Artificial sweeteners are approved sugar substitutes that provide sweetness without calories. While they are beneficial for managing blood sugar levels in diabetic patients, studies show artificial sweeteners may increase obesity risk and type 2 diabetes incidence in non-diabetic individuals by not curbing sweet cravings as effectively as sugars. The document discusses various artificial sweeteners approved by the FDA like aspartame, acesulfame potassium, and saccharin, and their properties, effects on blood sugar levels, and implications for diabetes and weight management.

1. • Role of Artificial Sweeteners in
Diabetes
Dr. M. Uwais Ashraf
JN Medical College, AMU Aligarh

2. An introduction to sugars
Going back to 327 BC, the
people of India used raw sugar.
Since then,
humans have an
acquired taste for
sugar.
Sugar can be a GOOD thing or a BAD
thing. It has it’s pros and cons.
+ poor judgment =

3. What is sugar?
Sugar is
derived from
sucrose.
Sucrose is complex
carbohydrate that is
made up two
sometimes more
simple sugars that
are attached
together.
Carbs in sugar = Disaccharides
The
carbohydrates in
sugar are called
disaccharides.
Disaccharides
are groups or
compounds that
have a link
together between
carbon in one
sugar and a
hydroxyl group
from any
position on the
other sugars

4. TYPES OF SUGAR
Refined Sugar
Refined sugar is sugar that has been
purified through a process. We call that
pure cane sugar.
Raw Sugar
Raw sugar is the pre stage of final refined sugar.
Raw sugar is cane sugar in its middle form
before being refined. The raw sugar is made in a
sugar cane milling area, and is tan colored in
appearance due to the evaporation of disinfected
sugar cane juice.
Brown Sugar
Brown sugar crystals are sugar crystals that have a
molasses coating with its natural flavor and color.
Another way is when the molasses is spun with the
white sugar crystals until it has become dry. The
excess molasses syrup is what gives the sugar the
brown color.
Turbinado Sugar
Turbinado sugar is the raw sugar crystal that have gone through the refinery stage to
give it the light tan color by having it placed in a centrifuge machine to take out the
molasses contained on the surface.

5. Sweeteners
• Definition : food additive which adds the basic taste of
sweetness to a food, provides texture, bulking properties,
aroma and color.
• Sugar is a major sweeteners in food industry.
• Sugar is used to prolong or extend food shelf life
ex : fruits and vegetables, cooking spices.
• Sugar is also used in bakery, confectionery, jelly, soft
drinks and fermented beverages.
• Sweeteners that aren't purely sugar are sugar substitutes.

6. Types of Sweeteners
• "Nutritive" and “Non-nutritive" :
• Nutritive: The amount of energy provided is
around 4 kcal/g.
• Sugar alcohols or polyols: Less energy per
gram (2 kcal/g); not fully absorbed from the
gut
• Non-nutritive sweeteners offer no energy (or
insignificant energy): high-intensity
sweeteners

7. Nutritive Sweeteners
• Crystal (Sucrose, Dextrose, Fructose, Glucose,
Lactose)
• Honey
• Fruits
• Invert Sugar (by sucrose hydrolisis)
• Syrups :
Glucose, Maple, birch, pine, palm, sugar beet, sorghum,
corn, cane, barley malt, molasses, brown rice, etc.
• Sugar alcohols :
Sorbitol, xylitol, manitol, polyol, etc

8. Nutritive Sweeteners
• Crystal (Sucrose, Dextrose, Fructose, Glucose,
Lactose)
• Honey
• Fruits
• Invert Sugar (by sucrose hydrolisis)
• Syrups :
Glucose, Maple, birch, pine, palm, sugar beet, sorghum,
corn, cane, barley malt, molasses, brown rice, etc.
• Sugar alcohols :
Sorbitol, xylitol, manitol, polyol, etc

9. Nutritive Sweeteners
• Occupy large portion of the space on grocery
store shelves worldwide.
• Satisfy consumer’s desire for sweetness
• Play other important role in food ex : provide
texture, stability, and color.
• Increasing concern about tooth decay,
obesity and diabetes.

10. • Foods and drinks that use artificial sweeteners are
another option that may help curb cravings for
sweet.
• Sometimes artificial sweeteners are also called
low-calorie sweeteners, sugar substitutes, or non-
nutritive sweeteners.
• Their sweetening power is at least 100 times more
intense than regular sugar, so only a small amount
is needed.

