Sweeteners and sugar... it's a minefield!
Sweeteners are recommended to replace table sugar in many recipes but with so many different sweeteners on the market, it can be extremely confusing knowing which ones to use and the pros and cons of each type.
Here we will share some information with you which will hopefully help you with selecting which sweeteners to try and also which ones you may prefer to avoid.
We will also talk about sugar and different types or forms of sugar which many may think would be acceptable on a gestational diabetes diet as they are thought of as 'natural' forms of sugar e.g. honey.
Curbing that sugar craving
Cutting back on sweet foods and drinks will help your body adjust to less sugar in your diet and eventually the sugar cravings will subside. For that reason, some ladies prefer to forgo sweetened food and drinks to help them cope with the change in diet longer term.
The trouble is that sugar (and carbs which turn to sugar in the bloodstream) are hidden in so many places that many will not realise the amount that is hiding in their seemingly 'healthy' diets. Which means that they don't necessarily know where or how they can cut sugar back, as in their eyes, they're not eating any! So it really helps to understand where sugar and carbs are hiding. This information can be found on our confused about carbs page.
Granulated Sugar (table sugar, white sugar, brown sugar)
Something that always amazes me is the amount of ladies who are diagnosed with gestational diabetes who still add sugar to hot drinks or food. They may have cut back, but they still add it.
Any sugar which is added, is sugar which the body has to process. Sugar releases straight into the bloodstream and causes blood sugar levels to rise and the body has to release insulin to process the sugar.
With gestational diabetes, we do not produce or use as much insulin as we normally do, or as effectively as we normally do, so the odds are stacked against us (and more importantly your baby/babies) straight away.
Sugar digested as part of any food takes away from the rest of the meal which could be used for food with more nutritional goodness.
Sugar dissolved into liquid is absorbed even faster into the bloodstream and so it acts like a direct hit of sugar. For this reason, it's best to avoid adding ANY additional sugar to your diet when you have gestational diabetes.
Make the choice with sugar:
- Eat or drink sugar which makes diet control and stabilising your blood sugar levels for your baby much more difficult and will feed the craving for more sugar
- Omit sugar completely and replace with alternatives which do not raise blood sugar levels as high
- Omit sugar completely from the diet, go 'cold turkey'
Other forms of Sugar (honey, maple syrup, molasses, treacle, golden syrup, coconut sugar, dried fruit etc)
Straight away, many ladies jump to thinking that 'natural' alternatives like honey, maple syrup or dried fruit may be a good healthy alternative to table sugar for sweetening things.
Honey in particular is raised in our support group as something that many perceive as being a natural alternative to sugar, however even raw honey will raise blood sugar levels.
These are all forms of sugar and will still spike blood sugar levels. Some may have lower GI (Glycaemic Index) than table sugar, but they will still all raise blood sugar levels.
Many high protein bars contain honey and/or dried fruits like apricot or dates for sweetening them and so yes they may have 'no added sugar', be 'high in protein' but a bar that is packed with dates and honey is going to spike your blood sugar levels the same as any sweet candy bar!
Are sweeteners safe to use?
Although there is much controversy over artificial sweeteners, they are deemed as safe to consume:
All sweeteners in the EU will have undergone a rigorous safety assessment by the European Food Safety Authority (EFSA) or its predecessor, the Scientific Committee on Food (SCF), before they can be used in food and drink. "Large studies looking at people have now provided strong evidence that artificial sweeteners are safe for humans."As part of the evaluation process, the EFSA sets an acceptable daily intake (ADI), which is the maximum amount considered safe to consume each day over the course of your lifetime. You don't need to keep track of how much sweetener you consume each day, as our eating habits are factored in when specifying where sweeteners can be used.
Are sweeteners safe to use in pregnancy?
While data concerning the use of sugar substitutes during pregnancy are limited, they do not suggest an increased risk of toxicity, adverse pregnancy outcomes, or neonatal issues. It is recommended that they be consumed in moderation and that pregnant women adhere to the ADI (acceptable daily intake) levels outlined by regulatory directives.
Sugar substitutes during pregnancy 2014 Nov
Different forms of sweeteners
There are lots of different types of sweeteners available on the market ranging from artificially made sweeteners, to natural sweeteners. Some come in tablet form, others are fine powders, some are very similar to sugar granules and there are also liquid sweeteners. These different sweeteners have a range of pros and cons and many people will find that they will choose to use different sweeteners for different things.
Sweeteners which come in tablet form are best used for adding to hot drinks. They are a direct replacement for sugar, one tablet being the equivalent of one tsp of sugar. They dissolve into hot liquids well, but many people feel they leave an aftertaste.
These tablet sweeteners can usually be bought in most shops at reasonable cost.
Granulated sweeteners (fine powdered sweeteners)
Most shops sell granulated sweeteners which are actually more of a very fine powder than 'granulated' in crystals like sugar (despite them being called 'granulated').
These granulated sweeteners are often made from maltodextrin. Maltodextrin is a highly processed, neutral tasting white powder made from rice, corn, wheat, or potato starch. It is a filler, thickener and preservative.
