Amy Campbell is a registered dietitian and certified diabetes educator who has been working in the field of diabetes for many years. She is the author of several books about diabetes, including 16 Myths of a Diabetic Diet and Staying Healthy with Diabetes: Nutrition and Meal Planning. In addition, Amy is a lecturer and frequent contributor to several diabetes-related websites.

Deciding whether to use an artificial sweetener is about as easy as trying to find a needle in a haystack. Artificial sweeteners, also called nonnutritive sweeteners or sugar substitutes, have come under quite a bit of scrutiny lately. Some studies show that they can help people lose weight. Or do they actually cause weight gain? Raise blood sugar levels? It all seems very confusing.

What are artificial sweeteners?

Unlike regular sweeteners such as sugar, honey and maple syrup, artificial sweeteners contain virtually no calories or carbohydrate (carb).

Because they are calorie- and carb-free, artificial sweeteners seem well-suited for people who want to lose weight and manage their diabetes. For comparison, consider the following:

1 teaspoon sugar = 16 calories, 4 grams carb
1 12-ounce can regular cola = 140 calories, 40 grams carb

1 teaspoon artificial sweetener = 0 calories, 0 grams carb
1 12-ounce can diet cola = 0 calories, 0 grams carb

What artificial sweeteners are available?

There are 7 artificial sweeteners available in the United States:

• Acesulfame potassium (Sunett, Sweet One)
• Aspartame (Equal, NutraSweet)
• Monk fruit extract (Monk Fruit In the Raw)
• Neotame (Newtame)
• Saccharin (Sweet ‘N Low, Sugar Twin)
• Stevia/rebaudioside A (Pure Via, Truvia)
• Sucralose (Splenda)

Also, the new artificial sweetener Advantame has been approved by the U.S. Food and Drug Administration but is not yet on the market.

Are artificial sweeteners safe?

Artificial sweeteners have long been a topic of controversy. They’ve been linked with a host of health problems, such as epilepsy, brain tumors, kidney problems, nausea and headaches, to name a few. But there’s not much credible evidence to support these claims. Keep in mind that these sweeteners have been widely and carefully studied by the FDA and other health organizations around the world.

How do artificial sweeteners affect weight?

There’s a lot of debate as to how artificial sweeteners affect body weight. A handful of studies claim that people who use these sweeteners, say in the form of diet soda, are more likely to be overweight and may even end up gaining weight. Some health experts believe that artificial sweeteners set people up to crave sweets. But critics point out that people who drink diet soda are more likely to be overweight anyway. People may also feel that choosing a diet drink over a regular drink justifies consuming more calories from other sources, hence the “I’ll order those fries along with my burger because I’m drinking diet soda” mentality. On the other hand, several studies show that using sweeteners can help with weight control. One study, called the CHOICE (Choose Healthy Options Consciously Everyday) Study showed that a group of overweight folks who drank diet soda were more likely to achieve a 5 percent weight loss than the group who drank water; they also ate fewer desserts than the water drinkers.

How do artificial sweeteners affect diabetes control?

A new study out of Israel has caused quite a stir. In this study, mice were given water sweetened with aspartame, saccharin or sucralose. Another group of mice was given plain water. After 11 weeks, the mice given the sweetened water had developed glucose intolerance, a condition that can lead to type 2 diabetes. These mice were then given antibiotics to wipe out their gut bacteria. Their blood sugar levels returned back to normal. When the mice were then given fecal samples from glucose-intolerant mice, their blood sugar levels climbed back up. The researchers believe that the sweeteners affected the bacteria that’s normally found in the gut in a way that leads to higher blood sugar levels.

To see what would happen in people, the researchers then fed saccharin to 7 people for one week. Four out of seven of the people showed higher blood sugar levels.

Remember that one of these studies was done with mice fed large doses of sweetener, and the study done with people was very small. Still, the possibility of sweeteners (and other food substances) affecting the bacteria in the gut (called the “microbiome”) is certainly interesting and no doubt we’ll hear more about this.

Bottom line

Here are a few thoughts to ponder:
• Artificial sweeteners may be helpful for some people in controlling both their weight and their diabetes.
• When used in moderation, they’re thought to be safe.
• Foods sweetened with artificial sweeteners aren’t necessarily “free” foods – some, like no-sugar-added ice cream or sugar-free cookies, still contain calories and carbs. Always read the Nutrition Facts label.
• It’s okay to use a little bit of a regular sweetener. A teaspoon of sugar in your coffee won’t lead to weight gain or high blood sugars. It’s also okay to treat yourself to a piece of cake or a scoop of regular ice cream every once in a while.
• Center your eating plan on “whole” foods: fruits, vegetables, whole grains, beans, nuts, vegetable oils and lean protein foods. The less processed the food, the better it is for you.

To learn more on this topic:
Two Sides to the Artificial Sweetener Story
Why We Fear Artificial Sweeteners
Artificial Sweeteners: Not as Diabetic-Friendly as You Thought