a potential for cancer, so clearly that’s not a good thing.
Saccharin was once banned due to cancer concerns, and it is still controversial despite being deemed safe for consumption. Ace-K has also been associated with potential health risks, including disruptions in metabolic processes. Sucralose is another artificial sweetener used in many products. It was once considered safer to eat than aspartame and other artificial sweeteners, however, more recent research has shown it can negatively affect gut bacteria and might have cumulative effects that disrupt glucose metabolism. And for all these artificial sweeteners, there is some research showing they may increase blood glucose levels, promote atherosclerosis, and increase risk for heart disease. From the research we’ve looked at over the years, we don’t generally recommend artificial sweeteners. If you can avoid them altogether that’s probably a good idea, although if you’re somewhere with sugar free foods available, some of them may contain these artificial sweeteners. And if you had a choice, sucralose would be a much better option that aspartame, Ace-K or saccharin.
11:13
So far we’ve talked about natural sugars and syrups, and artificial sweeteners, so what other options are there?
Well, the next type of sweetener we have are the ‘tols’ – xylitol, erythritol, maltitol and several others. These are all sugar alcohols, also known as polyols, and they are a type of carbohydrate that chemically have characteristics of both sugars and alcohols. Despite their name – sugar alcohol, they do not contain ethanol and are not actually alcohol. Sugar alcohols can naturally be found in small amounts in fruits and vegetables, but for commercial production they are most commonly produced by chemically converting sugars, which allows them to be widely used in sugar-free and reduced-sugar products. Two of the most common sugar alcohols are xylitol and erythritol. Sugar alcohols like erythritol and xylitol do not significantly impact blood sugar levels. However, be aware that they can cause digestive issues in some people, xylitol being worse. And just be aware that xylitol can be toxic to pets, especially dogs, so it should be used with caution if you have animals around the house. Erythritol is often found in combination with other sweeteners like stevia, which can make it easier to use in baking and other recipes.
I want to highlight that there were some sensational headlines and controversial reports around erythritol increasing risk of heart disease and stroke, but the headlines were not based on strong or founded evidence but instead have misrepresented erythritol safety and led to confusion. I’ve since heard all sorts of things, with some people even saying they’ve read research that it’s a neurotoxin, which based on my knowledge there certainly is no evidence to suggest that at all. Backtracking to those headlines, the controversial study that led to all this mess suggested that high blood levels of erythritol were associated with an increased risk of cardiovascular events. However, this study did not account for dietary intake of erythritol and only measured endogenous erythritol levels, which are produced naturally in the body. Therefore, it’s important not to jump to conclusions based on this study alone. The large body of evidence available suggests that erythritol is perfectly safe to consume. Studies have shown that erythritol is absorbed into the bloodstream and then excreted in the urine without being metabolized, some studies have shown it to have antioxidant properties, which can help reduce oxidative stress and inflammation. Anyway, at this stage there is no data to say erythritol isn’t safe.
Another thing to keep in mind as well is that some sugar alcohols can still spike blood sugar, not in everyone, but this is more common with maltitol, polyglycitol, isomalt, sorbitol and xylitol.
15:57
Beyond the sugar alcohols we have monk fruit and stevia, with stevia being used more frequently than monk fruit. Stevia comes in both powder and liquid form. Monk fruit is mainly powder. There’s been a lot of research on stevia, being it has grown in popularity. Overall the evidence suggests it’s safe, with no carcinogenic or genotoxic effects. When stevia was compared with sugar it has been shown to regulate appetite with less food being consumed throughout the day as opposed to sugar. Stevia causes no glycemic response and has also been shown to reduce blood sugar levels at 20 and 30 minutes post meal compared to sugar. stevia has been shown to increase insulin sensitivity. According to research stevia possesses interesting medicinal activities, including antidiabetic, antihypertensive, anti-inflammatory, antioxidant, anticancer, and antidiarrheal activity. According to research some of the benefits of stevia are that it stimulates Glucagon-like peptide 1 (GLP-1), reduces oxidative stress, can help to regulate lipid metabolism, which can be beneficial for cholesterol, and stevia doesn’t affect gut bacteria negatively. Overall, stevia has the strongest evidence for safety and benefits.
While we might not have heard of it until recently, immigration brought monk fruit to the U.S. in the 1940’s, so it’s been around for a long time. Research on monk fruit shows it may help regulate blood sugar, and it has antioxidant and anti-inflammatory properties. There certainly isn’t as much research on monk fruit as there is stevia but there doesn’t seem to be any negative impacts out of all the research we’ve read, so it’s certainly another suitable option.
