Adam S. Nally, D.O.
about the sweeteners that can be used with a low carbohydrate diet. There are a number of sweeteners available
that can be used with cooking; however, many of them are not
use with a low carbohydrate diet.
an understanding that
weight gain or weight loss is controlled by the hormone insulin, our
goal is to lower the insulin levels in the blood stream.
Glucose (a carbohydrate in its most simple
form) stimulates insulin to rise. A
carbohydrate diet works because insulin levels are significantly
throughout the day. Elevation in
cholesterol, elevation in triglycerides and stimulus for production of
acid also occur because of surges in the hormone insulin. The most
stimulus for insulin to rise is the body’s recognition of the presence
carbohydrates or sugars.
and foremost, we
must understand how these carbohydrates or sugars are labeled or named
we can identify them in the food products we eat. Most
sugars are labeled with the ending “ose".
glucose, dextrose, lactose, and maltose are very common sugars you’ll
the ingredient list of many products containing carbohydrates. All of
types of sugars will stimulate a significant insulin rise and lead to
gain, elevation in cholesterol and triglycerides.
very commonly used
names that you will find containing the sugars above are: white and
sugar, succanat, corn syrup, high fructose corn syrup, honey, malt
juice, cane syrup, rice syrup, barley syrup, maple syrup, molasses,
and fruit juice concentrate. Beware of
products that contain "no added sugar" because they will often
contain sugar concentrates in the form of concentrated grape or apple
promoted as a suitable sweetener for patients with diabetes or people
wanting to follow a low-carb diet; however even though it does not
significant insulin rise, it is rapidly absorbed by the liver and
into glycerol which leads to increased triglyceride and cholesterol
levels. Even though fructose occurs
naturally in regular fruits and some vegetables, it is usually only
small amounts. The fiber in these fruits or vegetables balances out the
fructose content. Today, fructose is
added commercially to many foods in a highly refined purified form as
fructose corn syrup. Be careful because this form of fructose is found
drinks, ice teas, fruit drinks, jams, jellies, desserts, baked goods
in many baby foods. This form stimulates
an extremely powerful stimulus in the liver to form triglycerides and
fatty liver disease, a form of non-alcoholic cirrhosis (J Am Diet Assoc, Lustig RH, 2010 Sep;
Most artificial sweeteners
fall into a class that is referred to as “non-nutritive” meaning that
no nutrient value to the human body. They provide a sweet taste to the
without raising the blood sugar. These sweeteners can be useful in
in maintaining blood sugars; however, it is important to realize that
them still stimulate an insulin response.
The most popular
artificial sweetener in use today is aspartame
(NutraSweet™, Equal™). Aspartame
is calorie and carbohydrate
free; however, it is not the ideal sweetener for cooking. Because of its chemical
instability, it breaks down under heat into its chemical constituents -
phenylalanine and aspartic acid. This makes it notably unsuitable for
and for storage for more than a few days.
in light of its
safety profile maintained by the manufacturer, a number of people of
side effects including headache, stomach upset, migraine and
depression (Neurology October
1, 1994, vol.
1787). However, most people enjoy its use without problem. Most diet sodas have stop using this sweetener because of bad press, however, it still remains the only sweetener in diet soda that does not raise insulin levels. The following sodas still use aspartame: Diet Dr. Pepper, Diet Coke, Diet Mug Rootbeer and Diet A&W Cream Soda
A second popular sweetener
has been identified by the food and beverage companies called acesulfame potassium (Ace-K™, Sunette™).
This sweetener is not fully absorbed by the gut, and yields no
does it raise blood sugar. It also
contains no carbohydrates. To many
palates, it has a slightly bitter savor, so it is often combined with aspartame to eliminate the bitter
aftertaste. The problem with acesulfame
potassium is that there are a
number of studies revealing it significantly increases
insulin response without raising blood sugar. Studies
show that the insulin response is as
as if a person ingested an equivalent amount of glucose (Horm Metab Res. 1987 Jun; 19(6):233-8.). It
that acesulfame potassium works
directly on the pancreas to stimulate insulin release (Horm Metab Res. 1987 Jul; 19(7):285-9).
This product appears to be
one of the most popular artificial sweeteners currently used in a
number of low-carb
products. It can be found in many of the protein bars and protein
shakes on the
market. It is also found in Coke
Pepsi One™ and a number of other diet sodas. I
have found in my private medical practice that this
significantly limits weight loss.
(Splenda™) is actually derived from regular sugar in such a way that
doesn't recognize it, and it is not absorbed. It contributes no
carbohydrates to the body in its pure form. Amazingly, it remains
heat and has become ideal for cooking and baking. It
is available as a bulk sweetener and
actually measures equivalently to table sugar. Be
aware, however, Splenda™ is not carbohydrate free.
