Artificial sweeteners — also known as low-calorie sweeteners, sugar substitutes, or “nonnutritive sweeteners” — are chemical compounds that taste like sugar but are not metabolized the same way as are “nutritive sweeteners” such as table sugar, honey, and agave. Artificial sweeteners can be very low in calories (i.e., NutraSweet) or have no calories at all (i.e., Stevia, Splenda). But do artificial sweeteners raise blood sugar?
Many patients diagnosed with prediabetes or diabetes look to artificial sweeteners as a way to control their blood glucose levels so that they can keep some degree of sugary sweetness in their diet. But are artificial sweeteners a healthy option? The research is controversial, in part because of inconsistent clinical trial designs. Consult with your personal medical provider before considering any significant dietary changes. Based on current regulatory and scientific views, it seems that consumption of artificial sweeteners, in the place of table sugar and in moderation, is safe and could potentially be one way to help manage your blood glucose levels and reduce your caloric intake — both of which may benefit your metabolic health. More impactful and sustained dietary health will come from adoption of a larger, holistic glycemic management plan involving multiple shifts in dietary and lifestyle habits.
What are artificial sweeteners?
Artificial sweeteners are referred to by both their scientific name and their brand name. Artificial sweeteners are hundreds, sometimes thousands, of times sweeter than regular table sugar, which means a lot less can go a long way. So even if the substitute does provide calories, the impact to your daily energy intake is insignificant. Some sweeteners are more potent than others. See the following chart:
Are sugar alcohols considered artificial sweeteners?
Sugar alcohols are a type of sugar substitute, but they’re grouped separately from artificial sweeteners. Sugar alcohols, like artificial sweeteners, are metabolized differently than table sugar in your body. The difference between artificial sweeteners and sugar alcohols is that sugar alcohols are carbohydrates, meaning they have some calories and can have an effect on blood glucose levels; however, they only require a very small amount of insulin, after consumption, to bring glucose back down.
Most sugar alcohols can be identified on a food label with the ending “-tol”: sorbitol, xylitol, lactitol, mannitol, glycerol, erythritol, and maltitol. However, isomal, glycerin, glycerine and starch hydrolysates are also sugar alcohols. On a food label, sugar alcohols are in their own group so it’s easy to identify if your packaged food contains them.
Sugar alcohols are usually either equal in sweetness level to table sugar or as low as 25% as sweet. They are not associated with tooth decay or a significant spike in blood glucose levels, according to the FDA.
Do artificial sweeteners raise blood sugar levels?
The short answer: No. Artificial sweeteners are not carbohydrates, so they don’t require an insulin response, and thus do not raise your blood sugar (glucose) levels. A 2019 research review published in Advances in Nutrition reviewed the metabolic processes of artificial sweeteners and found no evidence to suggest that they significantly impact blood glucose levels.
For example, Stevia products are formed from steviol glycosides, a compound derived from the native South American shrub Stevia rebaudiana (Bertoni). Steviol glycosides don’t get absorbed in your upper gastrointestinal tract, so they don’t provide calories nor impact your blood glucose levels.
Are artificial sweeteners safe for diabetics?
To date, regulatory bodies have indicated that when it comes to glycemic management, artificial sweeteners are safe — as long as they’re consumed in moderation. The American Diabetes Association produced a 2021 report stating that nonnutritive sweeteners are a good substitute for nutritive sweeteners (think sugar, agave, honey, maple or date syrups) because research indicates that nonnutritive sweeteners have the benefit of potentially reducing caloric and carbohydrate intake if used as a food/drink substitute and not a food/drink addition.
However, the 2019 research review cites preliminary human studies that showed consumption of saccharine (Sweet‘N Low) and sucralose (Splenda), as well as the sugar alcohols lactitol, isomalt, xylitol, and maltitol, shifted gut microbiome composition. (Scientists are studying the gut microbiome because intestinal microbial communities play a significant role in human health and disease.) The review authors note, however, that the clinical trials they analyzed had study design flaws, and in some of them the study participants were consuming very large quantities of artificial sweeteners. Reviewers concluded: “Further studies are needed to elucidate whether the changes observed in the intestinal microbiota in animals are present in humans and to study the effects of sweeteners — for which evidence is not available so far.” But it’s a topic to keep an eye on since a healthy gut microbiome is key to metabolic health.
Can artificial sweeteners help me lose weight?
Consuming fewer calories, increasing your physical activity, managing your stress and getting a good night’s sleep are all important steps toward shedding your unwanted pounds. Because artificial sweeteners provide fewer or no calories for the same amount of sweetness, they do have the potential to help reduce your caloric intake and thus could help you lose weight. But researchers point out that for this strategy to pay dividends, people need to incorporate artificial sweeteners as a replacement of their table-sugar- and calorie-filled snacks and desserts, rather than as an addition to them.
However, using artificial sweeteners as a weight loss strategy is not without controversy. Some research from observational studies suggests that consuming artificial sweeteners instead of table sugar isn’t a surefire path to weight loss. In fact, a 2017 meta analysis found that consuming artificial sweeteners was associated not only with increased obesity rates and body mass index (BMI), but also with higher risk of cardiometabolic disease in adults. However, other researchers criticize these early findings, stating that the studies fell short of the well-designed, long-term, double-blind, placebo-controlled, randomized clinical trials — with appropriate doses and adequate subject sizes — that are still needed before we can properly evaluate the potential impact of both artificial sweeteners and sugar alcohols on the major outcomes and risk biomarkers related to chronic diseases.
Why does Aspartame promote insulin resistance?
While Aspartame lacks the sweetness intensity compared to many of the other types of sweeteners, and we’ve established that, no, artificial sweeteners do not raise blood sugar levels given they’re not carbohydrates and therefore don’t require an insulin response, people sometimes report that Aspartame and other artificial sweeteners may actually show a small lift in blood glucose levels. So why is that? Our best theory is that the sweet taste of artificial sweeteners like Aspartame triggers cephalic phase insulin release, which causes a small rise in insulin levels. Consistent use of Aspartame changes the balance of our gut bacteria, which could make our cells resistant to the insulin we produce, leading to both increased blood sugar and insulin levels. The research is often contradictory in this area so more research is necessary.
Artificial sweeteners can be a good alternative to table sugar when you’re looking for something sweet but want to cut back on sugar and calories. They have little to no calories and metabolize differently in your body, so they don’t signal an insulin response. However, these sweeteners shouldn’t be considered “free calories”; it’s important to use them as a replacement, rather than an addition, to your diet. And while artificial sweeteners can be one small tool for maintaining control over your blood glucose levels when you’re in the mood for something sweet, a larger, holistic glycemic management plan — involving multiple shifts in dietary and lifestyle habits — is the most effective way to manage your blood sugar levels.