Unraveling the Sweet Truth: A Comprehensive Review of Artificial Sweeteners and Their Effects on Blood Sugar Levels

Sugar is naturally present in carbohydrate-rich foods, fruits, and vegetables. Conventional refined sugar can raise blood glucose and damage a person's health if consumed regularly and in excess. Many Americans have chosen artificial sweeteners to curb their cravings without the added calories or direct health implications of real sugar. It's estimated that 25% of children and more than 41% of adults consume artificial sweeteners as a part of their diet. Understanding what artificial sweeteners are, how they are processed in the body, and their impact on blood sugar regulation are a few key points to educate yourself with so you can make a sound decision on what you are consuming.

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What are Artificial Sweeteners?

Food additives come in many forms, one of them being artificial sweeteners. These sugar substances taste like sugar or are sometimes sweeter. They became so popular because they contain little to no calories but have a similar taste to traditional sugar. These sugar substitutes are lab-made from chemicals and are considered non-nutritive because they contain no nutritional value. The FDA has approved a handful of artificial sweeteners, including:

• Sucralose (Splenda)
• Saccharin (Sweet'N Low)
• Aspartame (NutraSweet, Equal)
• Advantame
• Acesulfame potassium (Sweet One, Sunett)
• Neotame (Newtame)

There are also three artificial sweeteners that are plant-derived: stevia, luo han guo (monk fruit extract), and thaumatin. These additives, chemically or plant-derived, are often used in fat-free, calorie-free beverages and food items to improve the taste.

What is Blood Sugar's Role in The Body?

Blood glucose is your body's primary source of energy. It's often called blood sugar and is measured in the blood to evaluate whether or not your body is appropriately processing and utilizing the sugar you are obtaining from your diet. The purpose of glucose in the blood is to feed all the cells in our body to produce energy. In moderate amounts, blood glucose is essential for maintaining these bodily functions. This process does not work independently. It's dependent on insulin, which is a hormone secreted by the pancreas that moves glucose from the blood into the cells. In addition to insulin's mobilization role, the peptide hormone glucagon, which is also released from the pancreas, plays a vital role when blood glucose is low. Glucagon will cease the storage process of glucose and signal the liver to release its stored form of glucose called glycogen. When blood sugar levels drop (hypoglycemia), blood sugar production from other sources, such as amino acids, is activated in a process called gluconeogenesis. All of this occurs to create homeostasis of blood sugar in the body.  

While glucose is not the body's only energy source, it is a primary source for brain function. Brain functionality relies on access and utilization of glucose, as it consumes about 20% of your glucose-derived energy. This aids in brain ATP production, neuron transmission, and neurotransmitter production. Blood sugar regulation is essential when it comes to metabolic function. When your body stops properly responding to blood sugar, you become insulin resistant, could be on the brink of being prediabetic or even be in a diabetic state. Regulating blood sugar is essential in the prevention of diabetes and the long-term consequences of this condition.  

How Do Artificial Sweeteners Impact Blood Sugar Levels?

The impact that non-nutritive sweeteners (NNS) can have on blood sugar is through an indirect relationship. Newly emerging science shows that NNS can impact gut microflora and change an individual's glycemic response. A glycemic response is a change in blood sugar that occurs after a carbohydrate-rich meal. Literature also reveals that artificial sweeteners can impact insulin levels. Although artificial sweeteners do not have the calorie content effect on blood glucose like traditional sugar, a paradox occurs when ingesting artificial sweeteners. When ingested, these sweeteners are perceived as real sugar, thus causing a release of insulin from the pancreas. Even though there is no actual sugar to process, this stimulates the insulin receptor, which is not necessary. Over time, this can cause less response by the insulin receptor leading to insulin resistance. When the body then sees your normal sugar, there's a chance that it may not cause the once-operational insulin release and receptor response. Over time this can lead to blood sugar processing issues like Type 2 Diabetes.

Functional Medicine Labs to Help Monitor Blood Sugar Levels

Here are a few functional medicine labs that practitioners use to help monitor blood sugar levels:

Comprehensive Metabolic Panel

A CMP will give insight into multiple organ functions, such as the liver and kidney. It will also give a baseline glucose reading, which can be utilized as a screening tool to check blood sugar. Glucose should be measured in a fasting state to give the most accurate reading. Glucose can also be done independently if you are routinely monitoring blood sugars.

