Artificial sweetener as sugar substitute: is it good for you? Which is best for diabetics?

The mention of the word “sweet” always conjures up visions of goodness, happiness and pleasure. Honey, sugar or sweetheart are popular terms of endearment. Sweet-tempered or sweet-natured people are always preferable to those who are bitter. Yet we all know that sugar is now blamed for many of our ills, including obesity, diabetes, heart disease and even cancer. Indians were the first to use cane sugar crystals (around 400 BCE) which they called sharkara (gravel). The word sugar itself is derived from sharkara.
With the growing awareness of the ill effects of sugar, particularly for those with diabetes, the quest to satisfy our sweet tastebuds without causing harmful effects has picked up pace. People commonly substitute sugar with brown sugar, honey and jaggery in the maken belief that they are safer whereas in terms of calorie content they are the same as sugar (a gram of sugar has 4 calories). Similarly many feel that fruit juice is a good substitute for colas but actually their calorie content is almost the same.
Natural sources, therefore, don’t give us many healthy options to satisfy our sweet cravings. Undoubtedly, sugar substitutes help in reducing calorie intake, since many of them have close to zero calories. A 500 ml can of a cola has approximately 12 spoons of added sugar, almost 220 calories. A can of diet cola has zero calories! Theoretically, therefore, sugar substitutes are a very attractive proposition.
Types of sugar substitutes
There are two common types of sugar substitutes — artificial sweeteners and sugar alcohols. Artificial sweeteners are synthetic substitutes and include saccharin, cyclamate, aspartame, sucralose, acesulfame and neotame. Stevia is a separate category, described as a “natural” sweetener since it is derived from plant sources.
The other variety of sugar substitutes comprises plant-derived sugar alcohols (they don’t contain alcohol!) like erythritol, mannitol and sorbitol. In addition to sweetness, they add some texture to food. The sweetness of sugar alcohols varies from 25-100 per cent as compared to sugar. Eating high quantities of sugar alcohols can cause bloating, loose stools or diarrhoea. Over a period of time, tolerance usually develops to these effects.
Sugar substitutes are widely used in processed foods, including soft drinks, jams and dairy products. Some, like sucralose, can be used in baking or cooking. It is important to check what kind of sweetener a product contains. A “sugar free” label on a product can be misleading—we then tend to consume excess amounts, considering it to be totally safe, not realising that it could be laden with fat or might contain sugar alcohols. A typical bar of sugar-free chocolate contains about 60 per cent of the calories of a regular slab.
Can sugar substitutes reverse diabetes?
Notwithstanding their commercial popularity, sugar substitutes have always attracted controversy. Other than improvement in dental health, it remains unclear if replacement of dietary sugar with artificially sweetened products can reverse the health consequences (like obesity, diabetes, and heart disease) of sugar over-consumption. In some studies, artificial sweeteners have been shown to increase the risk of diabetes and obesity, although others have not found such evidence. The WHO 2022 report on the health effects of artificial sweeteners observed modest associations between consumption of beverages with artificial sweeteners to cholesterol abnormalities and high blood pressure.
Using artificial sweeteners may provoke a sense of complacency and drive us to eat other high-calorie food more liberally. It is common to see people digging into their brownies and pizzas but taking extra care to order only diet colas. It has been suggested that these intensely sweet substances may alter how our brains respond to signals, making less sweet substances like fruits unappealing to our senses. Some scients feel that the use of these products may lead us to crave more sweets.
Saccharine was once linked to cancer in rats, and aspartame to brain tumours without much evidence. Concerns like adverse impact on kidneys, memory loss, dementia and stroke are unproven. It has also been suggested that use of these sweeteners may alter our gut flora, potentially leading to a greater risk of weight gain and diabetes. The mixing of alcohol with artificially sweetened beverages increases blood alcohol levels and increases chances of intoxication.
A population-based study from France, published in September this year, involving more than 100,000 participants, followed up for more than 10 years, showed a potential association between artificial sweeteners (especially aspartame, acesulfame, sucralose) intake and cardiac disease, stroke and cancer. Since it was an association study, it cannot be regarded as definitive, but certainly suggests the need for caution in using the products.
Children should not consume sweeteners over long periods as the risks may be greater. Adults who consume large amounts of sweet beverages can use artificially sweetened beverages temporarily and gradually try to taper the consumption, replacing them with water. Artificial sweetener use can only help if the overall calorie intake is reduced. Those with bowel disorders and who have bariatric procedures should also avoid them completely.
How to control intake of sweeteners
What then should those of us trying to lose weight or control diabetes do? Try and give up sugar completely. If your sweet cravings are persent, it is safe to consume sweeteners in small amounts. Adding a sweetener to your morning tea or evening coffee or to an occasional low-fat dessert is fine.
Following are the popular sweeteners in India and their sweetness intensity as compared to sugar
Aspartame- 200 times
Saccharine- 300-600 times
Sucralose- 600 times
Stevia- 200-400 times