QUESTION

Are artificial sweeteners bad for me if I have blood sugar problems? I am borderline diabetic and have started using them to cut back on sugar.

ANSWER

If you're borderline diabetic—aka, you have prediabetes—you should cut back not just on sugar and starches but also on artificial sweeteners. Use them rarely—no more than once a month. Why? Since the 1950s, when tiny tablets of saccharin became available to shake into your morning coffee, artificial sweeteners have promised dulce...but for people with blood sugar concerns they are more likely diablo. Recent evidence: An 18-year study of 61,440 women showed that those who "always or almost always" used artificial sweeteners of any kind had an increased risk of developing type 2 diabetes. Nor was the link based on the likelihood that people who are overweight may be using artificial sweeteners. It was independent of body weight. New research is uncovering just how artificial sweeteners may contribute to diabetes—or make it worse if you already have it. Example: Aspartame (NutraSweet, Equal) can alter the activity and composition of the microbes in your intestine, creating glucose intolerance. It may also increase levels of the stress hormone cortisol and increase systemic oxidative stress—both contributors to metabolic diseases including diabetes. Aspartame may also interfere with the N-methyl D-aspartate (NMDA) receptor in nerves, which can cause insulin deficiency or resistance. It's not the only artificial sweetener that's troubling—Sucralose (Splenda), although considered safe for most people, has been reported to raise blood sugar levels in people with diabetes. The truth is, artificial sweeteners are bad for everybody, not just for people with prediabetes or diabetes. Healthy people who drink more diet soda, compared with those who drink little or no soda, are more likely to become obese...and have big bellies. That, too, may have something to do with interference with a healthy gut microbiome. Plus, by tricking your palate into thinking that you are eating something with calories (sugar) when there are no calories, you may stimulate your appetite, making it easier to overeat. A recent review of 37 studies found that long-term use of artificial sweeteners was associated with weight gain, diabetes, high blood sugar and heart disease. Small amounts of stevia, a natural sweetener derived from a South American plant, are likely safe for daily use. But I wouldn’t use large amounts of stevia extracts, which may disrupt hormones in large doses according to some reports. Extracts are different from the whole unprocessed leaf, which is likely the safest choice—you can boil the leaves in water and then keep the sweetened water in the refrigerator to use by the teaspoon. You can also reeducate your sweet tooth. Gradually cut back on natural sweeteners such as sugar, honey and maple syrup to reprogram your "sugar meter" so you crave sweetness less. (For tips on cutting back, see Bottom Line's article, "How to Still Eat Sugar and Stay Healthy.") Fruit, which is naturally sweet, has a place in a balanced diet. Dried fruit is often high in sugar, but you can learn to use small amounts to sweeten dishes. For cooking, especially whole grains and whole-grain salads, I like "sweet" herbs and spices such as cinnamon, anise, clove, fennel and allspice.  And you know what? Your gut bacteria will come back in balance shortly after you stop the synthetics.