Are Nonnutritive Sweeteners Helpful for Prediabetes?
By Constance Brown-Riggs, MSEd, RD, CDE, CDN
In the United States, there are 86 million adults living with prediabetes, a condition that increases the risk of type 2 diabetes, heart disease, and stroke.1 Research supports that achieving a healthy body weight and increasing physical activity reduces the risk of type 2 diabetes by up to 58%. 2
According to the 2012 scientific statement from the American Heart Association and the American Diabetes Association, substituting nonnutritive sweeteners for added sugars in beverages and other foods has the potential to help people reach and maintain a healthy weight and control blood glucose. However, myths and misinformation regarding the role of nonnutritive sweeteners in weight management and appetite control have patients with prediabetes questioning their use.
This article discusses the latest research on nonnutritive sweeteners’ effectiveness on weight loss and appetite control, and provides tips on counseling individuals with prediabetes about their use.
People with prediabetes have blood glucose levels that are higher than normal but not high enough for a diabetes diagnosis. Without lifestyle changes, including achieving weight loss and increased physical activity, 15% to 30% of people with prediabetes will develop type 2 diabetes within five years of their prediabetes diagnosis.2 Nonnutritive sweeteners play an important part in helping these individuals reduce caloric intake, improve diet quality, and lose weight.
“When someone is already prediabetic, their blood sugars can be higher than ideal. Therefore, eating foods that are very high in carbohydrates, such as cakes and cookies, isn’t desirable. Nonnutritive sweeteners, in turn, can sometimes provide a patient with a better alternative than eating their usual sweetened desserts and beverages,” says Marlisa Brown, MS, RD, CDE, CDN, president of Total Wellness in Bay Shore, New York.
Weight Loss and Appetite Control
Previous studies have suggested that using nonnutritive sweeteners may increase a person’s appetite for sweet foods and cause weight gain.3,4 Sylvia E. Meléndez-Klinger, MS, RD, LDN, owner of Hispanic Food Communications in Chicago, says new research from a groundbreaking randomly controlled trial proves differently. “The most recent study published in the June 2014 issue of Obesity directly compared the effects of nonnutritive sweetened beverages to water on weight loss. The study found that subjects who consumed nonnutritive sweetened beverages lost 44% more weight than controls over 12 weeks,” she says.
Additionally, more than one-half of the participants in the nonnutritive sweetened beverages group lost at least 5% of their body weight, which is good news for individuals with prediabetes. Losing just 5% of body weight can lower the risk of type 2 diabetes.2 Moreover, the hunger scores were significantly lower among the nonnutritive sweetened beverages group than the control group, showing that nonnutritive sweetened beverages don’t increase appetite.
The following tips can help clients and patients with prediabetes to healthfully consume nonnutritive sweeteners:
• Go easy and natural. “Many individuals who come to me are already guzzling artificially sweetened drinks all day,” says New-York based dietitian Marie Fasano Ruggles, MS, RD, CN, CDE, who encourages her diabetes education students to experiment with different options for natural nonnutritive sweeteners, such as Nectresse, which is made with monk fruit extract, or stevia, made from the leaf of the stevia plant. “The taste of these products varies from company to company, so I advise my students to obtain samples and experiment,” she says.
• Make healthful food choices. Brown cautions her patients to be mindful of calories and the nutritional value of products sweetened with nonnutritive sweeteners. “When I look at some of the treats that contain artificial sweeteners, I often see foods that have no nutritional value. Just because the sugar is removed doesn't mean there aren’t many additional calorie-dense ingredients,” she says.
• Control portion sizes. Substituting nonnutritive sweeteners for sugars added to foods and beverages may help individuals with prediabetes reach and maintain a healthy body weight as long as the substitution doesn’t lead to eating extra calories. “I find that people may eat many portions thinking that they can because the sugar is removed,” Brown says.
• Dispel myths. Teach patients the names of nonnutritive sweeteners and provide resources so they can learn more about their safety and efficacy.
Stick With Current Evidence
Individuals with prediabetes and dietitians can benefit from learning more about nonnutritive sweeteners so they can make informed decisions about their use based on available evidence rather than on misinformation. Recent research from a randomly controlled clinical trial provides evidence that nonnutritive sweetened beverages can facilitate weight loss without increasing appetite.
— Constance Brown-Riggs, MSEd, RD, CDE, CDN, is the past national spokesperson for the Academy of Nutrition and Dietetics, specializing in African American nutrition, and author of the African American Guide to Living Well With Diabetes and Eating Soulfully and Healthfully With Diabetes.
1. Diabetes latest. Centers for Disease Control and Prevention website. http://www.cdc.gov/features/diabetesfactsheet. Accessed June 28, 2014.
2. Prediabetes facts. Centers for Disease Control and Prevention website. http://www.cdc.gov/diabetes/prevention/factsheet.htm. Last reviewed March 13, 2014. Accessed June 28, 2014.
3. Mercola J. Artificial sweeteners may be worse than sugar for diabetics. Mercola.com website. http://articles.mercola.com/sites/articles/archive/2012/08/09/artificial-sweeteners-worse-than-sugar.aspx. August 9, 2012. Accessed June 30, 2014.
4. Yang Q. Gain weight by “going diet?” Artificial sweeteners and the neurobiology of sugar cravings. Yale J Biol Med. 2010;83(2):101-108.
5. Wiley Online Library. The effects of water and non-nutritive sweetened beverages on weight loss during a 12-week weight loss treatment program. Website: http://onlinelibrary.wiley.com/doi/10.1002/oby.20737/pdf. Accessed July 3, 2014.