From nortonhealthcare.com
If you have Type 2 diabetes and use artificial sweeteners, learn how they can affect blood sugar, inflammation and possibly brain health — get a doctor’s tips on healthier ways to manage your sweet cravings
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.
“With Type 2 diabetes, your body does not correctly use the insulin created by your pancreas,” said Manikya Kuriti, M.D., an endocrinologist with Wendy Novak Diabetes Institute, a part of Norton Healthcare. “Instead of the insulin being used by cells as energy, your cells don’t respond. When the body produces more insulin to overcome this issue, 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 have found links between higher intake of artificial sweeteners and cognitive decline,” Dr. Kuriti said. “The thought is these sweeteners can change the gut microbiome, which then causes inflammation. They also may change metabolic signals and disrupt how the body responds to insulin.”
There are a few artificial sweeteners available, and they affect the body in different ways:
- Aspartame: Based on observational studies, use of aspartame can result in cognitive complaints and mood fluctuations.
- Sucralose, saccharin, acesulfame potassium (also called acesulfame K or ace-K): These sweeteners have been shown to change the gut microbiome as well as interfere with normal metabolic processes. This 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 derive 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.
- Tagatose: A newly discovered sweetener called tagatose is not yet on the market and requires more research to determine if it has any long-term effects on health. At this time, clinical studies show very low increases in plasma glucose or insulin after ingestion of tagatose. Unlike sucrose, which fuels cavity-causing bacteria in the mouth, tagatose appears to reduce the growth of some of those bacteria, and evidence suggests it has probiotic effects to support healthy oral and gut bacteria.
“It’s important to note that current research does not show artificial sweeteners directly cause dementia,” Dr. Kuriti said. “For people who already have a risk of dementia, there is a greater need to limit use of artificial sweeteners for long-term health.”
Those at greatest risk 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?
Patients who have Type 2 diabetes do need to monitor sugar intake, and high use of artificial sweeteners is not the answer.
“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.
This means working with your provider on a plan. You’ll need to reduce sugar-sweetened and artificially sweetened drinks and foods, replacing them with healthier alternatives to help with glycemic control. Instead of sweetened drinks, try sparkling water. Instead of processed sweets, try fruit, and always work to increase fiber.
“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,” Dr. Kuriti said. “Diabetes in most cases is a lifelong condition and requires changes to lifestyle and diet to reduce further risks.”
Tips to reduce use of artificial sweeteners:
- Start with one meal a day, decreasing how much sweetener you use.
- Each day, 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.
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