One last sweetener, one that is newer on the market is allulose. Allulose is a rare sugar with almost zero calories, and in recent years researchers found a new way to manufacture it and subsequently allulose has been investigated for its potential benefits for T2 and prediabetes. This one is a very interesting one. Studies have actually shown it lowers postprandial blood sugar levels, that’s your after-meal blood sugar levels. What’s interesting about that, is there are not many foods that actually lower postprandial blood sugar levels when the same meals are consumed. Let’s take a closed look at these study outcomes.
A systematic review looked at the effects of postprandial glucose when healthy adults added 5 or 10 grams of allulose to a carbohydrate-containing meal. They found that those taking the allulose had lower after-meal glucose levels. In another small study with type 2 diabetes, the allulose meal reduced after meal glucose by 18 mg/dL or 1 mmol/L. Another single arm trial found a reduction of 32 mg/dL or 1.8 mmol/L for fasting blood sugar when people had allulose each morning for 8 weeks, along with improvements in A1c and insulin resistance. But the results are mixed, as another, more rigorous randomized controlled trial found that allulose had no effect on glucose levels in healthy people. There have been various studies in animals showing allulose reduced liver inflammation, lower insulin resistance, and slowing down the progression of diabetic nephropathy. Overall, the research here is very interesting and we’ll be keeping an eye on developments. Allulose certainly had the extensive research that something like stevia has, but with the potential benefits of lowering postprandial levels and it is considered safe, it’s definitely a sweetener worth considering. It is now readily available in grocery stores like Walmart and on Amazon etc. And it’s often used in combination products with other sweeteners like stevia and erythritol.
22:52
So with all that said, what is the best and safest sweetener?
Considering the evidence, the most suitable sugar substitutes are stevia and monk fruit, sugar alcohols like erythritol and the newly available allulose. These are unlikely to have any impact on blood sugar levels and at least stevia and monk fruit may offer several health benefits. Allulose may also help to lower postprandial levels. There are also some suitable syrups and sugar-free honeys available that use monk fruit, stevia and allulose and natural flavors, herbs and spices. Consuming natural sugars in very small quantities on occasion is also a suitable option, just keeping in mind they will have an impact on blood sugar levels, raising them by a certain degree. If you need to use an artificial sweetener, or you’re choosing a product with an artificial sweetener, sucralose is the better choice over others like aspartame or saccharin. However, it’s still better to opt for more natural alternatives when possible, the stevia and monk fruit for example. Overall, it may also come down to your personal taste preferences – the ones you prefer the taste of compared to others. Always remember to read the nutrition facts labels and consider the ingredients in a product, so you can make the best choice for you.
If you’re a sweet-tooth kind of person, overall, if you can focus on reducing your intake of sweets for other food options, this will have multiple benefits for your health and reduce your intake of added sugars and sugar substitutes as well. If sugar cravings are an issue, listen to episode 8 where we covered 7 effective ways to tame sugar cravings.
I hope you’ve found this information useful. Remember, you can head down to our website at Type2DiabetesTalk.com to review some of the info we cover today. And if you’re one of our members, you can find a newly updated and detailed sugar substitutes guide inside the members site. Find that in the ‘Food Guides’ or alongside episode 49.
Thank you for joining me today. If you did find this episode helpful, please share it with others and take time to leave a rating and review to help the podcast reach more people who can benefit from this valuable info.
That’s all from me today. Stay healthy and sweeten your life wisely!
Dr. Jedha over and out.
References
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Noya-Leal F, van der Wielen N, Behrens M, Rouschop S, van Arkel J, Jongsma M, Witkamp R, Mes JJ, Bastiaan-Net S, Meijerink J. Rebaudioside A from Stevia rebaudiana stimulates GLP-1 release by enteroendocrine cells via bitter taste signalling pathways. Food Funct. 2023 Jul 31;14(15):6914-6928. doi: 10.1039/d3fo00818e. PMID: 37431625.
Patel S, Navale A. The Natural Sweetener Stevia: An Updated Review on its Phytochemistry, Health Benefits, and Anti-diabetic Study. Curr Diabetes Rev. 2024;20(2):e010523216398. doi: 10.2174/1573399819666230501210803. PMID: 37138480.
