R. Gougeon, M. Spidel, K. Lee and C. Field: Canadian Journal Of Diabetes, 2004; 28(4): 385-399.
The current Canadian Diabetes Association Clinical Practice
Guidelines for the Prevention and Management of Diabetes
in Canada state that up to 10% of daily calories can be
derived from sugars. However, individuals with diabetes may
also be relying on alternative, low-calorie sweetening agents
(providing little or no calories along with sweet taste) to control
carbohydrate intake, blood glucose, weight and dental
health. Most low-calorie sweeteners, sometimes called
intense or artificial sweeteners, are classified and regulated as
food additives with set acceptable daily intake (ADI) levels.
The Health Canada Health Products and Food Branch
approved intense sweeteners for table-top use and as additives
in products such as soft drinks, chewing gum, fruit and
fruit spreads, dairy products and desserts.
review summarizes the literature on the potential health benefits
and risk associated with the consumption of non-nutritive
intense sweeteners (excluding polyols) and the evidence
for the safety of intense sweetener use among individuals
with diabetes and their effects on glycemia, appetite, weight,
blood lipids, blood pressure and renal function. Research
investigating the potential metabolic effects, benefits and risk
of intense sweetener use among individuals with diabetes,
children and adolescents, and pregnant and lactating women
was reviewed to draft evidence-based recommendations for
their use by people with diabetes.
Current evidence does not
support an earlier belief, reported in the medical literature,
that low-calorie sweeteners stimulate appetite or affect
mechanisms that regulate hunger and satiety. Evidence indicates
that daily consumption (up to ADI levels) of aspartame,
sucralose, saccharin, cyclamate and D-tagatose has no significant
effect on glycemic control or blood lipids in persons
with diabetes. Current evidence indicates that intense sweeteners,
used as an adjunct to multidisciplinary programs, may
improve weight loss and weight control in obese persons.
Consumption of intense sweeteners by older children and
adolescents is unlikely to exceed ADI levels. Aspartame consumption
below ADI levels has no effect on behaviour in children.
In pregnancy, saccharin and cyclamate are not
recommended, while other intense sweeteners have not been
shown to be unsafe during this time. Intense sweeteners are
most beneficial when they are used to replace energy-dense
and nutrient-diluted foods including sucrose, and are least
beneficial when used to displace nutrient-dense foods such as
milk, fruits and fruit juices.