February 29, 2016
Refined sugar isn't the evil carb it once was, but substitutes still have their place.

Refined sugar isn't the evil carb it once was, but substitutes still have their place.(ISTOCKPHOTO)

In the past, sugar—we're talking about sucrose, or common table sugar—was a "bad guy" to be avoided by people with type 2 diabetes. But research has shown that all carbohydrates (from sugar to bread, cereals, grains, juice, fruit, and starchy vegetables) can increase blood sugar (called glucose) in roughly the same way.

So if you want to consume sugar in coffee or have a sugar-containing treat, it's OK as long as it's in moderation and it's factored into your meal plan in terms of calories and carbohydrates.

Yellow, blue, or pink: Sugar substitutes in packets
However, low-calorie or no-calorie sugar substitutes can be an easy way to cut carbohydrate and caloric intake. And food companies have introduced low-sugar desserts such as ice cream and candy bars, aimed straight at the waistlines and wallets of people with diabetes.

"Sugar-free foods let me give my husband a treat, so he doesn't feel like he's denied all the things he liked to eat before," says Harriet Kritz, who looks after her husband, Karl, 78, who was diagnosed with type 2 diabetes more than 20 years ago.

You have to read the labels even on sugar-free or low-sugar options to be sure you know how many calories and grams of fat and carbohydrates you're getting along with the sweet taste.

Although some sweeteners don't contain calories or carbohydrates themselves, the prepared foods that contain them—such as some yogurts—still have carbohydrates from other sources.

Some common "table sweeteners" found in packets include the following.

  • Equal: Found in blue packets; contains dextrose, maltodextrin, and aspartame; aspartame was approved by the Food and Drug Administration (FDA) in 1981
  • NutraSweet: Found in white packets with a red swirl; contains aspartame
  • Splenda: Found in yellow packets; contains a sweetener called sucralose, which was FDA-approved in 1998
  • Sweet'N Low: Found in pink packets; contains saccharine and has been on the market since 1957
  • Stevia: Found in health-food stores; not FDA-approved as a sweetener

Just keep in mind that cooking and baking with some sugar substitutes (some can't be used in high-temperature cooking) can take some experimentation; you may not get the same results in flavor and texture as with sugar.

Next Page: Safe in moderation

[ pagebreak ]Sweeteners are safe, though some cause diarrhea if eaten in large amounts
"There's really no evidence that sweeteners should not be used," said Nadine Uplinger, member of the board of the American Association of Diabetes Educators and director of the Gutman Diabetes Institute at the Albert Einstein Healthcare Network in Philadelphia. "It's really an individual preference."

Aspartame and saccharin are decades old, and are considered by the FDA to be safe for human use.

However, there's still debate over whether such sweeteners in diet soda and other products can stimulate the appetite, says William Bornstein, MD, an endocrinologist at the the Emory Clinic in Atlanta. "That's the lingering question," he says.

The FDA recommends that consumers use the sweeteners in moderation.

Other low-calorie sweeteners you should use in moderation are those containing "sugar alcohols." These contain calories and carbohydrates, and can cause diarrhea if you eat large amounts. They are often found in chewing gum, candy or in baked products.

They include:
• Sorbitol
• Mannitol
• Xylitol
• Isomalt
• Hydrogenated starch hydrolysates

"Too much of those particular diet sweeteners will upset the stomach," says Dr. Bornstein. "Frequently we run into people with diabetes or not who are chewing a lot of sugarless chewing gum and having a lot of loose stools or gas, and it turns out that's the cause."

A German study published in BMJ (British Medical Journal) in 2008 linked chronic diarrhea and weight loss in two patients to excessive use of sorbitol-containing chewing gum (15 sticks a day or more).