Kurek JM, Mikołajczyk-Stecyna J, Krejpcio Z. Steviol glycosides from Stevia rebaudiana Bertoni mitigate lipid metabolism abnormalities in diabetes by modulating selected gene expression – An in vivo study. Biomed Pharmacother. 2023 Oct;166:115424. doi: 10.1016/j.biopha.2023.115424. Epub 2023 Sep 5. PMID: 37677968.
Singh G, McBain AJ, McLaughlin JT, Stamataki NS. Consumption of the Non-Nutritive Sweetener Stevia for 12 Weeks Does Not Alter the Composition of the Human Gut Microbiota. Nutrients. 2024 Jan 18;16(2):296. doi: 10.3390/nu16020296. PMID: 38257188; PMCID: PMC10821022.
Tey SL, Salleh NB, Henry CJ, Forde CG. Effects of non-nutritive (artificial vs natural) sweeteners on 24-h glucose profiles. Eur J Clin Nutr. 2017 Sep;71(9):1129-1132. doi: 10.1038/ejcn.2017.37. Epub 2017 Apr 5. PMID: 28378852.
Braunstein, C.R.; Noronha, J.C.; Glenn, A.J.; Viguiliouk, E.; Noseworthy, R.; Khan, T.A.; Au-Yeung, F.; Blanco Mejia, S.; Wolever, T.M.S.; Josse, R.G.; et al. A Double-Blind, Randomized Controlled, Acute Feeding Equivalence Trial of Small, Catalytic Doses of Fructose and Allulose on Postprandial Blood Glucose Metabolism in Healthy Participants: The Fructose and Allulose Catalytic Effects (FACE) Trial. Nutrients 2018, 10, 750. https://doi.org/10.3390/nu10060750.
Yuma T, Tokuda M, Nishimoto N, Yokoi H, Izumori K. Allulose for the attenuation of postprandial blood glucose levels in healthy humans: A systematic review and meta-analysis. PLoS One. 2023 Apr 6;18(4):e0281150. doi: 10.1371/journal.pone.0281150. PMID: 37023000; PMCID: PMC10079081.
Fukunaga, K.; Yoshimura, T.; Imachi, H.; Kobayashi, T.; Saheki, T.; Sato, S.; Saheki, N.; Jiang, W.; Murao, K. A Pilot Study on the Efficacy of a Diabetic Diet Containing the Rare Sugar D-Allulose in Patients with Type 2 Diabetes Mellitus: A Prospective, Randomized, Single-Blind, Crossover Study. Nutrients 2023, 15, 2802. https://doi.org/10.3390/nu15122802.
Tak, J., Bok, M., Rho, H., Park, J., Lim, Y., Chon, S., & Lim, H. (2022). Effect of diabetes-specific oral nutritional supplements with allulose on weight and glycemic profiles in overweight or obese type 2 diabetic patients. Nutrition Research and Practice, 17, 241 – 256. https://doi.org/10.4162/nrp.2023.17.2.241.
Bae, H., Shin, S., Han, Y., Yoo, J., Kim, S., Young, H., & Kwon, E. (2023). D-Allulose Ameliorates Dysregulated Macrophage Function and Mitochondrial NADH Homeostasis, Mitigating Obesity-Induced Insulin Resistance. Nutrients, 15. https://doi.org/10.3390/nu15194218.
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Additional references can be found in all the posts and research linked to throughout this ultimate guide.
Hi, your website and resources are great! Please take a look at the recent research on erythritol and xylitol and increased CVD clotting event risk.
Hi Elizabeth, I’ve seen all the original research papers on erythritol and xylitol. At this point there is no strong link to CVD and clotting, all preliminary research that is weak, as detailed extensively in the podcast episode.
Glycine powder is an amino acid that is a building block for glutathione and has a mildly sweet taste. I use it in coffee (half teaspoon) or plain Greek yogurt
Hello:
All those “restaurant” sweetener packets, I believe, contain several things and maltodextrin-type ingredients. I’ve heard maltodextrin is the highest glycemic index of anything. It’s the first ingredient with stevia and silica in a powder
sweetener I’ve been getting. It’s only as a “flowing agent.” Good grief!! Wonder how bad that is? Supposed to be Keto…???? Buy at a health food store. Brand name NuNaturals.
Do you suggest or recommend monk fruit as as a sugar substitute?
Monk fruit is a suitable natural sugar substitute. Find more info here.
Allulose is a new sweetener found in Stop and Shop stores on east coast—- better than stevia or any other diabetic sweetener. Read about it online.
Allulose is proving to be a promising sugar choice for diabetics! It is a naturally occurring sugar, yet not metabolized by the body so it does not impact your blood sugar levels.
