Diabetes, formally called diabetes mellitus (DM), is a metabolic disease in which the person has high blood sugar levels over an extended period of time. It’s caused when the pancreas doesn’t make enough insulin (Type 1) or the person’s cells don’t respond as they should to the insulin the body has produced (Type 2). There is also a third main type, gestational diabetes, which develops during pregnancy. All diabetics need to monitor their sugar and carbohydrate intake and attempt to keep their blood sugar levels as close to normal as possible, without allowing levels to go too high or too low. One option, for keeping blood sugar levels stable, is to avoid refined sugars and look for sugar substitutes.
Unfortunately, it’s often that the added sugar is what makes certain foods taste good or edible. In the past, diabetics used to have to endure foods that didn’t taste good because of their need to eliminate refined sugars. But, that’s not the case anymore. Diabetics have more options these days as there are several viable sugar alternatives to choose from.
Sugars That You Need To Avoid
Being diabetic doesn’t mean you have to avoid anything that tastes sweet; there are a lot of other sugar substitutes out there that you can use. Sadly, there are also a lot of sugars or sweeteners that you should avoid.
The following is a list of sweeteners that you should avoid or use very sparingly, according to Diabetes.ca. These are the sweeteners that will increase your blood glucose levels, and may appear in foods, beverages and even in some medications:
- brown sugar
- white sugar
- icing sugar
- agave syrup (see below)
- brown rice syrup
- invert sugar
- corn syrup
- high fructose corn syrup (also called glucose-fructose)
- maple syrup
- fruit juice concentrates
- barley malt
Types of Sugar Substitutes
There is a whole range of sweeteners that do not increase your blood glucose levels. One large group is sugar alcohols that are really neither sugars nor alcohols. Small amounts can be found in vegetables and fruits, and can be manufactured, either from corn or other plants. These sugar alcohols are only partly absorbed by your body, don’t have as many calories as sugar, and don’t have a big effect on blood sugar. The only downside to sugar alcohols as a sugar substitute is that if you have more than 10 grams of these a day, you can suffer from side effects like bloating, gas, and/or diarrhea. Some of the sugar alcohols available are:
- hydrogenated starch hydrolysates (HSH)
- polyol syrups
In countries like Canada, artificial sweeteners are also available for diabetics and those wishing to limit their sugar intake. They are called non-nutritive sweeteners, meaning they contain no nutrients or calories, and do not affect blood sugar levels, although some do experience an insulin spike. They are far sweeter than sugar, so you need only a tiny amount to equal the sweetness of sugar. Artificial sweeteners are used in foods and drinks, and some are available as table-top sweeteners and can be used in baking as a sugar substitute.
There are some warnings for intake of artificial sweeteners. Health Canada has put out an Acceptable Daily Intake for them, and going above the ADI may cause adverse effects. There is also some controversy over their general safety. Here are the artificial sweeteners allowed for purchase in Canada:
- sucralose (Splenda) ADI: 9mg/kg body weight
- saccharin/cyclamate (allowed as a table-top sweetener only: Sweet Twin, Sugar Twin, Sweet ’N Low) ADI: 11mg/kg body weight
- aspartame (Equal, Nutrasweet) ADI: 40mg/kg body weight
- acesulfame-potassium (aka Ace-K: Sweet One, Sunnett) ADI: 15mg/kg body weight
Stevia is another sweetener that has become popular in the last decade, particularly with people who don’t want to use artificial sweeteners like sucralose and aspartame. It does not mess with your blood sugar levels.
Stevia is an herb in the sunflower family, mostly grown in South and Central America, although it can also be grown in North America. Sometimes called sugar leaf or sweet leaf, ingredients in stevia called rebaudioside and stevioside, which are together called glycosides, are what gives it its sweetness. Stevia is about 300 times sweeter than white sugar but is carb- and calorie-free. It doesn’t affect blood glucose levels, although some studies have shown that too much stevia can be mutagenic (cause changes to the DNA or genetic material, and thus could cause cancer. Stevia is safe in moderation, up to 4 mg/kg body weight per day.
Sweeteners that are stevia-based may be called:
- Truvia (may also contain sugar alcohols; check the label)
- Pure Via
Coconut Sugar/Palm Sugar
Coconut sugar, also called palm sugar, is a sweetener that has been gaining popularity recently. It’s made out of the sap that comes from the coconut tree. It has a low melt temperature and a really high burn temperature, so can be used in baked products instead of sugar. Diabetics can use coconut palm sugar, and it is said to have a lower glycemic index than sugar. However, just as there is a caveat with many other sugar substitutes, the American Diabetes Association says you shouldn’t eat any more of it than you would regular sugar because it has just as many carbohydrates (carbs) and calories as table sugar, around four grams of carbs and 15 calories per teaspoon.
Beware that some coconut sugar available can be mixed with cane sugar so it is important to look at the nutrition label and ingredients list on packaging.
Agave nectar hit the market about 10 years ago and immediately was hailed as a wonderful sweetener that was safe even for diabetics to use. Companies advertised it as natural, since it comes from the agave plant, which is the same plant used to make tequila. More accurately called agave syrup, this sweetener is highly processed. The agave plant is cut and pressed to extract the sugary fluid that circulates inside. The fluid is high in sugar but also has healthy things in it, like fructans, which can have good effects on insulin and metabolism (but the processing method breaks this down into fructose). The fluid is heated and/or exposed to enzymes to create the concentrated sweetener you see on the shelf.
Agave nectar does have a very low GI, mostly because it’s almost all fructose (85%), so it doesn’t spike your blood sugar much. The downside to fructose is that too much of it can be harmful to your liver, and can cause metabolic issues. Too much fructose can also lead to elevated blood triglycerides, fatty liver disease, and insulin resistance.
There are pros and cons with every sugar substitute, so each person must decide on the best option for his and her health and preferences. If you are unsure of which substitute to choose, consult with your physician first.