One tsp of this type of granulated sweetener is usually equivalent to one tsp of sugar, but this is where things can get complicated! These powdered sweeteners weigh much less than sugar and so if using this type of sweetener in a recipe you cannot use weight measurements like for like eg. 90g of sugar would not be 90g of granulated sweetener. This is one of the biggest mistakes people make when using these granulated sweeteners as a direct replacement for sugar in recipes.
To confuse matters further, there are lots of different types and brands of granulated sweeteners and it is advisable to read the label of the jar if using this type of sweetener in recipes, as you may need to convert the amount required from the details given.
TOP TIP: Never presume that the weight of one sweetener recommended in a recipe will be the same for all sweeteners. You should decide which sweetener matches your needs and add it to your personal taste!
Granulated sweeteners are versatile for many uses, from drinks to recipes. Using them in drinks, they can leave a froth on top of the drink and some people feel they leave an aftertaste.
These powdered granulated sweeteners are available to buy in most shops at reasonable cost.
Granulated sweeteners (ones which are actually granulated!)
By this I'm referring to sweeteners that are the same texture as granulated sugar. These sweeteners tend to cost more and are not so widely available. They are very versatile and can be used as a direct replacement for sugar in most recipes.
Many people prefer these type of sweeteners as a direct replacement for sugar as they have the same crunch, taste and texture.
Some granulated sweeteners such as xylitol caramelise like sugar when baking and so make for a perfect choice when baking things like GD brownies.
One type of liquid sweetener which is now more widely available is agave nectar.
Whereas sweetener drops and sugar free syrups are more specialist products that may need to be ordered from specialist stores or online and can be quite costly.
Different types of sweeteners
Stevia products (often the green lidded jars)
Stevia is a sweetener made from the sweet leaves of the stevia (Stevia rebaudiana) plant, native to Brazil and Paraguay.
Stevia can be around 300 times sweeter than table sugar and so a much smaller amount is needed to replace sugar, this is very important when adding to recipes! Using too much stevia may leave a bitter aftertaste.
Stevia is often blended with other types of sweeteners and so it is best to check the label to see whether you are buying 100% stevia product, or one which is mixed with other compounds. Stevia may also be called 'steviol glycosides' on ingredient labels.
100% pure stevia which is derived from the natural stevia plant, without added elements can be much more expensive than a stevia product which has been blended with other ingredients.
Do not be fooled into thinking you are purchasing an all natural sweetener as it contains some stevia!
Erythritol and Stevia blends
Erythritol is naturally occurring in many fruits and vegetables such as pears, melons, mushrooms, and occurs from the fermentation process. It is a polyol (or sugar alcohol) which does not raise blood sugar levels.
Erythritol is 60-70% as sweet as table sugar and is only partially absorbed by the body, excreted in urine and feces meaning it does not cause digestive tract upset like some other sweeteners.
Truvia is a brand of sweetener that is widely available in most shops and it is a mixture of stevia and erythritol (both natural sweeteners). The erythritol is the bulking ingredient which provides the crystal like granule like granulated table sugar.
To use Truvia in recipes as a replacement of sugar, you should use this conversion chart for working out the recommended amount needed.
Another similar product is Natvia. Natvia can be used spoon for spoon like sugar and so takes away the hassle of trying to work out how much sweetener is needed to replace sugar like for like.
The biggest issue I find with Natvia is that is much harder to find in stores to purchase, although it is available to purchase online easily.
One benefit is that they make some alternative products like an icing sugar alternative, which may be handy for decorating GD friendly cakes or cupcakes for special occasions like baby showers or Birthday parties!
Sukrin is the other large brand of stevia and erythritol blended sweetener. Sukrin has 3 types of products, Sukrin:1 which is a direct replacement for white sugar, Sukrin Icing which replaces icing sugar and they make the only brown sugar alternative called Sukrin Gold.
Xylitol (like Total Sweet)
Xylitol can be found in many fruits and vegetables, but is usually made from wood (birch and beech wood), so also has the name 'birch sugar' or 'wood sugar'. It is a sustainable source that is a bi-product from the paper making industry.
It is a polyol, also known as a 'sugar alcohol' which has a very low GI of 7, meaning it has little effect on blood sugar levels.
Xylitol may cause stomach upsets if eaten in large quantities and is toxic for dogs.
It is often found in chewing gums to help fight cavities and is actively promoted for good tooth health, inhibiting mouth bacteria and helping to repair tooth enamel.
Xylitol is the texture of granulated sugar and can be measured like for like, making it much easier to substitute for table sugar.
It can also caramelise when baking, meaning it can give the nice shiny crisp top to things like brownies. It does not cause a bitter aftertaste like many other sweeteners.
Total Sweet Xylitol is now available throughout the UK and Ireland at selected retailers, including Sainsbury’s, Waitrose, Tesco, Ocado, Amazon, Super Valu, Holland & Barrett, Grape Tree, GNC and independent health stores. Click here to find your local stockist.
