The Truth About Sweeteners

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The market contains a plethora of sugar-free products for diabetics: sugar-free puddings, yogurts, desserts, diet sodas, iced-teas, drinks, and more. But are they really “free?”

From Sweet and LowTM (saccharin), to NutraSweetTM (aspartame) to SplendaTM (sucralose) to Acesulfamine K, non-nutritive or fake sweeteners are everywhere.   Neotame is the newest one to hit the market.  These products all range from half as sweet as sugar to 8,000 times sweeter than sugar, with the average being 200-500 times sweeter than sugar.

Many diet programs and health-care professionals highly advocate the use of these sweeteners (and foods containing them) to decrease the amount of sugar and calories a person takes in, and lower blood sugar levels.  What is interesting, however, is that the longer these sweeteners have been around, the more obese our nation has become.  The reason is this: when you consume alternative sweeteners, you are trying to fool your body.   But you can’t. The body knows that what you are giving it is fake, so instead of being satisfied, it continues to give the signal that it wants to consume something sweet, compounding cravings someone with or without diabetes might naturally experience.

In 2008, a study was published in the journal Circulation which followed the health status of 9,500 men and women, ages 45-64, over a period of nine years. The researchers found that the typical Western diet increased levels of metabolic syndrome or insulin resistance. The most surprising results of the study linked drinking a diet soda each day to a 34% increased risk for metabolic syndrome compared to those who drank none.

Another study in Behavioral Neuroscience compared rats fed regular feed and yogurt sweetened with saccharin to rats that ate regular feed and yogurt sweetened with regular sugar.

The rats who ate the feed and the saccharin-sweetened yogurt took in 20 percent more calories than the rats consuming regular feed and yogurt sweetened with sugar, and they also gained body fat. Researchers have theorized that taking in large amounts of non-nutritive sweeteners over time conditions the body not to associate sweetness with calories, which can then disrupt the body’s ability to assess caloric intake accurately and lead to overeating.

In countries where much of the food is fresh, and there are fewer processed foods containing non-nutritive sweeteners and fewer low fat or “light” foods, obesity is not an epidemic.  The epidemic of obesity in the U.S. is, at least in part, due to the heavy consumption of products which create the illusion that one can eat more and more of them without gaining weight.  The human body was made to process real foods that are fresh and whole, not manufactured processed foods.

So what about sugar alcohols like maltitol or xylitol?  Are they “free?”

The premise behind carbohydrates from fiber or sugar alcohol is that since they are not digested like regular sources of carbohydrate, they have minimal effects on blood sugar levels.  Maltitol is one of the primary sugar alcohols found in foods and despite the myth, it does increase blood sugar.  Carbohydrates are equal to 4 calories per gram and maltitol is approximately 3 calories per gram. Fiber does add bulk to food, but to think it does not add any calories or impact blood sugars is a fallacy, and has not been proven by research.

In order to fool consumers into thinking products are low-carb, the food industry made up the term “net carbs.”  What does this mean?  To arrive at a net carb number, food manufacturers take carbohydrates coming from fiber or sugars from alcohol sugars, like maltitol, and subtract them from the total amount of carbohydrates. This is misleading since it leads you to believe you are consuming fewer carbohydrates than you actually eat.

In addition, all alcohol sugars contain laxative side effects, and can contribute to gas, bloating and diarrhea– definitely not worth it for the sake of sweetness.

And finally, agave syrup.  Agave syrup usually comes from the Blue Agave plant used to make tequila.  Agave syrup began to flood the market a few years ago, and you can find it as a sweetener in many health food store products… but is it really a health product?  And how does agave compare to high fructose corn syrup?

High fructose corn syrup is a cheap way to sweeten foods and it was developed for food companies to cut costs.  It is approximately 55-60% fructose, and not the natural kind you find  in fruit.  When you consume a large percentage of this type of fructose it gets processed directly by your liver, which not only increases your triglyceride levels, but can cause fatty liver, increased hunger levels and a number of other health issues you’d rather avoid.  High levels of fructose make your brain deaf to leptin, the hormone responsible for making you feel full.

With agave, the fructose percentages are even higher.  The syrup is 85-90 percent fructose and 10-15% glucose. The agave plant goes through heavy processing in order to concentrate it into a sweet syrup.  Rather than being natural as we’ve been led to believe, it is actually a processed food, often produced with few quality controls.

