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Sugar Substitutes and Type 2 Diabetes

Using Sugar Substitutes for Cooking and Baking

If you choose to use sugar substitutes for cooking and baking, there are some things to take into consideration, such as:
  • You can use alternative sweeteners (honey, maple syrup, agave nectar, or artificial sweeteners) instead of sugar. If you want to use an alternative sweetener, you may need to do it after cooking, as some sweeteners (like saccharin) will turn bitter when cooked. Aspartame and some others will lose sweetness when heated. However, Splenda or other sucralose products can be added before cooking and won't turn bitter or lose their sweetness when cooking.
  • Using artificial sweeteners may cause baked products to be lighter in color, as sugar is what causes the caramelizing/browning effect in baked goods.
  • Artificial sweeteners do not have the same bulking ability as sugar, so cakes, muffins, and quick breads may not be as plump.
  • Cooking time may be slightly different when using artificial sweeteners.
Before baking with a sugar substitute, make sure to read the package carefully or go to the manufacturer's Web site for the best way to substitute the sweetener for sugar in your recipes.

Do Sugar Substitutes Present a Risk for Someone With Type 2 Diabetes?

The FDA regulates artificial sweeteners as food additives, which must be approved by the FDA. The FDA has deemed the five artificial sweeteners (acesulfame potassium, aspartame, saccharin, sucralose, and neotame) as "generally recognized as safe (GRAS)." This approval is based on a detailed review of a large amount of data, including hundreds of toxicological and clinical studies.
At this time, there isn't sufficient scientific information that would cause the FDA to change its conclusions about the safety of the five approved artificial sweeteners. However, concerns (some valid, and some nothing more than urban myth) persist about the safety of artificial sweeteners.
As an example of a valid concern, aspartame (found in Equal Classic and NutraSweet) carries a warning on its label, as there are some people who have a genetic condition called phenylketonuria that requires them to limit their intake of phenylalanine (an amino acid in aspartame).  
Claims about the cancer-causing effects of artificial sweeteners abound. Many of these claims stemmed from studies of a sweetener named cyclamate, which has now been banned from use in U.S. food products. When cyclamate was combined with saccharin, it appeared to cause bladder cancer in laboratory animals. Although the FDA considered banning saccharin as well, further studies showed that saccharin causes cancer in animals by a mechanism not found in humans. Due to these studies, saccharin was considered not carcinogenic to humans.
Although stevia is considered a natural substance, that doesn't automatically mean it is safe. Laboratory studies have indicated that stevia can be converted into a "mutagenic" compound, which may increase the risk of cancer by causing DNA in the cells to mutate. In the 1990s, the FDA rejected stevia for use as a food ingredient. However, in 1995, the FDA allowed stevia to be used as a dietary supplement.
Weight Gain and Diabetes
Although the FDA has deemed the five approved artificial sweeteners, as well as stevia (a natural sweetener), to be "safe," few studies have been done in humans to evaluate the long-term effects of using them. It is important to note that recent research has indicated that artificial sweeteners can cause weight gain, and even possibly contribute to developing diabetes in some people.
In particular, a study that was released in early 2013 showed that sucralose may change the way the body responds to regular sugar, increasing blood sugar and insulin production in response to sugar. This study was done in a lab situation in obese people unaccustomed to sugar substitutes. However, researchers are not yet sure how these findings apply to "real-world" or long-term use of sucralose.
Research is also being done on whether artificial sweeteners would cause more weight gain than plain sugar. Some studies indicate that using no-calorie sweeteners may make it harder for people to control their food intake. In animal studies, animals that consumed saccharin-sweetened foods consumed more calories and gained more weight than those that consumed foods with real sugar.
Some researchers suspect that these alternative sweeteners may fool the brain into thinking more calories are coming. Basically, the thought is that when the taste buds sense something sweet, they signal the brain to prepare the digestive system to gear up for calories. However, when the calories don't come, the body may have problems regulating appetite. This can increase appetite, causing you to want to eat more.
Some research also links diet drinks with a higher risk for obesity and metabolic syndrome, which is closely tied to type 2 diabetes. Again, more research in humans is needed.
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