Ask the Dietitian: Which Sugar Substitutes are Best for People with Type 2 Diabetes?

Dear Jillian,

There are so many types of sugar substitutes and the research surrounding their effects on blood sugar can be confusing. How do I know which ones are best for me?

— Bezzy Type 2 Diabetes Member

Finding a sweetener that won’t significantly affect your blood sugar can be challenging.

Although people with diabetes don’t have to avoid sugar and other sweeteners completely, cutting back on added sugar and using sugar substitutes may help improve blood sugar control, maintain body weight regulation, and benefit liver health.

But while some sugar alternatives can benefit overall health, some may do more harm than good.

In this article, I’ll share the best sugar substitutes for people with type 2 diabetes and explain why it’s best to limit or avoid some artificial sweeteners.

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The best sugar substitutes for people with type 2 diabetes

Natural sugar alternatives are sweeteners derived from natural sources, like plants. They’re also a safer option than most artificial sweeteners.

Monk fruit

Monk fruit extract — also known as Luo Han Guo — is a zero-calorie, natural sweetener derived from the Siraitia grosvenorii plant. It’s 300 times sweeter than table sugar, so you only need to use a small amount to add some sweetness to a drink or recipe.

Since monk fruit doesn’t have calories or carbs, it won’t impact blood sugar, making it a good choice for people with type 2 diabetes.

Monk fruit is a relatively new natural sweetener in the United States, so there’s not a lot of research on its potential health benefits. That said, it’s approved for use in food by the Food and Drug Administration (FDA) and is considered safe to use on a daily basis.

Monk fruit works well as a sugar substitute in baked goods and coffee drinks. NOW Foods Organic Monk Fruit Liquid Sweetener is perfect for use in beverages like coffee.

Allulose

Allulose is a type of sugar that’s naturally found in certain foods, like figs. It’s less sweet compared to other natural sugar alternatives, providing about 70% of the sweetness of table sugar. It’s very low in calories, containing just 0.2 calories per gram. For reference, table sugar contains 4 calories per gram.

According to one study, compared to table sugar, allulose can help reduce post-meal blood sugar and insulin levels in people without diabetes. Another small study showed that allulose may help improve post-meal blood sugar in people with type 2 diabetes, but research is limited.

Allulose is FDA-approved and can be used in place of sugar in baked goods, drinks, and more. Wholesome Sweeteners Allulose Zero Calorie Granulated Sweetener is a good choice for baking.

Stevia

Extracts from the leaves of the Stevia rebaudiana plant can also be used as a zero-calorie sugar alternative. It’s 200 to 400 times sweeter than table sugar.

Stevia doesn’t impact blood sugar and could help people with type 2 diabetes maintain better blood sugar control if it’s used in place of regular sugar.

Steviol glycosides, which are natural compounds found in stevia plant leaves, are FDA-approved and considered safe. Keep in mind that some research suggests stevia may negatively impact gut bacteria, so it’s best to consider limiting your intake, as you should all sugar substitutes.

When shopping, choose products that use pure stevia extracts whenever possible. SweetLeaf SteviaClear Sweet Drops and Pyure Organic Stevia Powder are some examples of high quality stevia products.

Some sugar alcohols

Sugar alcohols or polyols are types of carbs that are found in foods like fruits and vegetables. Your body isn’t able to completely absorb sugar alcohols, so they’re fermented by bacteria in your large intestine.

Sugar alcohols like xylitol and erythritol are popular natural sugar alternatives that can be found in a variety of products like protein bars and candy. Erythritol and xylitol contain 0.2 and 2.4 calories per gram, respectively, and have minimal impact on blood sugar levels. Xylitol is about 95% as sweet as table sugar, while erythritol is about 70% as sweet.

Replacing table sugar with sugar alcohols can help cut calories and carbs from your diet, which could help you manage your blood sugar levels. Plus, they’re considered safe for people with diabetes.

That said, limited research has found an association between the intake of erythritol with health conditions like heart disease and obesity as well as an increased risk of stroke and heart attack. Also, a high intake of certain sugar alcohols, like xylitol and sorbitol, can cause digestive issues like bloating and diarrhea in some people.

For these reasons, it’s best to consider limiting your intake of all sugar alcohols and use them sparingly as low calorie sugar alternatives.

Dates

Dates are a fruit with a low glycemic index (GI) of around 42. Table sugar has a GI of 65. This means that dates have less of an effect on your blood sugar compared to table sugar and may help support healthy blood sugar levels when used in place of table sugar.

Dates are sweet, yet they’re high in fiber and antioxidants, making them a healthy alternative to table sugar for people with type 2 diabetes.

Although they’re high in carbs, according to one study, eating up to 3 dates per day didn’t raise levels of the long-term blood sugar control marker hemoglobin A1c (HbA1c) in people with diabetes and prediabetes. It may also help lower LDL cholesterol levels, which can benefit heart health.

Dates can be used in place of sugar in smoothies and baked goods and can take the place of sugary ingredients like candy in recipes like trail mix.

Sugar substitutes to limit or avoid

Artificial sweeteners are popular among people with diabetes because they have zero calories and carbs. But studies show that artificial sweeteners aren’t that helpful for improving blood sugar control or promoting weight loss. Plus, many artificial sweeteners have been linked to side effects and may negatively impact overall health.

For example, the use of artificial sweeteners like aspartame, acesulfame potassium, and sucralose may be associated with an increased risk of heart disease and certain cancers.

What’s more, artificial sweeteners may negatively impact gut bacteria and promote a pro-inflammatory environment in the gut.

Even though the following artificial sweeteners are deemed safe by the FDA, research investigating their long-term effects on human health is ongoing.

In my opinion, and in the opinion of many other health professionals, it’s best to limit your intake of the following sugar substitutes:

• saccharin
• acesulfame potassium (Ace-K)
• sucralose
• aspartame

Other considerations

Even though sugar substitutes could help you cut back on added sugar if they’re used in place of sweeteners like table sugar, it’s still important to watch your portion sizes of foods made with sugar replacements.

Often, foods like cakes and cookies made with zero- or low calorie sweeteners are considered “healthier” or thought to be lower in calories. But in reality, they may contain the same or more calories as a product made with regular sugar along with other additives to improve their taste.

If you enjoy foods and drinks made with natural sugar substitutes, it’s perfectly fine to eat them, but don’t feel that you have to use them to be healthy or healthier. While using natural sugar substitutes in place of table sugar or other sweeteners that have a significant impact on blood sugar can be helpful, your main concern should be your overall dietary intake.

One of the most important parts of taking care of your physical and mental health and promoting optimal blood sugar control is to follow a nutritious diet composed of mostly whole foods, including vegetables, fruits, beans, seafood, eggs, nuts, and seeds.

If you follow a well-balanced, nutrient-dense diet, but consume small amounts of added sugar from time to time, you generally don’t have to worry about it.

Also, even though using stevia or monk fruit in place of sugar can cut down on your carb and calorie intake, it won’t make a significant difference in your health if the rest of your diet is high in ultra-processed foods and low in whole foods.

If you’re interested in using sugar substitutes to cut back on your added sugar intake, go for it. But don’t forget to zoom out and consider your entire dietary intake and how it affects overall health, too.

The takeaway

Swapping out sweeteners with some sugar substitutes like monk fruit and allulose can help you cut back on calories and carbs, which could help you better manage your blood sugar.

Still, it’s important to choose natural sugar substitutes when you can and limit your intake of all sugar substitutes in order to promote optimal health.