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An EatingWell guide for diabetes.

The debates in the nutrition world about the value of low- and no-calorie sweeteners are often loud and raucous, but when the discussion turns to their role in diabetes, the conversations become much more harmonious. Let’s face it, the availability of something that makes food taste sweet, without contributing carbohydrate grams, can sometimes make life with diabetes a little easier. That said, there are still some important issues to keep in mind.

Safety
Currently, the U.S. Food and Drug Administration (FDA) has approved four low- or no-calorie sweeteners as safe for use: aspartame (NutraSweet, Equal), acesulfame potassium (Sunett, Sweet One), saccharin (Sweet’n Low, SugarTwin and other brands) and sucralose (Splenda). To earn FDA approval, these sweeteners had to undergo rigorous testing and be shown safe when consumed by the general public—including people with diabetes. However, some organizations—notably, the nonprofit consumer-advocacy group Center for Science in the Public Interest (CSPI)—remain skeptical. Of the currently approved sweeteners, only sucralose earns CSPI’s vote as safe.

Taste
Low-calorie sweeteners have no problem in the sweetness department; most are hundreds of times sweeter than regular sugar. But some people find they have an aftertaste, or that the foods prepared with them “just don’t taste right.” It’s a matter of personal preference, of course; some people claim saccharin has a bitter aftertaste, for example, while others appreciate that it isn’t tooth-achingly sweet. And low-calorie sweeteners tend to be an acquired taste; people who regularly use a particular sweetener sometimes become loyal to its flavor profile. In our own Test Kitchen, we found sucralose, which is derived from cane sugar, came closest to the taste of regular sugar, but still had its own aftertaste.

Performance
If you use a low-calorie sweetener just to perk up your iced tea, just about any one will do. But when you want to use it for something more complex, like a batch of muffins, performance can be a problem. Aspartame, for instance, breaks down when heated, so it’s a no-go in baking. Other problems result from the one-dimensionality of low-calorie sweeteners compared to sugar: while they contribute only sweetness, sugar adds volume and texture, and, when heated, it caramelizes, adding complex toasty flavors as well as an appealing browned look. Recreating those properties without using sugar can be tricky.

Substituting with Splenda
In the EatingWell Test Kitchen, sucralose is the only alternative sweetener we test with when we feel the option is appropriate. For nonbaking recipes, we use Splenda Granular (boxed, not in a packet). For baking, we use Splenda Sugar Blend for Baking, a mix of sugar and sucralose. It can be substituted in recipes (1⁄2 cup of the blend for each 1 cup of sugar) to reduce sugar calories by half while maintaining some of the baking properties of sugar. If you make a similar blend with half sugar and half Splenda Granular, substitute this homemade mixture cup for cup.
When choosing any low- or no-calorie sweetener, be sure to check the label to make sure it is suitable for your intended use.

What About Stevia?
While stevia (stevioside), a natural sweetener extracted from the leaves of the stevia plant, has not been approved by the FDA for use as a sweetener, it’s widely available as a “dietary supplement” that makes no sweetening claims on its labels. Stevia is about 300 times sweeter than sugar, with a slight licorice flavor; some health-food aficionados seek it out as a “natural” alternative to manmade sweeteners.
The FDA hasn’t given stevia the green light because of questions about its safety. There’s a reason for setting the bar high: while the herb has been used safely for centuries in Paraguay, and since the 1970s in Japan, it’s likely to be used much more liberally in the soft-drink-and-sweet-treat-loving United States. If you choose to use stevia, use it the way the Japanese and Paraguayans do, only in small amounts—say, to sweeten your coffee.

What About Fructose?
Fructose (sometimes called “levulose” on food labels) is a simple sugar that occurs naturally in foods, including fruits and honey; it’s also a key component in table sugar (which is sucrose, a blend of half fructose and half glucose). While it has the same amount of calories and carbohydrate as sugar, fructose produces a lower and slower rise in blood glucose, and requires less insulin for the body to process. For that reason, some “health” or so-called “diabetic” foods are sweetened with fructose, and pure fructose is sold in the alternative sweetener section in supermarkets.
Should you buy fructose-sweetened foods? Most experts don’t feel it’s necessary or desirable. For one, foods sweetened with added fructose may contain other carbohydrates that can also affect your blood-glucose levels. And they cost more than traditionally sweetened foods. But perhaps the most important concern is that fructose can raise triglycerides and LDL cholesterol, potentially raising heart-disease risks. Some scientists and nutrition researchers are concerned about the rapidly growing presence of fructose in the food supply, largely through the increasing use of high-fructose corn syrup (HFCS).

HFCS, made by processing cornstarch to a highly sweet syrup, is cheaper than sugar, so it has been steadily replacing sugar in many foods and beverages, including soda, juice drinks, baked goods, breakfast cereals, desserts and condiments (ketchup, for example). Unlike fructose, HFCS is similar in composition to table sugar (about half glucose), so it doesn’t have fructose’s gentler effects on blood glucose. And because of its prevalence, it has become much easier to consume a lot of added fructose. Some experts believe the wide use of HFCS has played a part in the dramatic increases in the national obesity rate—which began its climb in the 1980s, when HFCS entered the food supply. Since people with type 2 diabetes are often overweight and at increased risk of heart problems, it makes sense to keep an eye on fructose by reading labels—and steering away from HFCS-sweetened foods. The American Diabetes Association recommends people with diabetes avoid fructose, other than that naturally occurring in foods.

What About Sugar Alcohols?
While their names sound less than appetizing, and sometimes like a boozy dessert sauce, sweetening agents like sorbitol, mannitol, xylitol, maltitol, lactitol and hydrogenated starch hydrolysates (HSH) are familiar to many people with diabetes. These so-called sugar alcohols are often added to food products such as “sugar-free” candy or gum, cookies or certain medications. They are listed on food labels under the Total Carbohydrate heading. Because these sweeteners are only partially digested compared to other sugars, they cause a lower rise in blood glucose. They also don’t cause tooth decay. But their lack of digestibility can be a problem, causing stomach upset, gas or diarrhea in some people, especially if eaten in large amounts. The most important fact about sugar alcohols is that they still contribute some carbohydrate (about half is digested). To calculate how much, note the grams of carbohydrate contributed by any sugar alcohol listed on the food label, then subtract half that number from the Total Carbohydrate count.



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