Those artificial sweetener packets? They can be up to 600 times sweeter than sugar

Those colorful packets of artificial sweeteners at coffee shops and in grocery stores can be appealing to diabetics.

On the surface the products seem like a sure bet — they’re low in calories, pack a sweet taste and don’t significantly impact blood glucose levels.

“The obvious benefit for people with diabetes is they do not contribute to your caloric intake, and you may be able to have a sweet and stay within the parameters of controlling your blood sugar,” said Amy Kimberlain, a registered dietitian at Baptist Health South Florida.

However, Kimberlain and other health experts say these products may not always be the best option for the 34 million Americans living with diabetes.

“These sweeteners are insanely sweet,” said Dr. Michelle Pearlman, a gastroenterologist with the University of Miami Health System, who points out that substitutes can be anywhere from 300 to 600 times sweeter than table sugar. “I don’t promote artificial sweeteners.”

Sweeteners can cause spikes in blood sugar

In fact, Yale researchers published a study in March in the journal “Cell Metabolism” that found artificial sweeteners can cause spikes in blood sugar when consumed with carbohydrates. Another study out of India was published in January in the Journal of Family Medicine and Primary Care and found artificial sweeteners can cause insulin resistance.

“Our bodies and brains respond to these sweeteners in such a complex way,” said Kimberlain, a certified diabetes care and education specialist.

Pearlman said people can get hooked on the sweetness of artificial sweeteners, which also go by the names non-nutritive sweeteners or sugar substitutes. The sweeteners can also lead to indulging more during meals.

“Just keep in mind that sweeteners affect your microbiome and you’re going to feel hungrier,” said Pearlman, who has expertise in obesity medicine. “They alter your sweetness scale, so it influences what you eat in the future.”

Dr. Clifford Medina, the chief of general medicine at Mount Sinai Medical Center in Miami Beach, encourages his diabetic patients to educate themselves on these products so they can make the right choice for themselves.

“If you’re staying away from processed sugars, then theoretically it’s better to stay away from those sugars,” he said. “The best thing to do is to consider there are three classes of carbohydrates — regular sugars, starches and fibers — and a diabetic should try to consume them in a balance.”

Get sugar from fruits and vegetables, not sweeteners

Medina said diabetics should generally try to focus on getting their sugar from natural sources, such as fruits and vegetables.

“You should consider high-fiber diets,” he said. “One of the methods that has been promoted by the American Diabetes Association is the 9-inch plate rule. Half of the plate should be high-fiber vegetables like cucumbers and tomatoes.”

Then another quarter of the plate can consist of high-fiber carbs such as whole grains, while the rest of the plate can be lean meats such as chicken or a plant-based source of protein such as tofu.

“By eating in that fashion you’re seeing a nice balance,” Medina said.

This advice mirrors what Pearlman tells her patients about sugar alternatives.

“It’s about using food as your sweetener,” Pearlman said.

Talking to a medical professional, especially a nutritionist, can be critical in a patient’s care. Kimberlain said she tries to encourage mindfulness with her patients, and encourages them to take a step back before eating food with artificial sweeteners and ask themselves: Why am I using this?

“We eat in such a rushed manner, we really need to pause and reflect on what we’re eating,” she said. “What I tell people is to do a pair testing. To eat a meal and test a few hours later to see how their body responds.”

This way if a sweetener causes a spike, the patient will know it right away and can adjust their intake accordingly.

The most important tip she can give people with diabetes is to take things a step at a time.

“We’re always works in progress,” Kimberlain said.