So, how can you have something sweet from time to time, keep your blood sugars under control, and avoid unhealthy, processed food?  Here are some guidelines:

1.  Have a variety of fresh or frozen (unsweetened) fruit with your meals as long as you keep to your carbohydrate limits.  Fruit has natural fructose with fiber attached to it which lowers its effect on blood sugars.

2.  Drink water or sparkling water sweetened with a squeeze of lemon, lime or orange for flavor.

3.  Have 2 squares of good quality (over 70%) dark chocolate per day.  It contains very little sugar and has minimal effects on your blood sugar.  Dark chocolate contains a type of phytochemical called flavonoids which are linked to a reduction in bodily inflammation, and helpful in lowering risks associated with diabetes.


Staying away from sugar-free products gives the food industry a message that nothing is free, keeps your sugar cravings at bay, and your blood sugars under control.  What can be sweeter than that?

Susan B. Dopart, M.S., R.D., is a Los Angeles-based nutrition and fitness consultant who specializes in medical nutrition-related issues including diabetes. She has a B.S. in Nutrition and Clinical Dietetics from UC Berkeley and an M.S. in Exercise Physiology and Sports Medicine from California State University, Hayward.

Susan has been in private practice in Los Angeles for more than 18 years, working with clients to find lifestyle solutions for their optimal health and well-being. She is the author of A Recipe for Life by the Doctor’s Dietitian – a nutrition guidebook, resource, and teaching tool with cutting-edge nutrition information for those with insulin resistance and diabetes.


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Comments (4)

  1. Susan,
    I certainly agree with your overall guidelines for patients to eat wholesome foods, and limit sweetened foods, both artificial and caloric, but as a consultant for the corn refiner’s association, and more importantly as a registered dietitian and nutrition educator, I would like to clarify some of the points made in your article regarding high fructose corn syrup.
    First off, high fructose corn syrup (HFCS) was developed not only to for cost-containment, but also because it offers specific properties that are beneficial to food production: it’s stable in acid, it promotes browning (helpful for high quality breads), it enhances flavors, retains moisture and resists crystallization. All of these properties allow HFCS to be an effective caloric sweetener in food processing.
    Secondly, as you know, fructose is fructose. It’s a simple sugar (a monosaccharide). Our body handles any type of fructose the exact same way, no matter the source (from fruit, from sucrose, etc). Also, HFCS is not “50-60% fructose”. There are actually two types used in processing: HFCS-42 and HFCS-55. The latter is primarily used in soft drinks and contains 55% fructose, and 45% glucose. HFCS-42, which is widely used in other foods, contains 42% fructose (less than that of cane sugar, or sucrose, which is 50% fructose and 50% glucose). Often studies done on pure fructose are mistakenly related to high fructose corn syrup (which, as you see, is actually not high in fructose, despite the name).
    In addition, HFCS does not “cause fatty liver” and does not have a negative effect on leptin (appetite hormone). Several studies have concluded that fructose (which is not the same as HFCS) may have adverse metabolic affects in large quantities (note – the amounts of fructose used in these studies does not realistically compare to anything in our food supply. That is, we don’t consume “pure fructose”), but no study has linked HFCS to any liver disorders.
    In fact, HFCS and sucrose (table sugar) affect plasma glucose, insulin, triglyceride, leptin and ghrelin levels, in the same way when ingested. In other words, HFCS and sucrose are metabolically the same. Sucrose (table sugar) actually increases triglyceride levels slightly more than HFCS, yet not clinically significant.
    Of course, those with diabetes, or without, should consume any caloric sweetener in moderation, and eat a balanced diet as you suggest in your practice and your cookbook.

  2. I would like to know Susan Dopart’s opinion of Stevia natural sweetener, from health benefit – positive or negative – point of view?

  3. Stevia is the most natural of sweeteners and does not have the same repercussions as others.  However, it is still 300 times sweeter than sugars, which can continue to condition the body to want more sweetness.  Hence, I do not recommend it.
    Hope that helps.

  4. jerrie lee at

    What about truvia (erithrotol? spelling) versus splenda? Your article mentions splenda in the introduction but not in content. If using truvia as a sweetner for minimal consumption, what is the impact  versus splenda?

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