One of my young patients asked me a question which is uppermost in the minds of those living with diabetes -- “Should I use sugar in moderation or are artificial sweeteners a safer option?” Sugar in any form — be it white sugar, brown sugar, jaggery, or honey — causes a direct rise in blood glucose levels. Even if taken in moderation, it contributes to insulin resistance, or the inability of your muscle, fat and liver cells to respond as well as they should to insulin, a hormone that regulates blood sugar. The recommended daily limit for sugar is about six teaspoons for women and nine teaspoons for men, but for someone with diabetes, even small amounts can make blood sugar control difficult. Avoiding sugar as much as possible is the best approach. If I avoid sugar, should I completely switch to sweeteners? Are they safe? Not all sweeteners are the same. Some are safe in limited amounts while others may have potential risks. Sweeteners like sucralose and stevia are generally safer options for people with diabetes. Sucralose is widely used and does not raise blood sugar, stevia is a natural plant-based sweetener with no impact on insulin, and erythritol is a sugar alcohol that has minimal calories. How much sweetener is too much? Sweeteners have an upper safety limit but it’s so high that you cannot reach it by simply using them in your coffee or tea. The issue arises when you start using them in large amounts for making sweets, cakes or puddings. Baking or heating of certain sweeteners can alter their chemical composition, which is not always safe. Sucralose, for example, is stable up to 120°C. What about sugar-free products like chocolates and diet sodas? Are they safe? That’s another hidden trap. Many people think ‘sugar-free’ means ‘healthy,’ but that’s not always the case. In sugar-free chocolates and diet sodas, sugar is removed but fats and artificial sweeteners are added. Some of these fats —especially hydrogenated or saturated fats — can negatively affect heart health. Also, frequent consumption of sugar-free products can lead to weight gain because they still contain calories and fat. Diet sodas, for instance, may not raise blood sugar immediately, but their high content of artificial sweeteners can increase cravings and slow down metabolism, leading to increased appetite over time. As you opt for reward-seeking and high-calorie foods, they put you at a greater risk of weight gain. A study found that people with obesity, who switched over to diet soda, were likely to consume more calories in food than their counterparts who drank regular soda. In fact, those who drank diet soda reported a higher body mass index (BMI) than their counterparts. Is sucralose completely safe? Sucralose, in moderate amounts, is safe. In fact, our own study on sucralose showed that if used in tea or coffee, it might actually be beneficial by reducing blood glucose levels, body weight, waist circumference and lipid parameters. (Dr Mohan is chairman, Dr Mohan’s Diabetes Specialities Centre, Chennai)