What about Monk Fruit? My wife has been using a product that is a combo of Erythritol and Monk fruit extract. 4 carbs per tsp 0 calories. This sweetener works well for both of us, our friends can not tell the difference. I am a type 2 diabetic that has had the disease in remission for over 2 years. It has become second nature now to read labels and test, test, test! Diet and exercise keeps the beast sleeping. My doc is very pleased. “Whatever it is you are doing is working, and you need to continue doing it.” he tells me. This website too, has contributed to the proper nutrition and understanding of how it all works. Thank you!
Hi John, great results well done! YES, monk fruit and erythritol are both good forms of natural sugar substitutes.
What about agave?
You can find info on agave here Candi.
Has anyone EVER tried Monk Fruit? It comes in a liquid form, 3 drops=1 teaspoonful of sugar, and has no carbs and registers ) on the Glycemic Index. No one on your site even mentioned this GREAT sugar substitute. Just read the label as some have added chemicals such as erythritol.
Thank you for bringing up Monk fruit and we do recommend it too. We have an article on Monk fruit you can view here.
The best ive ever tried bought it and it works wonders
There’s a lot of them not mentioned here, not an all inclusive list. Also Xylitol causes death in animals, I’d never have it in my house! Monfruit is great.
Sure, it’s not all inclusive but gives some good suggestions.
Hi Jedha,
We are waiting on the doctor test results for
complete blood labs.
My husband had the stick test yesterday and it registered as 340.
He eats oatmeal every morning.
Should he or shouldn’t he.
Thanks,
Cindy
Oatmeal is a food that so frequently get’s labeled as “healthy” but when you look at it from a nutrition standpoint you quickly realize it’s just a big bowl of carbs that will break down into sugar! Find more information about oatmeal here. Instead your husband may want to try some of these breakfast ideas.
Truvia is good, right? I eat oatmeal every a.m. with Truvia and blueberries.
Truvia is stevia based, so yes it is an acceptable sweetener. You may want to give this article about oatmeal a read– oatmeal is commonly mislabeled as “healthy” when in actuality it’s just a big bowel of carbohydrates waiting to send your blood sugar soaring.
Have you heard of/used Swerve?
I have not, but a quick google search seemed to indicate this is an erythritol based sweetener and it looks like a good choice for you to use if you like the way it tastes.
Jedha, thank you for sharing this helpful information. I’ve been using Splenda & Stevia. It works well for me!
You are welcome- we are glad you have found the information valuable!
Hi Jehda,
I was wondering if the drink ICE are okay for diabetics to drink. They indicate no sugar. I wanted your expertise on this product as a substitute for drinking soda soft drinks.
Please advise
These are actually an okay drink to have. It’s true they have no sugar and calories. Just keep in mind they do contain sucralose, which does have mixed results in terms of studies. You can read more about sucralose here and decide for yourself.
I use Pure Via in my coffee
While I use Stevia, I also use raw unfiltered honey and Blue Agave Nectar as sweeteners.
One common misconception is that raw honey and/or agave is healthier than sugar- but at the end of the day it’s all the same! If you’re struggling to maintain good control of your blood sugar, I would strongly recommend you eliminate your intake of the honey and agave, and just stick to the Stevia.
Are pure maple syrup god for a diabetic
Maple syrup is not a good choice for people with diabetes.
People get very confused when it comes to maple syrup, but it’s seriously just pure sugar and will definitely send your blood sugar soaring. Find more information regarding maple syrup over here.
Thanks for your help Emily!
I Have recently heard that sugars derived from Monk Fruit are better for diabetics than even Truvia or Stevia. Is that true?
Great question, Susan. The short answer is yes, monk fruit is a good choice as far as sweeteners go. We actually have a whole article about monk fruit if you’re looking for some more information.
Thanks for all the good information. I have been using a sweetener called Ideal. Are you familiar with it and is it a good choice? It is hard to find. I once could buy it in grocery store but now only online. Thanks for your help.
I am not familiar with this product but I checked the website and it appears Ideal is “a blend of xylitol, dextrose, maltodextrin and sucralose.” Xylitol, a sugar alcohol, causes GI upset in some people, but is generally safe for diabetics. Dextrose and maltodextrin are both forms of sugar (starch) that help add bulk to this particular product, and these can impact your blood sugar. Sucralose, an artificial sweetener more commonly known as Splenda, is probably one of the better artificial sweeteners for diabetics.