11. • Also, with the exception of aspartame, all of the
sweeteners known so far cannot be broken down by
the body.
• They pass through our systems without being digested
so they provide no extra calories
• There are five artificial sweeteners that have been
tested and approved by the U.S. Food and Drug
Administration (FDA):
– Acesulfame potassium (also called acesulfame K)
– Aspartame
– Saccharin
– Sucralose
– Neotame

12. • These sweeteners are used by food
companies to make diet drinks, baked
goods, frozen desserts, candy, light
yogurt, and chewing gum.
• Many people feel that using artificial
sweeteners instead of sugar is the
healthier choice.
• But, researchers are now saying the
opposite may be true.

13. • The American Heart Association suggests
that people should avoid added sugars,
which are sugars and syrups put in foods
during preparation, processing etc.
• They been linked to obesity, type 2
diabetes and metabolic syndrome, which
includes risk factors for heart disease and
stroke.

14. • An opinion article published on July 2010
in Trends in Endocrinology and Metabolism
reveals that artificial sweeteners like
aspartame, sucralose and saccharin may not
be as good as one may have thought.
• About 30 percent of adults and 15 percent of
children in the U.S. currently use artificial
sweeteners

15. Overconsumption of sucrose:
• The most common problem is dental caries or tooth decay.
• Oral bacteria convert sugars (sucrose) into acids  attack
tooth enamel.
• Obesity

16. • Sucrose, is a pure carbohydrate, high food
energy content 4 kcals per gram or 17
kilojoules per gram)  hypercaloric
• Raises blood glucose
• Can cause problems for people suffering from
defects in glucose metabolism, such as
persons with hypoglycemia or diabetes
mellitus.

17. Sugar-sweetened beverages are associated with
increased weight gain and increased risk for
development of type 2 diabetes in women. The
authors suggest that the association may be the
result of excessive calorie intake from sugar-
sweetened beverages and increased availability of
large amounts of rapidly absorbable sugars.
Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, Hu
FB: Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in
young and middle-aged women. JAMA292 : 927-934,2004

18. Relative Sweetness
Sweeteners Relative
Sweetness
Sweeteners Relative
Sweetness
Fructose 114 Maltose 40
Sucrose 100 Lactose 39
Invert Sugar 95 Cyclamate 3000
Glucose 69 Saccharin 30000
Sorbitol 51

19. GLYCEMIC INDEX
• The Glycemic Index is an indication of how
quickly a specified amount of food will
cause a rise in blood sugar level.
• The glycemic index for sweeteners is a
function of three things:
1. The amount of carbohydrate present.
2. The type of carbohydrate present.
3. The presence of other substances (soluble fiber for
example) that slow metabolism of carbohydrates.

20. • Glucose has a glycemic index (GI) of 100
and fructose is 25.
• Sucrose (Ordinary sugar) which is made
up of a combination of these two has a GI
of 65.
– Rating System for Glycemic Index:
Below 55 - low GI.
56 to 69 - medium GI.
Above 70 -high GI.

21. • Common Glycemic Indices
• Glucose 100
• Sucrose 65
• Maltose 105
• Honey 50
• Fructose 25
• Glycerol 5
• Sorbitol 4
• Aspartam 0
• Cyclamate 0
• Saccharin 0

22. Glycemic Index of Various Sugars

23. Nonnutritive sweeteners
• Adenosine monophosphate (AMP)
• Acesulfame potassium/sunett
• Alitame/Aclame
• Aspartame/nutrasweet
• Anethole
• Cyclamate
• Clycyrrhizin
• Inulin

24. Non Nutritive Sweeteners
• Lo han guo
• Neotame
• Perillartine
• Saccharin
• Selligueain
• Stevioside
• Sucralose

25. Nonnutritive Sweeteners
5 non-nutritive sweeteners approved by FDA
• Aspartame
• Acesulfame potassium
• Saccharin
• Sucralose
• Neotame (most recently)

26. • Some studies have indicated that zero calorie
sweeteners do not help reduce weight, and
this may explain the reason. However this does
not take into account several useful aspects of
zero calorie sweeteners:
1. They do not cause a blood sugar spike and this alone is
beneficial to health.
2. They are suitable for diabetics who would otherwise have a
limited choice of sweet things.
3. They are harmless to teeth.
4. All things being equal they contain no calories and should be of
assistance in a diet plan.

