Sugar Substitutes, Gut Health and Type 2 Diabetes

The whole conversation around the risks of consuming sugar, added sugars, and artificial sugar substitutes is confusing for anyone, especially those with diabetes.

The health risks associated with consuming too much sugar in your foods and drinks are alarming. But sugar is sneaky. When you think you figured it out, you look closely at nutrition labels, only to discover manufacturers have ways of hiding sugar in foods and drinks marketed as ‘healthy.’  

When you know, a 16 oz bottle of Coke contains almost ten teaspoons of sugar; you think you’re making a better choice by reaching for a Diet Coke or Coke Zero. But recent studies suggest that fake sugars can also have unexpected effects on your gut and metabolic health and even promote food cravings and insulin resistance, leading to Type 2 diabetes. Not to mention, quitting Diet Coke can lead to headaches and withdrawal symptoms. I know because I’ve experienced the vicious cycle of quitting Diet Coke several times without much success. 
And what about these murmurs that diet drinks make you fat? Morning TV shows love to share results from studies that have found using artificial sweeteners and drinking high amounts of diet soda is associated with an increased risk of obesity and metabolic syndrome. One study also reported a link between the high consumption of diet drinks and the increase in belly fat in older adults.
Drinking water is a great alternative. But if you’re like me, you enjoy a carbonated drink from time to time. So what do you do? A glance at the cold drinks shelves at my local bodega reveals a plethora of diet drinks. Every company offering a popular sugar-sweetened beverage now offers a sugar-free alternative. Each contains a list of ingredients a mile long with names only a scientist could understand.   
If you’re wondering why sugar substitutes seem more prevalent in our food and drink choices, one reason could be the Food and Drug Administration’s proposal to stop companies from labeling a food “healthy” unless it adheres to strict new limits on added sugars. Savvy companies can conform to the proposed rules by replacing added sugars in foods with artificial sweeteners.
“When companies reformulate their foods to contain less sugar, it leads them to use more non-nutritive sweeteners,” said Jotham Suez, an assistant professor at the Johns Hopkins Bloomberg School of Public Health, told the Washington Post.
Studies show that when countries such as Chile and Australia instituted similar policies to reduce sugar consumption, there was an increase in artificially sweetened foods and beverages.
“These low-calorie sweeteners are ubiquitous in the food supply, and so people often aren’t even aware that they’re consuming them,” said Allison Sylvetsky, an associate professor in the Department of Exercise and Nutrition Sciences at George Washington University.
Many sugar substitutes are often hundreds of times sweeter than table sugar. Some are synthetic, while others, like stevia and monk fruit extract, are referred to as “natural” because they’re derived from plants.
The confusion surrounding what to do makes me feel like I’m talking from two sides of my mouth. Divabetic has hosted several Sugar-Free Baking Programs on Zoom, and we have shared dozens of Sugar-Free Dessert Recipes. Both of these offerings have proven to be very popular with our community. We’ve even rewarded our followers with free gift baskets of popular artificial sweeteners. But after seeing the new findings, I’m unsure how to proceed.
The World Health Organization cautioned people to limit their intake of sugar substitutes because of their potential for “undesirable” long-term effects, including detrimental effects on gut and metabolic health.
What the heck is Gut Health?
Gut health refers to the health of the entire digestive system — the parts of our body responsible for breaking down our food into individual nutrients we use to run our bodies.

If you suffer from frequent discomfort, gas, bloating, constipation, diarrhea, and heartburn, your gut has difficulty processing food and eliminating waste. People with chronic fatigue may have imbalances in the gut.
Health Studies Seem To Only Make It More Confusing!
According to a Cedars-Sinaistudy, one type of bacteria in the gut may contribute to the development of Type 2 diabetes, while another may protect from the disease. The researchers admitted it is too early to know how people can change their microbiome to reduce their diabetes risk.

In the meantime, experts recommend using artificial sweeteners sparingly because science changing all the time. Many of these old and new sugar substitutes seem destined to spur ongoing concerns and confusion. All we can hope for is to use them in moderation as we strive to live our best diabetes lives. 

Common Questions About Sweeteners with Jill Weisenberger MS, RDN, CDE, FAND

Recently we received this question about sweeteners from Linda in Rochester NY, a member of the Divabetic community, who is living with type 2 diabetes on Divabetic’s FB page.

Linda writes “Splenda (sucralose) is my sweetener of choice, tasting the most like sugar. I’ve been told it raises blood sugar. I’ve also heard that stevia does not affect blood glucose levels, but it has a nasty after taste to me. Splenda has a stevia product out that’s not bad, but expensive. Your thoughts?”

We contacted our good friend, a Diabetes Late Nite podcast guest, Registered Dietitian Nutritionist, Certified Diabetes Educator and Best-Selling Author Jill Weisenberger MS, RDN, CDE, FAND, who consulted to Splenda about two years ago on a small project. Currently, Jill is a consultant to the Calorie Control Council, a trade organization for non-nutritive and low calorie sweeteners like sucarlose and stevia. Below are Jill’s answers and advice regarding Linda’s questions.