Keep in mind, although Ideal is marketed as a zero calorie product, the FDA allows companies to market something as zero calorie as long as it’s under 5 calories per serving. If using a full cup of Ideal, that will be around 200 calories and 50 carbohydrates. Be cognizant of how many servings you are consuming at a time (also be aware this is still much better than table sugar.)
Here are some other sweeteners we like to recommend. It all depends on how your using them, what’s available to you, and your personal taste preference.
what about agave ? is that an alternative and good for diabetics
Find info on agave here Meg.
Hi this is confusing. I tried every sugar out there and they was all not tasteful. Accepted coconut sugar. Does that taste good.
It can take a little time to adjust to sugar substitutes as they do taste a little different Randolph, but you do adapt. Coconut sugar is not a sugar we recommend for good blood sugar control. According to the research we’ve conducted, the best substitutes include stevia, tagatose, monk fruit extract, xylitol and erythritol.
What about Blue Agave Nectar? I’ve been taking one tablespoon mixed with a tablespoon of Bragg’s Apple Cider Vinegar and water for a couple of months now and it seems to be helping lower my A1C.
We generally don’t recommend agave Ray. And I’ve never heard of agave helping to lower blood sugar. It’s likely the apple cider vinegar, which has known benefits for lowering blood sugar.
Is 100%wheat bread good if you are prediabetic i’ve lost 22lbs.and i walk twice a day and my aic is still 6.1
We don’t encourage eating bread, simply because it is a high carb food and research shows even whole grains do not help with blood sugar control. Additionally, when you take grains and make them flour, the glycemic index also rises. You can find more info on bread here and whole grains here. In the end you can only rely on your blood sugar to tell you what’s best.
Hi, I am Regine, I have been diagnosed type 2, 12 years ago. I strangle with it, doesn’t become stable. I take 2 kinds of insulin’s : novolog and levemir, the blood sugar is up and down !! I try to do my best but….
What can I do ? Help me please,
Thank you
Regine, have you considered trying a low carbohydrate diet?
Based on research we have reviewed at DMP, we believe this is one of the most effective ways to gain control over blood sugar levels. Carbohydrates are the nutrient that most impact blood sugar/A1c, so naturally if you eat a lot of foods high in carbohydrates it can become very difficult to gain control over your levels. Because you are on insulin, let your doctor know you are going to change your diet so that they can better monitor changes in your sugar levels.
Hi! I’m a newly diagnosed type 2. I’m overwhelmed. I have no idea what I’m doing. I don’t want to eat chicken breast and salad everyday the rest of my life.
Robin, you won’t be stuck eating salad and chicken breast forever! I’d recommend you take our 30 Day Turnaround Program – it will take you through nutrition step-by-step and demystify everything. Plus there are tons of food ideas, recipes and a meal plan.
I just found your site and I read it with a lot of interest. Thank you so much! My husband and I have been dx with pre-diabetes. Scares us to death! I have found “Sugar-free” Chocolate from Russell Stover and also I have been using Stevia in the powder form as well as Organic Blue Agave and 72% cacoa. I am very concerned about cancer causing foods as well as kidney stones. Can you tell me if any of those cause those by consuming it? Thank you so much! -Gloria from Utah
Hi Gloria, no one can really say what “causes” any disease so unfortunately I cannot really give you a definitive answer on that. As long as you follow a healthy balanced diet full of lots vegetables it will minimize your risk. Agave though is not a great option for sweetener. We are not fans of agave liquid. Although it’s a ‘natural’ sweetener and has been promoted as low GI, it’s still the same nutrition value as sugar but it’s worse that eating sugar because it’s almost entirely fructose, which is a real downer. You can read more about why over here.
What about Agave Sweetener? it says it is has a low GI. I have beenusing that in my coffee and teas. Is it a god option or not?
I answered this question yesterday. In fact, I think I’ll write an article about this one because it’s a question we often get. We are not fans of agave liquid. Although it’s a ‘natural’ sweetener and has been promoted as low GI, it’s still the same nutrition value as sugar but it’s worse that eating sugar because it’s almost entirely fructose, which is a real downer. You can read more about why over here.
What about Monk fruit? I like the monk fruit in the raw and have used Agave in the raw liquid. i am having trouble finding information related to either of them and diabetes. angie
Monk fruit is a good option, like stevia it does not affect blood sugar the way natural sugars do. Agave liquid is not good. Although it’s a ‘natural’ sweetener and has been promoted as low GI, it’s almost entirely fructose, which is a real downer. You can read more about why over here.