27. Saccharin
• In 1977, FDA proposed a ban on use of saccharin because it was
reported to be a carcinogen in rats
• In 2001, products with saccharin no longer need to carry a
warning of its use associated with causing cancer in laboratory
animals
• ADI for saccharin to 5 mg/kg bw/day

28. • Despite the decline in usage since a peak in
1982, saccharin is the largest volume, lowest
cost, high-intensity sweetener used in the
world
• It is approved for use in over 100 countries and
has shown increased popularity in India
• Ammonium saccharin, Ca-saccharin, and Na-
saccharin forms are available

29. Aspartame
• A dipeptide (L-α-aspartyl-L-phenylalanine methyl ester)
• Intestinal esterases hydrolyze aspartame to aspartic acid, methanol,
and phenylalanine.
• Metabolized to provide 4 kcal/g,

30. • Only minute amounts need to be added, the
amount of energy derived is egligible.
• In 1981, approved by FDA
• FDA requires that foods that contain aspartame
have the prominent display of the following
label:
"PHENYLKETONURICS: CONTAINS
PHENYLALANINE"

31. Acesulfame-K (ACE-K )
• 5,6-dimethyl-1,2,3-oxathiazine-4(3H)-one-2,2-dioxide
• Pharmacokinetic studies: 95% excreted unchanged in
urine and does not provide any energy
• Consumption of acesulfame-K does not influence
intake of potassium

32. • Acesulfame-K can withstand high
temperatures.
• FDA first approved acesulfame-K in 1988, and
it is currently approved as a general-purpose
sweetener.
• ADI of up to 15 mg/kg bw/day

33. Acesulfame Application
• Low calorie beverages
• Sweets / candy
• Ice cream
• Jam, marmalade

34. Nonnutritive Sweeteners Characteristics

35. Obesity
• There is no current evidence supporting a "direct link"
between increasing obesity and increasing sweetener
intakes (energy)
• High intakes of fructose increase energy intake and
obesity risk through the blunting of circulating insulin and
leptin levels.
• Nonnutritive sweeteners have the potential to save the
consumer up to 16 kcal/tsp of sweetening.
• Replacing intake of added sugars with nonnutritive
sweeteners could result in a deficit of 380 cal/day or 1
pound of weight loss in 9 to 10 days, if intake was at 95 g
(24 tsp) daily

36. Diabetes and glycemic response
• Current evidence does not indicate that, in isocaloric amounts,
glycemic response to nutritive sweeteners differs from dietary
starch
• Intakes as high as 60 g fructose or sucrose per day may not
adversely affect glycemic or lipid response in persons with
type 2 diabetes However, because there exists concern for
increased blood lipid levels with high intakes of fructose,
addition of fructose as a sweetening agent is not recommended
for people with diabetes

37. • Polyols produce a lower glycemic response
than fructose, glucose, or sucrose, most likely
because of their incomplete absorption.
• Nutritive sweeteners need not necessarily be
restricted, but, if consumed, they should be
substituted for other carbohydrate sources
• Nonnutritive sweeteners do not affect
glycemic response and can be safely used by
those with diabetes

38. Effects of Artificial Sweeteners in Diabetic Patients
• Whereas, sweeteners have been found to be
detrimental for non-diabetic patients, they have
been found to be useful in diabetic patients:
– They act as substitutes for sugars which impair glycemic
control in diabetic patients.
– Have been shown to improve metabolic and
anthropometric variables in well controlled Type 2 Diabetic
patients*
* Nadia Y Reyna, Climaco Cano et al. Sweeteners and Beta Glucans Improve Metabolic
and Anthropometric Variables in Well Controlled Type 2 Diabetic Patients. American
Journal of Therapeutics 10, 438-443 (2003)

39. • Effects of Artificial Sweeteners in Non-Diabetic Patients
• Artificial sweeteners are present in a variety of beverages
known as SSBs Sugar-Sweetened Beverages.
• It includes soft drinks, fruit drinks etc.
• They have been shown to increase the risk of obesity in
healthy subjects*
• They have also been shown to increase the incidence of type
2 diabetes mellitus in hitherto non-diabetic patients*
*Vasanti S Malik, Frank B Hu. Sweeteners and Risk of Obesity and Type 2 Diabetes: The Role of Sugar Sweetened Beverages.
Curr Diab Rep, 2012. 12:195-203

40. CONCLUSION:
• Artificial sweeteners are a good substitute to
sugars in diabetic patients
• They reduce the calorie intake and reduce
craving for sugars in diabetic patients
• They have also been shown to improve
glycemic control in diagnosed cases of type 2
diabetes
• However, they have been shown to increase
the incidence of obesity and type 2 diabetes
in non-diabetic patients

41. NO QUESTIONS !!!!!!!!