Q: Can Splenda raise blood sugars?

Jill Weisenberger MS, RDN, CDE, FAND(JW): Splenda is a brand. It’s not a specific product. I assume that you mean sucralose, as this was the original Splenda sweetener.

There is no reason to think that a compound that is essentially without carbohydrate (like sucralose) could directly affect blood sugar. A teaspoon of sucralose provides less than a gram of carbohydrate. A teaspoon of sugar provides 4 grams, and a teaspoon of honey provides about 5 grams of carbohydrate. From a blood sugar standpoint, sucralose is the better choice.

Q: Can Stevia raise blood sugars?

JW: As with other non-nutriitive sweeteners (NNS), it cannot directly affect blood sugar levels.

Q: Can you recommend any Stevia products that have little to no after taste?

Some newer stevia products use the extract Reb D instead of Reb A. I find that Reb D tastes better, but taste is an individualized thing. Splenda Naturals is a stevia sweetener made with Reb D. If you hunt around in the supermarkets, you might find others as well.

Q: What sugar substitutes do you recommend?

JW: I have no real preference. I am not fearful of low calorie and non-nutritive sweeteners. Many of the scary headlines are misleading or based on studies that provide only a small picture of the full health landscape. Other headlines are downright false. That being said, I don’t think anyone needs artificial or NNS. We can adjust our tastes to learn to enjoy foods without added sweetness or we can use very small amounts of regular sugar. I use very little of any type of added sweetener, but I use a wide variety of types – both natural and artificial, both with calories and carbs and without. But since I use very little, I know that it affects me minimally.

Q: Can you share a few tips about using sugar substitutes for people living with type 2 diabetes?

JW: If anyone is truly fearful but wants to continue using sweeteners, I recommend using a variety, so no one sweetener is consumed in large amounts. The category of NNS is quite large, and each compound is metabolized differently. Keep in mind that the dose makes the poison. Small amounts of NNS are not considered harmful. But even water when consumed in very large amounts can cause death.

Jill Weisenberger’s comprehensive guide, ‘Prediabetes: A Complete Guide: Your Lifestyle Reset to Stop Prediabetes and Other Chronic Illnesses’ will lead you through dozens of concrete steps you can take to reduce the risk of developing type 2 diabetes and other lifestyle-related chronic diseases. Taking an individualized approach to your lifestyle “reset,” this book will allow you to choose your own path to wellness, help you gain a greater sense of wellbeing, boost your confidence in your abilities to maintain a healthful lifestyle, and potentially even help you reverse prediabetes and avoid type 2 diabetes and other chronic illnesses. You’ll be feeling better than you have in years! Inside, you will learn to:

Identify your risks for developing type 2 diabetes

Set personalized and meaningful behavioral goals

Identify and build on your motivation for a lifestyle reset

Create positive new habits

Change eating habits for weight loss and greater insulin sensitivity

Choose wholesome foods in the supermarket and when away from home

Tweak your favorite recipes

Reduce sedentary time

Start or improve upon an exercise plan

Reduce emotional eating

Organize and track your progress with tools included in the book

Much more

Jill Weisenberger, MS, RDN, CDE, CHWC, FAND is a great resource for all things nutrition, food and diabetes. Whether she’s speaking, writing, chatting on social media, appearing on TV or working with individuals, her candid and energetic approach appeals to busy people, and her sound nutrition and fitness advice gets results. In fact, her appreciation for science and ability to translate science into actionable information earned her a place in US News & World Report’s 10 Dietitian’s You Need to Follow on Social Media.

 

LISTEN NOW: Diabetes Late Nite podcast featuring music by Patti Austin. We’re talking about healthy strategies to help you deal with the “FOOD POLICE” with guests: Poet Lorraine Brooks, Jill Weisenberger MS, RDN, CDE, CHWC, FAND, Chris Pickering co-founder of ‘The Betes Bros, Patricia Addie-Gentle RN, CDE, and Mama Rose Marie.

Mr. Divabetic is celebrating World Diabetes Day with musical inspiration from Aretha Franklin on Diabetes Late Nite scheduled for Wednesday, November 14, 6 -7:30 PM, EST.   Guests include Poet Lorraine Brooks, Dr. Wendy Satin Rapaport, Diabetes Strong‘s owner Christel Oerum, Beautyphonics CEO and “Beneath The Makeup”Author Suzanne Perez, Mama Rose Marie and the Charlie’s Angels of Outreach. Throughout the podcast we will be playing music from Aretha Franklin’s Aretha Franklin Sings the Great Diva Classics’ courtesy of SONY Music.

Diabetes Late Nite is a fast-paced, full-filled hour of diabetes education and wellness advice that encourages listeners to “laugh a little, learn a  lot.” Enjoy over 175 free podcasts available on demand anytime, anywhere on blogtalkradio.com and i-Tunes!