I’m a type 2 diabeic, i was diagnosed about 6 months ago. I will not use artificial sweetners. They scare the willies out of me. I have started using Swerve. But im concerned that its A processed artificial Sweetener like aspartame . Is this true? I also use stevia. But the taste is so sweet that it is bitter.
Help.
Thanks,
linda
Hi Linda, Swerve is made with erythritol, which is also a pretty safe option. If you prefer it and it’s not influencing your blood sugar, then sounds like it’s best for you.
Bitter come from using far to much. I use one 16th teaspoon stevia daily to add a little sweetness to my latte.
Very true David. You just need a touch of stevia to get the sweetness.
Hi. Do you know tagatose?
Have any info about it?
Thanks!
I will have to look into this more Angela but a couple of studies I found: Tagatose did not effect A1C. No changes to glucose or insulin. Again another study found no effect.
The thing that concerns me about tagatose is the Food Association says “foods containing tagatose would not be suitable for individuals with disorders in fructose metabolism as the absorbed fraction of tagatose is metabolised in the same way that fructose is metabolised. Individuals with such conditions are likely to also be intolerant to tagatose. Avoidance of foods containing tagatose is therefore highly recommended for individuals with disorders in fructose metabolism.”
As a diabetic you do have issues with carbohydrate/ fructose metabolism, so I’d be unsure as to whether it’s really a good choice. At the end of the day, you have to test how it effects you.
What about monk sugar ?
Thank u
Monk fruit sugar substitute is another safe option Jerome. It’s often not just monk fruit but a blend of monk fruit and erythritol. Also watch out if it’s in products as it can be mixed with other things too.
What about sweet-n-low would like to know about it. I am a type 2 Diabetic.
You can find info about artificial sweeteners here Patricia.
I have been diabetic for 12 years that I am aware of. I am still learning. Would love to know more. I love your site. So I will stay tuned in for more information. Ernestine
Welcome Ernestine, great to have you here 🙂
I was recently diagnosed with diabetes. While I am overweight by about 30 lbs., the doctor told me that it is my family history of diabetes that is the culprit here. I was put on Metformin and Gliperide to control my blood sugar. I am a 59 year old female still experiencing menopause symptoms for the last 10 years.
I am finding it difficult to wrap my mind around the diabetes issue with regards to diet. I know what I should eat. I know that I should get exercise. I find myself un-movitated to do the right thing all the time. My A1C is 12+ and is critical to get it lowered. Is this lack of movitation and confusion normal? Or is my depression from menopause holding me back from taking charge and owning this problem and doing the right thing?
Yes Barbara, it is normal, especially if you already have a dose of depression. It’s kind of like shock and denial really – it’s something you probably don’t want to face. None of us like the news of bad health and having to make changes. And you can also feel alone on the journey too.
But like you said, you know what to do – eat well and exercise daily – so how can you start? What one thing can you do starting today?
We’re here to support you. And you deserve to look after yourself 🙂
Is Manuka honey ok for a pre-diabetic person?
Hi Wendy, although manuka honey is the best form of honey in the world (with medicinal properties too), it is still honey – high in fructose/sugar that will increase blood glucose and A1C, not help it. The same applies to pre-diabetes really. In small doses it definitely is a better option but avoiding most sweeteners (most of the time) is the go.
Thank you for the good info. I prefer Stevia but I like to know I have options for times I am not at home.
I always look forward to your emails and I wait until morning so I can savor your information with my coffee. Always very informative.
Awesome Gloria. It’s great to know that the info is helping people – makes it worth getting out of bed every day 🙂
I have used Splenda for years and use it in baking. My husband uses Sweet and Low for coffee I can’t get him to stop using Sweet n Low.!! ):
It’s a tough one Mary! Keep at it, you might bring him around 🙂
What do you think about Truvia? We only use in tea n coffee? It doesn’t leave a after taste to us like everything else.
Truvia is okay. It’s a stevia/erythritol blend and if it works well for you and doesn’t affect blood sugars, that’s great Ruth 🙂
What about Swerve? I read a little about it, and it’s supposed to measure and bake exactly like sugar without the bitter aftertaste.
Swerve is a good option – it uses erythritol, which is mre tolerable than xylitol (without the stomach upsets). You’re right, it can be replaced 1:1 for sugar so it’s good for baking. Like anything, it’s a good idea to see how it affects you by testing because even natural sweeteners can affect some people. It’s not common but it can happen.