Humans have always had a sweet tooth. Sugar substitutes are natural or artificial substances that impart a sweet taste to food.

Caloric sugar substitutes

Sugar alcohols, or polyols, are sugar substitutes that contain calories but have little influence on blood glucose (sugar) levels. They contain fewer calories than white sugar and, unlike the latter, do not cause tooth decay:

• isomalt
• lactitol
• maltitol
• mannitol
• sorbitol
• xylitol

Non-caloric sugar substitutes

Non-caloric sugar substitutes have no impact on blood glucose (sugar) levels, are not digested, provide no calories and do not cause tooth decay.

• aspartame 
• sucralose 
• acesulfame potassium
• cyclamates
• saccharin 
• stevia (steviol glycosides)

According to the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Treatment of Diabetes in Canada, aspartame, saccharin, cyclamates, acesulfame potassium, sucralose, steviol glycosides and polyols are safe for people with diabetes.

Every sugar substitute available at drugstores and supermarkets in Canada has been approved by Health Canada. However, there is little data on the safety for people with diabetes of some of the more recent (“novel”) sugar substitutes, such as neotame, tagatose* and thaumatin.

*Approved by Health Canada only as an ingredient in natural health products and as a natural health product.

Diabetes Québec does not recommend any particular sugar substitute. Our role is to inform you of the results and implications of the scientific research relevant to people with diabetes.

Some considerations

The fact remains that the consumption of products sweetened with sugar substitutes maintains our desire for sugary foods and is therefore not the solution for a carbohydrate-controlled diet. It is important to get used to eating food that is less sweet.

Also, foods that contain sugar substitutes are often low in nutrients and high in calories. These foods do not necessarily promote weight control.

Finally, the intake of sugar substitutes and the products containing them is in no way essential for people with diabetes and should be consumed in moderation and only occasionally. If you have questions about this, consult your dietitian.

Warning for pregnant women and children

Cyclamates are not recommended during pregnancy or lactation. Aspartame, acesulfame potassium and sucralose are acceptable alternatives if consumed in moderation.

Also, although the acceptable daily intake (ADI) recommended by Health Canada is rarely exceeded by adults, we must take special care with children.

Research and text: Diabetes Québec Team of Dietitians

July 2014

References:

Dworatzek, P.D. et al., “Nutrition Therapy,” Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Treatment of Diabetes in Canada,” (Canadian Journal of Diabetes, vol. 37, pp. S45-S55), Canadian Diabetes Association.

Health Canada, (2014) List of Permitted Sweeteners. [Online]. Found at http://www.hc-sc.gc.ca/fn-an/securit/addit/list/9-sweetener-edulcorant-eng.php (Web page consulted April 10, 2014.)

Aspartame 

Aspartame has 200 times the sweetening power of white sugar. That is why you only need a very tiny amount to get a sweet taste.

Aspartame is found in many processed foods (soft drinks, some breakfast cereals, chewing gum, etc.), in sachet, powder and tablet form under the brand names Equal® and NutraSweet ®.

Aspartame is unstable in heat and therefore not recommended for prolonged cooking.

There has been a great deal of information circulating for several years linking aspartame to neurological problems and cancer. However, no clinical scientific study has proven these claims. Its use is therefore considered safe.

Sucralose 

Sucralose, better known as Splenda®, is about 600 times sweeter than white sugar. It is manufactured industrially from white sugar.

In Canada, it is approved for many products (yogurt, frozen desserts, etc.) and you can buy it as a powder, tablets and sachets.

Because of its stability when exposed to extreme temperatures or prolonged cooking, sucralose can be used in a variety of hot and cold drinks, in desserts and baked goods. To achieve optimal results, it is best to cook with recipes designed for sucralose use and read the instructions on the product packaging.

Acesulfame potassium

Acesulfame potassium is 200 times sweeter than white sugar.

In Canada, it is approved for processed foods and can be purchased as a table-top sweetener.

Note: the potassium in this sugar substitute cannot be used by the body because it is bound to another molecule (the acesulfame). Therefore, it has no effect on the level of potassium in the blood.

Cyclamates 

Cyclamates are 30 to 50 times sweeter than white sugar. However, they leave a metallic aftertaste.

In Canada, the law prohibits industry from adding them to processed foods. However, it is possible to buy them in sachets or powder form at the pharmacy or grocery store.

Cyclamates are very heat-stable and can therefore be used when cooking. Cook from recipes designed for the use of cyclamates in order to obtain the best results. Follow the instructions on the package or on the website of the company that makes it.

Cyclamates are not recommended for pregnant or lactating women.

Saccharin

Saccharin has similar characteristics to those of cyclamates: heat resistance and metallic aftertaste.

Saccharin is available in tablet form as a table-top sweetener. It can be found in pharmacies under the brand name Hermesetas®.

Saccharin has not been recommended for pregnant or lactating women for several years. After Health Canada studied the issue, however, it does not appear to be dangerous for this population.

Stevia (steviol glycosides)

Stevia is a sugar substitute gaining in popularity in Canada. It is extracted from the stevia rebaudiana plant, which is native to Brazil and Paraguay.

Stevia is added to several categories of processed foods, including baked goods, breakfast cereals, beverages, spreads and candies. It comes in different forms as a food additive. You can also buy the shrub in garden centres and make a tea from the fresh leaves.

Alcohol sugars (polyols)

Sugar alcohols, also known as polyols, are caloric sugar substitutes, unlike the above non-caloric sweeteners. They provide half the calories of white sugar and, because they are only partially digested by the body, have less of an impact on blood glucose (sugar) levels. They also do not cause tooth decay.

Sugar alcohols include isomalt, lactitol, maltitol, mannitol, sorbitol, xylitol, erythritol and hydrogenated starch hydrolysate. Ingredients ending in “ol” are often polyols, which can help you identify them.

They are found in foods labelled as "no sugar added” or “sugar-free," such as candy, chocolate, chewing gum, frozen desserts and some fruit spreads.

Consuming 20 to 50 grams per day, depending on the type of sugar alcohol, can cause gastrointestinal discomfort and diarrhea. A 45 g, sugar-free chocolate bar can contain nearly 19 grams of polyols. Consequently, if you decide to eat these products, it is important to do so in moderation. According to the Canadian Diabetes Association, consuming up to 10 g of polyols per day is safe.

Research and text: Cynthia Chaput, Dietitian

Scientific review: Andrée Gagné, Dietitian

July 2014