What you should know about artificial sweeteners if you have Type 2 diabetes

Patients with Type 2 diabetes often are told to cut down on how much sugar they eat. If you have a sweet tooth, you may think you should cut sugar altogether and switch to artificial sweeteners. What’s important is using artificial sweeteners in moderation.

“With Type 2 diabetes, your body does not correctly use insulin created by your pancreas,” said Manikya Kuriti, M.D., an endocrinologist with Wendy Novak Diabetes Institute, a part of Norton Healthcare. “Instead of insulin being used by cells to absorb blood sugar to make energy, your cells don’t respond. The body produces more insulin to overcome this issue, but it fails to work properly, and your blood sugar rises — which can turn into serious health issues.

“This then requires you to manage your blood sugar in other ways, including with diet and exercise or medication. Each patient is different.”

The role of artificial sweeteners

If you need to reduce your blood sugar, you might think that consuming less “sugar” and replacing it with artificial sweeteners is the way to go. But it’s not that simple, according to Dr. Kuriti.

“There are studies that report an association between higher intake of artificial sweeteners and mental decline,” Dr. Kuriti said. “The thought is these sweeteners may change the gut microbiome, which then causes inflammation. They also may change metabolic signals and disrupt how the body responds to insulin.

“It’s important to note, though, that current research does not show artificial sweeteners directly cause dementia, so more research with well-designed studies is needed to look at this issue further.”

Those at greatest risk for dementia are people with diabetes who are older than 65 and have a history of stroke, high blood pressure, vascular disease and other heart issues.

If you have Type 2 diabetes, what should you do about sugar?

If you have Type 2 diabetes, you need to monitor sugar intake. While artificial sweeteners can be helpful in reducing sugar, watching how much you consume is still important. Rather than relying on artificially sweetened products all day long, try to choose only one artificially sweetened item and fill in with unsweetened or naturally sweet options. 

For example, use fruit to sweeten oatmeal and yogurt. Instead of regular or diet beverages, choose water and unsweetened tea. Both of these choices will positively impact your blood sugar control with added fiber and hydration. As your taste buds adjust, you will find you enjoy less sweet food and drinks over time.  

“The best answer is to start with small changes that can improve your diet, your diabetes and your risks for other diseases,” Dr. Kuriti said. “Long-term use of artificial sweeteners or diet beverages might not be a healthier option, but the goal is to make smarter substitutions to retrain your tastes.

“Diabetes in most cases is a lifelong condition and requires changes to lifestyle and diet to reduce further risks.”

Need help with your diabetes? Schedule an appointment online or call (502) 559-3636 (ENDO).

Tips to reduce use of sugar and artificial sweeteners:

• Start with one meal a day, decreasing how much sugar and/or sweetener you use.
• Over time, reduce the amount you use.
• Decrease the amount of processed foods you eat and increase natural items such as berries, nuts and vegetables.
• Drink plenty of water or try sparkling water or unsweetened tea.

There are a few artificial sweeteners available, and they affect the body in different ways:

• Aspartame: Based on observational studies, use of aspartame may be associated with mental complaints and mood changes.
• Sucralose, saccharin, acesulfame potassium (also called acesulfame K or ace-K): These sweeteners have been shown to influence the gut microbiome as well as interfere with normal metabolic processes, which could lead to inflammation.
• Stevia: This plant-derived product is newer than the others but is still a processed product. It seems to have minimal effect on insulin and glucose and leads to limited microbiome disruption compared with the others. Its potential benefits for people with diabetes come from the fact that it is only partially absorbed in the small intestine, with much of it being fermented by gut bacteria in the colon. Because of this, its impact on blood glucose and insulin is much less than that of conventional sugar.

Learn more about how you can make a difference for patients living with diabetes.