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Recommendations Summary

DM: FDA-Approved Non-Nutritive Sweeteners (2015)

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    DM: Educate on Intake of FDA-approved Non-nutritive Sweeteners

    The registered dietitian nutritionist (RDN) should educate adults with diabetes that intake of FDA-approved non-nutritive sweeteners (such as aspartame, sucralose and stevia) within the recommended daily intake levels established by FDA will not have a significant effect on glycemic control. Research reports no significant impact of consuming FDA-approved non-nutritive sweeteners [such as aspartame, stevia (steviol glycosides) and sucralose], independent of weight loss, on A1C, fasting glucose levels or insulin levels.

     

    Rating: Weak
    Imperative

    DM: Educate About Substitution of FDA-Approved Non-Nutritive Sweeteners

    The registered dietitian nutritionist (RDN) should educate adults with diabetes that substituting foods and beverages containing FDA-approved non-nutritive sweeteners within the recommended daily intake levels established by FDA can reduce overall calorie and carbohydrate intake. However, other sources of calories and carbohydrates in these foods and beverages need to be considered. Use of non-nutritive sweeteners has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners without compensation by intake of additional calories from other food sources.



     

    Rating: Fair
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      These recommendations apply to consumption of FDA-approved non-nutritive sweeteners that are approved either as food additives or Generally Recognized as Safe (GRAS), within the Acceptable Daily Intake (ADI) levels established by FDA.

       

    • Potential Costs Associated with Application

      Costs of medical nutrition therapy (MNT) sessions and reimbursement vary. However, MNT sessions are essential for improved outcomes.

    • Recommendation Narrative

      • Limited research reports no significant impact of consuming FDA-approved non-nutritive sweeteners [such as aspartame, stevia (steviol glycosides) and sucralose], independent of weight loss, on A1C and fasting glucose levels in adults with diabetes (Nehrling et al, 1985; Grotz et al, 2003; Maki et al, 2008). No studies were identified that reported on the effects of saccharin, acesulfame K and neotame consumption among subjects with diabetes. Additional long-term studies are needed regarding the impact of consuming FDA-approved non-nutritive sweeteners on glycemia in adults with diabetes. Grade III
      • One study reports no significant impact of consuming FDA-approved non-nutritive sweeteners [such as stevia (steviol glycosides)], independent of weight loss, on endogenous insulin levels in adults with type 2 diabetes (Maki et al, 2008). No studies were identified in subjects with type 1 diabetes or that reported on exogenous insulin levels. No studies were identified that reported on the effects of sucralose, saccharin, acesulfame K, aspartame and neotame consumption among subjects with diabetes. Additional long-term studies are needed regarding the impact of consuming FDA-approved non-nutritive sweeteners on insulin levels in adults with diabetes. Grade III
      • One study reports no significant impact of consuming FDA-approved non-nutritive sweeteners [such as stevia (steviol glycosides)], independent of weight loss, on lipid profile and blood pressure in adults with type 2 diabetes (Maki et al, 2008). No studies were identified in subjects with type 1 diabetes. No studies were identified that reported on the effects of sucralose, saccharin, acesulfame K, aspartame and neotame consumption among subjects with diabetes. Subjects were not described as having any disorders of lipid metabolism, but only subjects with controlled hypertension were included. Additional long-term studies are needed regarding the impact of consuming FDA-approved non-nutritive sweeteners on lipid profile and blood pressure in adults with diabetes, especially those with disorders of lipid metabolism and hypertension. Grade III
      From the 2013 American Diabetes Association Nutrition Therapy Recommendations

      Use of NNSs has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners without compensation by intake of additional calories from other food sources. Grade B

    • Recommendation Strength Rationale

      • Conclusion Statements in support of this recommendation were given Grade III
      • The 2013 American Diabetes Association Nutrition Therapy Recommendations received Grade B.

    • Minority Opinions

      Consensus reached.