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About the Author Visions of Sugarplums…The Truth About Sugar and its Substitutes

As a dietician and certified diabetes educator, I am frequently asked about sugar, artificial sweeteners, and how they relate to carbohydrate counting and the Exchange List for Meal Planning. Here are some answers to questions I’ve heard often over the years.

Does eating too much sugar cause diabetes?
Satisfying your sweet tooth does not cause diabetes. If you have diabetes, however, learning to tame a sweet tooth will help you reach your blood sugar goals.

I’ve heard that people with diabetes should not eat sweets. Is this true?
In the old days, people with diabetes were told to avoid sweets. Now we have learned that white table sugar (sucrose) has the same effect on blood sugar as an equal amount of any carbohydrate. Sugary foods can be substituted for other carbohydrates in your diabetes meal plan, but remember that foods high in sugar are often high in fat and calories, too. Use them in moderation as part of a healthy diet.

A sugar bowl on it's side.I gave up all sugar. Now, instead of cookies for a snack, I eat a pound of grapes. This is better for me, right?
Grapes, indeed all fruits, have more nutritional value than traditional sweets, but you can have too much of a good thing! Remember that your total carbohydrate intake is what matters. One pound of grapes equals approximately 80 grams of carbohydrate. If you use the Exchange Lists for Meal Planning you know that one fruit, one bread/starch, or one milk exchange equals 15 grams of carbohydrate. A pound of grapes is more than 5 exchanges, which is probably more carbohydrates than you have allowed for a snack. I recommend that you have fewer grapes. You could also check the label on your favorite cookies and figure out how many you could have for a snack. It is sometimes okay to have cookies!

Is honey a better choice than white sugar?
Honey is still sugar. One teaspoon of sugar has 4 grams of carbohydrate while 1 teaspoon of honey has 5. If you prefer the taste of honey, go ahead and enjoy. Whichever you choose, use a measuring spoon so you can accurately count the carbohydrates.

What are sugar alcohols?
Alcohol in this term refers to the chemical structure of this type of sweetener. Sugar alcohols are used to sweeten foods in the same way artificial sweeteners are used. Sugar alcohols do not contain the alcohol that is found in beer, wine and spirits. Compared to sugar, they have fewer calories and less impact on blood sugar. But, unlike artificial sweeteners, they need to be accounted for in your meal plan. This process is described below. A disadvantage to sugar alcohols is that eating too much of them can cause bloating and diarrhea.

What does “net carb” or “impact carbs” mean on a food package?
These terms do not have a standardized definition and are not approved for use on food labels by the FDA. Sometimes, they may lead you to believe that a product is lower in carbohydrates then is actually true. You can find the most accurate information on the nutrition facts label. Since dietary fiber is not digested, you can subtract it from the total carbohydrates on the label. Also, if a product contains sugar alcohols, you can subtract half of the sugar alcohols from the total carbohydrates. For example, if a food contains 20 grams of total carbohydrate per serving with 2 grams of fiber and 8 grams of sugar alcohol, you can adjust the total carbohydrates to 14 grams.

I’ve heard that artificial sweeteners can cause things like cancer and multiple sclerosis. Is this true?
The Food and Drug Administration has approved 5 artificial sweeteners for use in the U.S. They are saccharin, aspartame, sucralose, acesulfame-k and neotane. Scientists have studied these food additives extensively and found them safe.

The FDA has established an Acceptable Daily Intake for each sweetener. This is the amount that can safely be eaten on average each day over a lifetime. For example, the ADI for aspartame (brand name NutraSweet, Equal) for an average adult is approximately 18 cans of diet soda. Few, if any, people would drink more than that in a day.

What is Stevia?
Stevia is an herb whose extract is much sweeter than sugar. It is used as a sweetener in various parts of the world. The Food and Drug Administration has not approved Stevia as a sweetener in the U.S. because of concerns over its potential ill effects on the kidneys, heart and reproductive system. However, it is available as a dietary supplement with claims to improve blood pressure and blood sugar. Dietary Supplements are not regulated by the FDA. Consult with your physician or dietitian before you use Stevia or any other dietary supplement.

I eat sugar free cookies, ice cream and pie. These are better for me aren’t they?
Be careful. Some people have the misconception that “sugar free” foods will not affect their blood sugar. This is not always true. Sugar free does not mean carbohydrate free. These products may contain flour, milk, fruit or sugar alcohols, all of which contribute carbohydrates. Read the nutrition facts label to get the real story.

What about fructose? That is better than sucrose for me, isn’t it?
Not necessarily. You may have seen foods sweetened with fructose (fruit sugar) in the “diabetic” food section of the grocery store, and it is true that fructose used as a sweetener does cause blood sugar to rise more slowly than sucrose (white sugar). However, it can negatively affect your heart health. For this reason, the American Diabetes Association has recommended avoiding the use of fructose as a sweetener. This is not the same as fruit itself, which has many benefits.

I hate diet soda. Will it hurt me to have a regular soda only a couple times a week?
Don’t write off diet sodas because you disliked one brand. Try a variety of diet drinks to find one that you do like. Water is another great choice. If you still want to drink regular soda, do so wisely. A can of regular soda contains approximately 45 grams of carbohydrate (3 bread/starch exchanges). For most women, this would use your total amount of carbohydrate for a meal. Avoid sipping on a regular soda throughout the day because it will provide a constant source of carbohydrate that will affect your blood sugar. If you drink regular soda, check your blood sugar 2 hours afterwards to see if you are still in your blood sugar target. If your sugar is high, cut back on regular soda or drink something different.

I have heard that high fructose corn syrup makes people overweight. What is it and should I avoid it?
High fructose corn syrup is sweeter and cheaper than sucrose (white sugar) and extends product shelf life, so it is widely used in fruit-flavored drinks, regular soda and a variety of processed foods. The rate of obesity in the United States increased at the same time as our increased consumption of high fructose corn syrup. However, it is unclear whether or not it is to blame. Regardless, foods that contain high fructose corn syrup are often high in calories and low in nutrients. So read food labels and select wisely.

Lynn BaillifAbout the Author
Lynn Baillif has been a registered dietitian for 15 years and a certified diabetes educator for 7 years. She has been a member of the National Federation of the Blind since 1987 when she was a national scholarship winner.