Because of the
maltodextrin used to make it bulk in nature, it contains about 0.5 g of
carbohydrate per teaspoon, or about 1/8 of the carbohydrate of sugar.
cause some insulin release and may lead to weight gain or difficulty
weight loss when used in excess (J Clin
Abstracts] June 2007 vol. 25no. 18_suppl 15127). 1 cup of Splenda™ is equivalent to 2
tablespoons of sugar, or 12-15 grams of carbohydrate in 1 cup of
Saccharine (Sweet’N Low™, SugarTwin™) is another
unstable chemical when heated,
however, it does not react chemically with other food ingredients and
stores well. It was used for quite some time as one of the original
sweeteners. It does not increase glucose
or blood sugar, but
it does stimulate an insulin response and can be problematic in weight
loss (Am Jour Physiol - Endo April
4 E336-E340). It is often combined with other
preserve their shelf life.
(SugarTwin™, Sucaryl™) is a sweetener available in Canada that is often combined with saccharine
similar to sucralose. However, there
is some controversy over this substance as it is known to cause bladder
in rats. There has been no human occurrence in its 30 years of study (Ann Oncol, October
2004, 15(10): 1460-1465.doi: 10.1093/annonc/mdh256).
This product is currently banned in the US because of the notable potential for
cancer. Cyclamate is stable in heat and
therefore is an alternative for cooking and baking.
is a non-caloric natural sweetener which contains no carbohydrate. He
rise from a South American plant and has been widely available for use
in Asia for many years. It comes from a shrub
called Stevia rebaudiana that has very sweet leaves. Stevia is in extract, a white powder that is derived from
leaves. It can be found today
commercially in extract, powder, or in a powdered green herbal leaf. It
intense sweet taste which actually does have the potential to be
bitter. Stevia has two faults. First, it
is so very sweet that it is hard to know just how much to use when
Second, he often has a slight bitter taste as well as a sweet one.
Therefore, stevia is often combined with
fructooligosaccharide (FOS). FOS is a
sugar, but it is such a large molecule that humans cannot absorb it. It
not raise blood sugar and it does not stimulate insulin release. Stevia
does not increase blood sugar and appears to improve insulin
sensitivity in the
pancreas (Metabolism, 2003
Mar;52(3):372-8.). FOS is only
half as sweet in table sugar; therefore, it makes it a perfect partner
Oligofructans (Chicory Root)
Fructooligosaccharides (FOS) are often called oligofructans and they are actually short chain fibers derived from inulin. These oligofructans exhibit sweetness between 30-50% of sugar and have been used commercially since the 1980's. They are commonly derived from chicory root, bananas, onions, garlic and the blue Agave. Because of their configuration, they resist breakdown by intestinal digestive enzymes, and instead, are broken down through fermentation in the colon by anaerobic bacteria. Therefore, eating larger amounts of FOS can lead to gastrointestinal "gymnastics." They do, however, combine well with other more intense sweeteners, and when combinded, improve the overall sensation of sweetness and diminish any aftertaste that can occur with other sweeteners.
The fructooligosaccharides do not raise blood sugar and have not been shown to effect insulin. Therefore, they are a good sweetener to use with a low-carbohydrate or ketogenic diet. [Daubioul CA, et al., Effects of oligofructose on glucose and lipid metabolism in patients with nonalcoholic steatohepatitis: results of a pilot study. European Journal of Clinical Nutrition (2005) 59, 723–726. doi:10.1038/sj.ejcn.1602127 Published online 16 March 2005]. A great option for use in cooking is a combination of FOS with erythritol called Swerve.
Sugar alcohols are also
called polyols. These are
a class of long-chain carbohydrates
that are neither sugar nor alcohol. Included in this group are maltitol, sorbitol, mannitol, xylitol,
erythritol, lactitol, and hydrolyzed starch hydrolysates (HSH). These sweeteners give the texture and
sweetness of sugar to corn syrup and can be used to make crunchy
jelly beans, and slick hard candies, moist brownies and creamy
chocolate. However, they are incompletely
absorbed by the
human intestine. This causes problems,
as side-effects of these long-chain carbohydrates include gas, bloating
diarrhea for a significant portion of people. The other issue is that
seems to be notable variability in people's ability to absorb these
carbohydrates. In other words, these
sweeteners affect people differently and may actually increase the
and insulin release in varying degrees among individuals.
Maltitol, sorbitol and xylitol
seemed to be worse offending culprits in this class of artificial
They cause an insulin response of about half that of normal sugar (American Journal
of Clinical Nutrition,
Vol 65, 947-950). Maltitol and
sorbitol have also been shown
to increase cholesterol (International
Journal for Vitamin and Nutrition Research, 1990 Vol.
60 No. 3 pp. 296-297). Erythritol
is absorbed and excreted unchanged and appears to have no insulin
and Chemical Toxicology Volume 36, Issue 12,
December 1998, Pages 1139-1174).
Erythritol also seems to inhibit fructose absorption (http://rave.ohiolink.edu/etdc/view?acc_num=osu1180462637). A great combination sweetener using stevia and erythritol is called Truvia.
sweeteners will not cause weight gain or cholesterol changes? From the research that is presently
available, aspartame, Stevia, and erythritol have no weight gain or cholesterol changes
with them. Splenda is a great
sweetener, but excessive quantities will limit your ability to loose
All of the other sweeteners listed above have significant insulin
ingested and will make it more difficult to lose weight.
I have found that combinations of Stevia,
Splenda and erythritol seem to provide adequate texture and remove any
aftertaste that may be found when using them individually.