Sweeteners for Diabetics: What Can Replace Sugar?

Sweeteners for Diabetics – Are They Healthy?

Diabetics and people with other carbohydrate metabolism issues, such as insulin resistance, often seek alternatives to sugar. However, they frequently overlook how these alternatives impact blood glucose and insulin levels, and whether they are truly beneficial for health.

Before choosing a sugar substitute, do your research and check which sweeteners are available on the market. Some alternatives can indeed be helpful, while others may be harmful. Before purchasing, make sure you know the acceptable daily intake (ADI) and the pros and cons of each product.

What Sugar Substitute Is Best for Diabetics?

Popular sweeteners for diabetics include:

• Xylitol

• Erythritol

• Stevia

• Inulin

• Fructose

• Acesulfame K

• Saccharin

• Aspartame

Xylitol

Xylitol, also known as birch sugar, was originally extracted from birch bark. Nowadays, it is mostly produced using microorganisms that process unused plant parts (e.g., olive branches, banana peels, soybean pods, rice stalks). It is commonly used in sugar-free toothpastes, chewing gum, and candies.

Xylitol is partially absorbed in the small intestine. The unabsorbed portion reaches the colon, where it serves as food for gut microbiota.

Xylitol has a sweetness similar to sucrose but provides significantly fewer calories (2.4 kcal/g). This makes it an excellent sugar alternative. It can be used in both cold and hot dishes.

Its only major drawback is a laxative effect when consumed in excess. Studies show a well-tolerated dose ranges from 20 to 50 g per day, although this may vary individually. Gradually introducing xylitol to the diet is recommended, as tolerance may increase over time.

Xylitol is suitable for people with diabetes or carbohydrate metabolism disorders. Compared to regular sugar, it causes a smaller insulin spike. However, it may worsen digestive symptoms in individuals with irritable bowel syndrome (IBS) or small intestinal bacterial overgrowth (SIBO).

Erythritol

Erythritol is a natural sweetener found in:

• corn,

• fruits (e.g., grapes, pears, melons),

• mushrooms,

• fermented products (e.g., soy sauce, cheese, sake).

It is 60–80% as sweet as sucrose and contains much fewer calories (0.2–0.4 kcal/g). It has a glycemic index of zero and does not affect blood glucose or insulin levels. For this reason, it is a good fit in a diabetic diet.

Erythritol is considered completely safe and approved for general use. However, due to its low production efficiency (and hence high cost), it is not widely used in the food industry.

As with xylitol, excessive intake can cause bloating, stomach pain, and diarrhea. A daily intake of 0.5–1 g per kilogram of body weight is generally considered safe, but individual tolerance can vary significantly.

Stevia

Stevia is a plant native to Brazil and Paraguay, with sweet-tasting leaves. It is sometimes used as an alternative treatment for diabetes due to its potential hypoglycemic effect. It may also enhance insulin activity.

Stevia may reduce glucose absorption in the small intestine and lower blood pressure. However, typical dietary doses may not be enough to produce these effects.

Its sweetness comes from steviol glycosides, which are used in sweetener production. The key benefits of stevia are its near-zero calorie content and sweetness that is 300–400 times greater than that of sugar.

The acceptable daily intake is 0–4 mg/kg of body weight. Higher doses may have negative health effects.

Stevia remains stable at temperatures up to 200°C, making it suitable for both cold desserts and baking. It is available in various forms, including potted plants, dried leaves, tablets, and liquid extracts.

Inulin

Inulin is a polysaccharide derived from plants and belongs to the soluble fiber group. Its richest sources are chicory roots, Jerusalem artichoke, onions, garlic, and bananas.

Inulin is not digested and reaches the colon unchanged, where it is broken down by gut bacteria. This makes it a natural prebiotic that nourishes microbiota and helps maintain a healthy balance.

Studies show that inulin may increase calcium and magnesium absorption. Its caloric value is around 1.5 kcal/g. It also has thickening properties and, when mixed with hot liquid, takes on a pudding-like texture.

However, it is about 70% less sweet than sugar. Therefore, inulin alone may not provide a sufficiently sweet taste. The recommended dose is 8–10 g per day; higher amounts may have a laxative effect.

Fructose

Fructose naturally occurs in fruit and, along with glucose, is one of the components of sucrose (table sugar).

It gained popularity as a sugar substitute due to its lower glycemic index and a different metabolic pathway than glucose. It was once thought not to raise blood glucose. Unfortunately, it does, and it also increases insulin secretion.

Many diabetic-friendly products were once sweetened with fructose. However, it is now being replaced by synthetic sweeteners, xylitol, and stevia.

Fructose not only affects carbohydrate metabolism but may also negatively impact lipid profiles by increasing triglyceride levels.

Acesulfame K, Saccharin, Aspartame – Zero-Calorie Sweeteners

Acesulfame K and aspartame are approximately 200 times sweeter than sucrose. Saccharin is about 500 times sweeter. Though they provide around 4 kcal/g, they are used in such small quantities that they are considered non-caloric.

Do Sweeteners Raise Blood Sugar?

Aspartame, saccharin, and acesulfame K do not raise blood sugar levels. Current evidence suggests that controlled consumption, within acceptable daily intake (ADI) levels, is safe.

The Polish Diabetes Association confirms their safety and recommends replacing sugar with these sweeteners for people with overweight, obesity, and carbohydrate metabolism disorders.

• The ADI for aspartame is 0–40 mg/kg of body weight,

• for saccharin 0–5 mg/kg,

• and for acesulfame K 0–15 mg/kg.

Potential risks arise when food manufacturers use multiple sweeteners in a single product to achieve the desired sweetness. Labels often don’t disclose exact quantities of each sweetener. Consuming several artificially sweetened products can unknowingly lead to excessive intake.

Sweeteners and Diabetes – Summary

There are many alternatives to traditional sugar on the market. These include natural sweeteners like stevia and xylitol, as well as synthetic ones like acesulfame K and aspartame. Most are safe for use and do not negatively impact health when consumed in appropriate amounts.

However, the best approach is to gradually reduce your preference for sweet tastes and use sweeteners only occasionally.