It seems intuitive that because people with Type 2 diabetes generally need to avoid sugar, clinicians should recommend eating foods and using recipes containing artificial sweeteners such as sucralose instead. However, experts agree that while non-sugar sweeteners (NSS) may help in certain scenarios, they can also be harmful.
“There’s not a lot of evidence that sweeteners like sucralose provide significant benefits, especially over the long term,” Susan Swithers, PhD, professor, Department of Psychological Sciences and associate dean for Faculty Affairs at Purdue University (Indiana USA), told Medscape Medical News. “At this point, we have pretty good evidence that these chemicals that were once touted as being completely inert are, in fact, not inert. We know that they’re unlikely to be toxic in the short term, but they are not benign, and they have consequences. Right now, we have little understanding of the outcomes of consumption of these products chronically.”
In 2023, the World Health Organization released a guideline that recommended against the use of NSS for weight control or to reduce the risk for noncommunicable diseases. It found that high intakes of NSS were associated with increases in body mass index and risks of developing Type 2 diabetes, cardiovascular events, and any type of stroke, as well as hypertension, bladder cancer, and all-cause mortality.
If NSS consumption can increase the risk of Type 2 diabetes, what about people who already have T2D? Some research suggests that NSS may affect people with and without Type 2 diabetes differently. For example, one small study showed that sucralose enhanced glucagon-like peptide 1 release and lowered blood glucose in healthy patients but not in patients with newly diagnosed T2D.
Moderation may be the key at this stage. As highlighted in the ADA’s Standards of Care, nonnutritive sweeteners (containing few or no calories) may be an acceptable substitute for sweeteners that contain sugar and calories when consumed in moderation. However, others are more circumspect. Jotham Suez, PhD, an assistant professor in the Department of Molecular Microbiology and Immunology at Johns Hopkins Bloomberg School of Public Health in Baltimore, commented: “Our results demonstrating that nonnutritive sweeteners are not inert, when taken together with a growing body of evidence on potential harms of these sweeteners, merit caution until additional studies are completed,” he added. “Our findings do not imply in any way that sugar consumption, shown to be harmful to human health in many studies, is superior to nonnutritive sweeteners. Sugar consumption should be minimized, especially in individuals with obesity or diabetes. Of all the options, unsweetened beverages, specifically water, seem to be the safest and best options.”
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