Hemoglobin A1C

An HbA1C is done to measure average blood glucose over a 3-month period. This test is standard of care when monitoring (or testing for) diabetes. It's useful in prediabetic states, so preventative measures can be put into place to either delay or stop the progression of Type II Diabetes.

How to Avoid Artificial Sweeteners in Your Diet?

Artificial sweeteners are commonly found in prepackaged food items to assist with taste and add to shelf-life. Many of these items are everyday condiments like ketchup, syrup, or jelly. These high-intensity sweeteners are also found in baked goods, candy, pudding, beverages, and prepared food items. The single best way to avoid "fake sugar" is to read the nutrition labels on items you are looking to purchase. Most artificial sugars go by their common name, but on labeling, you may find the brand name in the ingredients. Aspartame has the brand names Nutrasweet®, Equal®, and Sugar Twin®; Sucralose goes by Splenda®; and Saccharin goes by the brands Sweet Twin®, Sweet and Low®, Sweet'N Low®, and Necta Sweet®. Acesulfame potassium doesn't have a brand name but can be listed as an abbreviation, such as Acesulfame K or Ace-K.

It's important to know that companies use marketing tactics like "sugar-free," and although it doesn't have a calorie content of traditional sugar, there can be artificial sweeteners present. Also note that although it may not have calorie-dense sugar, there often are non-nutritive sweeteners in products labeled: fat-free, calorie-free, Keto, or alcohol sugars. I want to mention alcohol sugars because these are a different category of low-calorie sweeteners that are similar to artificial sweeteners. Alcohol sugars include Xylitol, Erythritol, Sorbitol, and Maltitol, and are used in products such as chewing gum, beverages, and baked goods.  

Best Natural Sweeteners for Blood Sugar Regulation?

One way to assess the impact of natural sweeteners on blood sugar is to look at the food's glycemic index. The glycemic index (GI) ranges from 0-100 as a representation of how quickly a food item will create a rise in blood sugar levels. Lower glycemic index foods are ideal for modulating blood glucose because there will be fewer spikes. Regarding natural sugars, stevia and monk fruit have a glycemic index of zero. Next up in terms of low GI would be agave and dates. If you want to maintain a whole foods nutrition plan where you are not adding any sort of sweetener, fresh and frozen fruits are great options to add sweetness to your palate.

How to Balance Blood Sugar With Nutrition

Having high or low blood sugar can be concerning. Supporting your levels through nutrition is key to getting your glucose levels back within range. There is a consensus that a Mediterranean Diet is a great option for both managing high and low blood sugar levels due to its anti-inflammatory nature. Foods include vegetables, nutritious whole grains, legumes, nuts, fresh fruit, olive oil, fish, eggs, poultry, and limited red meat.

Food pairing is also important when you're looking to balance blood sugar. Research has shown that high carbohydrate diets can be detrimental to postprandial blood glucose. When high-carbohydrate foods contain high fiber or are paired with high-fiber items, there are fewer spikes in glucose post-meal. This is a great insight that consuming fiber with carbs is beneficial for blood sugar balance. An example of a food that meets both categories is oatmeal.

Protein with carbohydrate meals has also been shown to reduce blood glucose spikes. One of the great benefits of consuming protein items such as chicken with a small complex carbohydrate is the ability it has to improve insulin sensitivity by uptaking the sugar more readily into the body. In theory, eating a Mediterranean Diet should meet these food pairing hacks as low glycemic carbohydrates, fiber-rich foods, and lean protein are what this nutrition plan advocates!

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Summary

This article lays out facts on artificial sweeteners. While it is not contributing to your daily calorie count, there should be some caution and moderation involved when adding any kind of sweetener to your diet. Making sure you are reading labels, understanding the types of artificial marketing tactics out there, and also knowing how your body responds to these non-nutritive chemicals is important. As science continues to delve down this path, we could possibly see more detrimental effects of consuming excess artificial ingredients, including sweeteners.