Walking through the grocery store, it is easy to be overwhelmed by the many brands and health claims on dozens of sugar substitutes. It can be particularly confusing for those with diabetes or pre-diabetes to keep their blood sugar controlled and control their weight.
With the growing diabetes and obesity epidemic, there has been increased awareness of the use of added sugars in foods. The latest edition of the US Dietary Guidelines for Americans recommends that added sugars be stored to less than 10% of the calories consumed, which turns out to be about. 270 calories a day.
This is because "added sugars" add sweetness or flavor, but add very little nutritional value. Because of this trend, the food industry has begun a quest to find or develop the perfect substitute for replacing sugar ̵
As a pharmacy that is also certified in advanced diabetes care, I talk to patients every day about blood sugar and ways to help them control their diabetes. They often ask me if the perfect substitute for sugar has been found. The short answer is no. Here's the long answer.
Sugar substitutes can be categorized into two main groups: sugar alcohols and high intensity sweeteners. The sugar alcohols include sorbitol, xylitol, lactitol, mannitol, erythritol and maltitol. High intensity sweeteners include saccharin, aspartame, acesulfame potassium (Ace-K), sucralose, neotam, advantame, stevia, and Siraitia grosvenorii Swingle fruit extract (SGFE).
Sugar alcohols are often found in toothpaste, chewing gum and some "sugar-free" foods. They are carbohydrates with a chemical structure that resembles sugar, but also the components that make them an alcohol. They are about 25-100% sweeter than sugar and have a similar flavor. But here's the catch: They are not calorie-free. Most have between 1.5 and 2 calories per day. Gram. Now compare the calorie content of sugar, also known as sucrose, which has four calories per day. Gram – twice as much.
Although sugar alcohols contain fewer calories, they will still increase the patient's blood sugar, especially when consumed in excess. However, compared to sugar, the effect is less dramatic. This is because these molecules are treated in the body. We measure this using the glycemic index.
The glycemic index is a reference to how quickly a food is degraded and absorbed. The higher the number, the faster the food goes down and the faster the sugar enters the blood. 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 cause a slower and lower increase in blood sugar after meals, which is typically better for people with diabetes. Because sugar alcohols are harder for the body to break down, some of them remain in the intestine, and if a person spends too much, they can experience digestive disorders such as gas, seizures, and diarrhea.
Here is the second disadvantage of foods containing sugar alcohols: they often have higher amounts of fat or salt to compensate for the lower sugar content.
High intensity sweeteners are zero or calorie alternative to sugar. They are made from different sources and are 100 to 20,000 times as sweet as sugar. Some leave a bitter or metallic taste behind. Two recent replacements – stevia and SGFE – come from plants and are often referred to as "natural" substitutes.
According to the guidelines of the American Diabetes Association 2019, the use of high intensity sweeteners can reduce calorie and carbohydrate intake. However, you cannot replace these "free" calories with calories from other food sources you want to lose or the benefits of blood glucose control and weight loss.
Researchers have seen this in some of the studies on high intensity sweeteners. Some of the experiments show no difference or even a possible increase in weight. However, in other studies where the intake of food is better regulated and the patients do not replace these free calories with other high-calorie foods, weight loss is maintained.
All sugar substitutes are labeled as food additives and are regulated by the US Food and Drug Administration. The latest trend is to label some of the sugar substitutes as "derived from plants" or "natural." This does not necessarily mean that these are safer or more effective in blood glucose control or weight loss. If used in excess, side effects such as Bloating or diarrhea constantly result.
Several researchers from researchers have been raised about high intensity sweeteners – saccharin and aspartame – and cancer. So far, the National Cancer Institute has concluded that there are no clear indications that any of the high-intensity sweeteners is associated 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 sugar and their diabetes There are three main ways to do this: medicine, increased activity and diet. The last two are probably more important in the long run.
If diet and activity levels never change, it is really hard to help patients bring their blood sugar down. Medications after medication are likely to be added. With this comes the potential for side effects. So if I can persuade patients to make changes to their diet, such as switching to a sugar substitute, it makes a big difference to help control blood sugar and the dose of medicine.
The overall focus on diabetes care should be to reduce the consumption of sugar-sweet beverages and foods. If you can switch one of these sweetened products to a food that has a high-intensity sugar substitute, it's better. But best of all is to take food and drinks that are not very processed and do not have added sugars.
Jamie Pitlick is Associate Professor in Pharmacy Practice, Drake University
This article originally appeared on The Conversation. You can read this here.