Navigating the supermarket aisles can be a frustrating experience with so many different brands, food labels and star ratings to think about. When you have diabetes to consider as well, the experience can be even more challenging. With the ever present message to reduce added sugars and discretionary foods where do alternative sweeteners fit in?

Not all sugars are the same

We can separate sugars into ‘naturally occurring’, like in fruit and milk, or ‘added sugars’ used to increase sweetness in products like cakes, soft drinks and biscuits. Foods high in added sugars are likely to be nutrient poor and high in kilojoules. Whereas foods with naturally occurring sugars are usually eaten in smaller amounts and provide many important nutrients.

People living with diabetes can include small amounts of sugar as part of a healthy eating plan but it is recommended these are derived from naturally occurring sources.

What are alternative sweeteners?

Alternative sweeteners are many times sweeter than sugar and therefore are used in much smaller amounts. Alternative sweeteners are added to foods as a replacement to sugar and are sugar-free and low in energy (kJ). Some alternative sweeteners do contain energy (kJ) and can have an effect on blood glucose levels so, like sugar, they are best consumed in small amounts. Foods and drinks that are artificially sweetened may provide a useful alternative to those high in added sugars.

Key points

• Many different alternative sweeteners are currently available and those that are used in Australian foods have been assessed as safe by Food Standards Australia New Zealand (FSANZ).
• Non-nutritive sweeteners include aspartame, sucralose and stevia. These do not have an effect on blood glucose levels and may be a useful alternative for replacing added sugar.
• Sugar alcohols are neither sugar nor alcohols, they are carbohydrates that resemble sugar, for example sorbitol, maltitol and xylitol. These nutritive sweeteners can contain as many kilojoules (kJ) as sugar and may have an effect on blood glucose levels. The body cannot completely digest sugar alcohols so eating too much can have a laxative effect.

Alternative sweeteners and weight management

We know that being overweight or obese is a risk factor for diabetes and blood glucose level management, along with many other health problems. Recent evidence shows that sugar-sweetened drinks can increase the risk of excessive weight gain in both children and adults. The best approach for weight reduction is to adopt a nutritious eating pattern and include enough physical activity each day whereby the total energy (kilojoule) needs for the day are slightly less than you actually need.

It has been hypothesised that the replacement of sugar with alternative sweeteners decreases energy intake leading to weight reduction, however it is unknown whether an individual will maintain this effect over the long term. The lack of evidence to support this hypothesis is further explained by the fact that weight management is a function of energy balance as reported in the Australia Dietary Guidelines for Australians.

Key findings from a systematic review of 15 randomised controlled trials (RCTs) in 2014 on the relationship between alternative sweeteners and body weight.

• Substituting alternative sweeteners for sugar modestly reduces body weight, body mass index (BMI), fat mass, and waist circumference.
• Reduction in weight was modest (0.80-kg decrease) and there was a lack of evidence suggesting a causal relationship between one single dietary change i.e. replacement of sugar with alternative sweeteners and weight.
• A multifaceted approach to weight management is recommended that includes a healthy eating pattern, physical activity, and other lifestyle behaviour changes
• The use of alternative sweeteners could assist in maintaining the palatability of foods and beverages with the absence of sugar and with less energy (kJ).

In the context of a healthy approach to eating, alternative sweeteners are not essential for people living with diabetes, however some people with diabetes may still choose to use alternative sweeteners (determined as safe by FSANZ) in place of sugar. As we know people living with diabetes can include a small amount of sugar as part of a healthy eating plan here are some final thoughts on limiting added sugars:

• Train your tastebuds to rely less on sweetness
• Reduce sugar in your tea or coffee – aim for zero
• Go for whole foods like fruit instead of cakes and biscuits
• Avoid sugar sweetened drinks

Have more questions?

Call the Helpline on 1300 342 238 to speak with a health professional.