Agave Nectar or Syrup
Agave nectar is very similar to honey or syrup as it is a runny texture which can be used for drizzling. Agave nectar or syrup is produced commercially in Mexico and South America from the agave plant (the tequila plant).
Agave is sweeter than honey, so can be used sparingly.
Although marketed as a healthy alternative it has been the subject of criticism due to its very high fructose content (70-90% fructose) which is even more than high fructose corn syrup and its potential to lead to insulin resistance and significantly increased triglyceride levels which is a risk factor for heart disease.
There is a lot of controversy over artificial sweeteners and lots of conflicting research around the use of them. It is up to each individual to research and make an informed choice around using artificial sweeteners.
Many diet, zero and no added sugar products, especially drinks contain these type of sweeteners.
Sucralose (usually the yellow lidded jars and branded product Splenda)
Sucralose can be up to 1.000 times sweeter than table sugar and so very small amounts are needed to achieve sweetness.
Sucralose keeps it's flavour and taste even when baked at high temperatures, hence it can be a popular choice for baking and recipes.
Sucralose has been reported to cause bloating, cramping, flatulence and cause laxative effects in some individuals, usually when eaten in larger amounts.
Aspartame, Saccharin, Acesulfame K (usually the red lidded jars and branded product Canderel)
All these types of sweeteners are artificially made.
Canderel (aspartame and acesulfame K), Hermesetas (tablets and liquid are saccharin based and the granulated Hermesetas is aspartame based), Sweetex and Sweet N Low (saccharin) are all well known brands of these artificial sweeteners.
With the tablet sweeteners, usually one tablet is equivalent to a tsp of sugar.
Aspartame is around 200 times sweeter than table sugar. It must be avoided by people with the genetic condition phenylketonuria (PKU)
Saccharin is around 400 times sweeter than table sugar and is known to leave a bitter aftertaste, especially when consumed in high amounts.
Acesulfame K or acesulfame potassium is around 200 times sweeter than table sugar.
These type of sweeteners have been reported to aggravate or worsen those who suffer with migraines and can cause bloating, cramping, flatulence and cause laxative effects in some individuals, especially when eaten in larger amounts.
Some small studies comparing saccharin to stevia now suggest that these type of sweeteners can alter the gut bacteria, may cause increased insulin resistance and may raise blood sugar levels.
Other common sweeteners found in products
Here are a few more commonly found sweeteners found in sugar free, low carb or no added sugar products:
- Sodium cyclamate
This is not an exhaustive list as there are lots of different sweeteners used in products. Many of these can cause bad gastric side effects when consumed in higher amounts.
We don't advocate purchasing specialist sugar free chocolate, biscuits and treats as many ladies find these cause bad gastric side effects and these products can often be priced higher than regular foods and drinks. To learn more about diabetic and specialist sugar free products, take a look at this page. For help with eating chocolate, our page on chocolate explains better choices and ideas on pairing the chocolate to slow down the release of glucose into the bloodstream.
Total carbs in sweeteners
The total carb amount in sweeteners can be very confusing. You will notice that the carb amounts in sweeteners can be very high, so how can they work on a low carb diet?
We learn on a diet where we are reducing carbs that high carb products are not good due to them converting into sugar in the bloodstream, therefore causing higher blood sugar levels. However, the exception of this are sweeteners. Whilst they are high in carbs, this type of carbohydrate does not get processed or broken down in the body the same way that other carbs do and have less effect on blood sugar levels.
Tip: Polyols (or sugar alcohols) may be highlighted on nutritional information as part of the carb breakdown.
What's sweet for me, might not be sweet for you!
If you decide you want to use sweeteners within your gestational diabetes diet, the key thing to remember is that we all have different tastes when it comes to sweetness! If making recipes it's always best to start with small amounts and then add more afterwards. You can always add more, but you can't take away once it's been added!
Although our study, and the one that preceded it, were both on small numbers of people, the consistent results – alongside the results found previously in mice – certainly suggest that saccharin is bad for some people, whilst we have no evidence that stevia is. The people whom saccharin tends to affect seem to be those with a specific gut bacteria composition, but there is no easy way to find out whether you are one of those people or not, so overall our advice has to be to avoid saccharin. The evidence in mice is that aspartame and sucralose may have a similar effect, but ours are the only results for stevia and they do not show a negative effect, so if you are looking for a sugar alternative then at the moment, stevia seems most likely to be the best out there. On the back of packaging it is sometimes called ‘steviol glycosides’, which are the sweet-tasting compounds in the Stevia plant.
We identified 6 eligible cohort studies and 2 RCTs (n = 15,641 children). Half of the cohorts reported increasing weight gain or fat mass accumulation with increasing NNS intake, and pooled data from 2 cohorts showed a significant correlation with BMI gain (weighted mean correlation 0.023, 95% confidence interval 0.006 to 0.041). RCTs reported contradictory effects on weight change in children receiving NNSs. No eligible studies evaluated prenatal or infant NNS exposure.
There is limited and inconsistent evidence of the long-term metabolic effects of NNS exposure during gestation, infancy, and childhood. Further research is needed to inform recommendations for the use of NNSs in this sensitive population