Sugar Substitutes May Worsen Diabetes And Gut Health

April 3, 2023

Summary: People living with diabetes often use sugar substitutes as they do not cause an upsurge in blood glucose levels and are zero calories. However, new studies show that they are not entirely safe for individuals with diabetic neuropathy. Sugar substitutes can still cause insulin resistance and changes in gut microbiota, which can worsen diabetic neuropathy symptoms. Thus, researchers recommend using them sparingly and consulting a doctor before incorporating them into a diabetic neuropathy treatment plan.

Sugars are readily digestible carbs. Once ingested, they cause a quick upsurge in blood glucose levels, causing a sudden rise in insulin levels. Frequent sugar consumption can accelerate insulin resistance. Thus, doctors recommend minimizing sugar intake when living with diabetes. But, of course, people have to satisfy their sweet tooth somehow. One of the ways of doing so is by using sugar substitutes. These sugar substitutes might be synthetic or natural, like saccharin or stevia. 

Sugar substitutes are unique in a few ways. They are zero calories, do not get converted to glucose, and consequently do not cause any upsurge in blood glucose levels. Yet, these sugar substitutes are much sweeter than regular table sugar. It means that adding them in minute amounts in beverages and desserts can make them taste sweet. The use of sugar substitutes is on the rise. They are added to beverages, and foods, that are often promoted as low-calorie or even zero-calorie. But are such foods and beverages really safe? Are these sugar substitutes as good as assumed?

New studies show that though they are relatively safe, they are not entirely safe. They may still make your diabetes worse. They can harm health in many ways, especially if you consume them in larger amounts, thinking they are completely safe. Of course, the degree of harm they cause varies. Some are less harmful, and others more. It means one should not abuse sugar substitutes by assuming they are completely safe. Of course, the question arises if they lack calories and do not cause an increase in blood sugar levels, how could they possibly harm health?

Researchers now know two ways in which sugar substitutes may harm health. There are likely some other ways, too. Researchers have been amazed to see that many of these sugar substitutes can still increase insulin resistance. It appears that when people use sugar substitutes, their brain is tricked. The brain still thinks that a person is consuming something sugary. Hence, the negative feedback system still works, as it would have worked after consuming sugar.

All this means that sugar substitutes still cause an increase in insulin secretion, and thus over time, they induce insulin resistance, quite like regular sugar. Of course, this upsurge in insulin levels will be lower than that induced by table sugar. But, nonetheless, it is there. Another issue with sugar substitutes is that they alter gut microbiota. These sweeteners do not provide calories, but they reach the large intestine, where most gut microbiota resides. Over the long run, sugar substitutes like saccharin, sucralose, and stevia can change gut microbiota composition.2

Of course, these substances are safe, and there is nothing to worry about. They are not going to cause any significant change immediately. Nonetheless, these findings are relevant. They show that one should not abuse these substances by assuming they are completely safe. These sugar substitutes are safer than table sugar in many ways. They do not contain calories and thus do not cause an increase in blood sugar levels. However, if a person starts consuming them too much, they might cause insulin resistance, changes in gut microbiota, and even low-grade inflammation.

This is not to say that one should stop using sugar substitutes. It is rather to say that one should not abuse them by assuming them to be totally safe. On the contrary, using them infrequently is quite safe. It is our mission to bring real hope and transformational change to patients who would otherwise be consigned to a lifetime of medications, doctor’s visits, and suffering. We expose misaligned incentives and return the power of health to the individual. We believe empowered individuals change their communities. We use a combination of lifestyle intervention, medication management, and emerging scientific research to help our patients.  When you are ready or have questions, reach out.

Medical Disclaimer: Keep in mind that the content provided is not direct medical advice for patient care, but is provided for thoughtful discussion.

By Gurpreet Singh Padda, MD, MBA, MHP