Nutritive and Non-Nutritive Sweeteners

NNNS: Diabetes and Glycemic Response (2006)

Diabetes and Glycemic Response: Non-nutritive sweeteners

• Intervention
  Can non-nutritive sweeteners (saccharin, aspartame, acesulfame-K, sucralose, neotame) be used to manage diabetes and glycemic response in people with diabetes?

  • Conclusion
    In a limited number of studies, NNS had no effect on changes in blood lipid profiles and glycemic response in adults with diabetes. No studies in children were identified. 
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: UNPUBLISHED Can non-nutritive sweeteners (saccharin, aspartame, acesulfame-K, sucralose, neotame) be used to manage diabetes and glycemic response?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cooper PL, Wahlqvist ML, Simpson RW. Sucrose versus saccharin as an added sweetener in non-insulin-dependent diabetes: short- and medium-term metabolic effects. Diabet Med. 1988 Oct; 5 (7): 676-680. PMID: 2975554.
      • Grotz VL, Henry RR, McGill JB, Prince MJ, Shamoon H, Trout JR, Pi-Sunyer FX. Lack of effect of sucralose on glucose homeostasis in subjects with type 2 diabetes. J Am Diet Assoc. 2003 Dec; 103 (12): 1,607-1,612.
      • Mackenzie T, Brooks B, O'Connor G. Beverage Intake, Diabetes, and Glucose Control of Adults in America. Ann Epidemiol. 2006 Jan 31; [Epub ahead of print].
      • Mezitis NH, Maggio CA, Koch P, Quddoos A, Allison DB, Pi-Sunyer FX. Glycemic effect of a single high oral dose of the novel sweetener sucralose in patients with diabetes. Diabetes Care. 1996 Sep; 19 (9): 1,004-1,005.
      • Reyna N, Cano C, Bermudez VJ, et al. Sweeteners and beta-glucans improve metabolic and anthropometrics variables in well controlled type 2 diabetic patients. Am J Therapeutics. 2003; 10: 438-443.
• Basic Research
  What is the intake of non-nutritive sweeteners (saccharin, aspartame, acesulfame-K, sucralose, neotame) in persons with diabetes, and is this within the Acceptable Daily Intake (ADI) of non-nutritive sweeteners?

  • Conclusion
    In a limited number of studies conducted outside the United States, children and adults with diabetes were found to have higher intakes of NNS as compared to controls, which did not exceed the Acceptable Daily Intake (ADI) in most instances. The exception was Swedish children’s intakes of acesulfame-K and saccharin, which was greater than the ADI when “worst case” estimates were used. Further studies are needed in both children and adults, specifically in the United States.

     

     

     

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: UNPUBLISHED What is the intake of non-nutritive sweeteners (saccharin, aspartame, acesulfame-K, sucralose, neotame) in persons with diabetes, and is this within the Acceptable Daily Intake (ADI) of non-nutritive sweeteners?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cullen M, Nolan J, Cullen M, Moloney M, Kearney J, Lambe J, Gibney MJ. Effect of high levels of intense sweetener intake in insulin dependent diabetics on the ratio of dietary sugar to fat: a case-control study. Eur J Clin Nutr. 2004 Oct; 58 (10): 1,336-1,341. PMID: 15054410.
      • Garnier-Sagne I, Leblanc JC, Verger P. Calculation of the intake of three intense sweeteners in young insulin-dependent diabetics. Food Chem Toxicol. 2001 Jul; 39 (7): 745-749.
      • Ilback NG, Alzin M, Jahrl S, Enghardt-Barbieri H, Busk L. Estimated intake of the artificial sweeteners acesulfame-K, aspartame, cyclamate and saccharin in a group of Swedish diabetics. Food Additives and Contaminates, 2003 Feb; 20 (2): 99-114.