Glycemic Index: How Artificial Sweeteners Rank, Plus the Best Ones for People With Diabetes

It's widely known that sugar is best enjoyed in small amounts. This awareness has led to a rise in the number of sugar substitutes on the market. From Splenda to stevia to monk fruit, there are many options available, including sweeteners that are lower on the glycemic index (GI).

While GI isn't the only way to decide on a sweetener, it can help you choose a sweetener based on how it will affect your blood sugar.

What is the glycemic index?

Developed in 1981, the GI helps people understand how quickly their blood glucose levels are likely to rise after eating a particular food.

When you eat foods containing carbohydrates (carbs), your body breaks them down into glucose. Glucose is the simplest form of sugar. It's also the body's main energy source. Foods rich in fast-release carbs or sugar cause your glucose levels (blood sugar) to rise quickly. These are considered high GI foods.

On the other end of the spectrum, foods that cause a low and slow rise in blood sugar are considered low GI foods. These foods are better for someone with diabetes or prediabetes who's concerned about their blood sugar levels.

The GI ranking system looks like this:

• Low GI: foods with a GI of 1 to 55

• Medium GI: foods with a GI of 56 to 69

• High GI: foods with a GI of 70 and up

The GI of plain glucose has a score of 100, which represents the fastest your blood sugar can rise.

Are low glycemic sweeteners healthier?

Typically, foods that have a low to medium GI are considered healthier than those with a high GI. So, in the context of sweeteners, a low GI sweetener may be a healthier alternative to refined table sugar if you have prediabetes or diabetes.

The healthiest option for all people is to cut back on sugar and sweeteners wherever possible. A low-sugar diet has been linked to many health benefits, including lower rates of diabetes and other metabolic disorders, healthier blood pressure, and improved dental health.

There's emerging evidence that, despite their low GI, long-term use of artificial sweeteners may be linked to increased appetite, weight gain, and Type 2 diabetes.

Sugars and sweeteners ranked from highest to lowest glycemic index

Below are GI values for different types of sugar.

Sugar

Sugar alcohols

*This is not a complete list of sweeteners, but rather examples of the different types that exist.

How should you use the glycemic index to pick the healthiest sugar or sweetener?

It depends on your health goals. For example, if you have prediabetes or diabetes, you might consider a sweetener that's on the lower end of the GI scale or even one with a GI of 0.

If you're looking for the "healthiest" sugar, maple syrup, coconut sugar, and molasses may be better choices, if they don't cause your blood sugar to spike too much.

Apart from GI, though, serving size and portion size are also important. Put another way, how much you consume matters as much as the GI of an individual food. This is expressed as the "glycemic load" of a food. It might be healthier to consume a small amount of a higher-GI sweetener than a large amount of a lower-GI sweetener.

And generally, it's best to focus on the glycemic load of your whole plate or meal rather than the GI of an individual ingredient. For example, you could choose to add a low-GI sweetener to your coffee. But if you drink that alongside a glazed doughnut, then the glycemic load of your whole snack is still high.

Which sweeteners are best for people with diabetes?

Based on some available research, sugar alcohols and natural sweeteners seem to have the least impact on glucose and insulin levels compared to other sweeteners.

Other research suggests that artificial sweeteners, like sucralose, can actually lower people's sensitivity to insulin and make them more insulin resistant. Long-term use of artificial sweeteners may also be linked to worsening metabolic health. This tells us that more research on the long-term effects of artificial sweeteners is needed to understand the impact on people with diabetes. In other words: There's more to it than GI alone.

Which sweeteners should people with diabetes avoid?

People with diabetes should avoid high glycemic index sweeteners. And medium glycemic index sweeteners should only be used in very small amounts to avoid a large glycemic load.

There's some evidence that artificial sweeteners can actually raise blood glucose levels, even though the sweeteners contain zero calories and have a low glycemic index. These include sweeteners like:

• Sucralose

• Aspartame

• Saccharin

Experts believe these artificial sweeteners change the bacteria (the microbiome) in a person's gut. The microbiome has been shown to have far-reaching effects on a person's metabolism.

Early research has also found that people who consume high levels of the sweetener erythritol were twice as likely to have a stroke or heart attack. People with diabetes are already at higher risk of both heart attack and stroke and may need to avoid erythritol as well.

The FDA stands by the safety of aspartame and other artificial sweeteners, though they don't specifically address their use by people with diabetes. Until more research is available, you should talk to a healthcare professional about the best sweeteners for you to use and which ones to avoid.

Other factors to consider when choosing the healthiest sweetener

Using GI or glycemic load may not be the only factors to consider when choosing a sweetener, though. Here are a few reasons why:

• Your whole diet matters. You're probably not eating a sweetener by itself. You may be mixing a sweetener into a beverage or food. And the nutrients in that beverage or food can control how fast your blood sugar increases.

• Sweeteners differ. The GI value doesn't give the full picture of a sweetener's quality. Some higher GI sweeteners - like coconut sugar or honey - are unrefined, whereas sugar alcohols and artificial sweeteners are processed.

• Diet and exercise are key. Your overall diet and lifestyle play a much bigger role on your health. Following a nutritious diet, exercising regularly, and getting quality sleep will have a bigger effect on your health than the sweetener you eat.

• Your time matters. Calculating the GI and glycemic load can take a lot of work or be a lengthy process.

If you're not sure where to start to develop a well-rounded diet, work with a nutritionist or dietitian to come up with a plan that supports your individual health goals.

What are the healthiest sweeteners?

In short, it depends. Having certain health conditions may make some sweeteners healthier options than others. How much sweetener you eat can also make a difference in how it affects your body.

Here's a look at the benefits and risks of each sweetener type. Remember, regardless of the type, use sweeteners in limited amounts.

Benefits and risks of different sweeteners

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