Over the past few years, there has been a spotlight on the sugar content of foods and how excessive consumption of these food sources may lead to adverse health effects.

The average South African consumes 24 teaspoons of sugar per day – more than double the World Health Organization guidelines for daily intake! From 1985, when 30 million people had diabetes, its prevalence has increased six-fold and today more than 230 million people worldwide are affected by diabetes. If nothing is done now to prevent this, this number will continue to increase to more than 350 million within the next 20 years.

That is why the Department of Health implemented the new sugar tax regulation in April 2017.

Now if you are reading this and you’re thinking: “There’s no way I’m taking in 24 teaspoons of sugar a day” – let us take a closer look:

  • 1 can regular soda = 9 teaspoons sugar
  • 1 can diet soda = ½ teaspoon sugar
  • 1 glass fruit juice = 3–5 teaspoons sugar
  • 1 slice bread = 1 teaspoon sugar
  • 1 glass sweet wine = 2 teaspoons sugar
  • 1 glass dry/low-kilojoule wine = ½ teaspoon sugar
  • 1 slab milk chocolate = 13 teaspoons sugar
  • 1 small packet jelly sweets (70g) = 9 teaspoons sugar
  • 100g low-fat yoghurt = 2 teaspoons sugar

But is the alternative healthier? There is a lot of controversy regarding sugar substitutes/alternative sweeteners. In this article we will examine sugar and alternative sweeteners and what you should know regarding both.

Sugars that increase blood sugar levels

Some foods will say “no added sugar” but will still be high in natural sugar (e.g. fruit sugars). These natural sugars also raise blood glucose levels and should be monitored for people with insulin resistance and diabetes.

Sugar Forms & uses Other things you should know
  • Brown sugar
  • Maltodextrins
  • Icing sugar
  • Agave syrup
  • Invert sugar
  • Brown rice syrup
  • White sugar
  • Corn syrup
  • Dextrose
  • High fructose corn syrup
  • Fructose
  • Maple syrup
  • Glucose
  • Fruit juice concentrates
  • Lactose
  • Honey
  • Maltose
  • Molasses
  • Sucrose
  • Barley malt
  • Used to sweeten foods and beverages
  • May be found in certain medications
  • There is no advantage to those with diabetes in using one type of sugar over another (in other words, one teaspoon of sugar has the equal effect of one teaspoon of honey).
  • Sugars may be eaten in moderation. Up to 5% of the daily caloric requirement can come from added sugar.
  • High sugar diets are not recommended as this could replace more nutritious foods and then lead to deficiencies.

Sweeteners that don’t increase blood glucose levels

Sweetener Forms & uses Others things you should know
Sugar alcohols & polydextrose

  • Lactitol
  •  Xylitol
  • Maltitol
  • Polydextrose
  • Mannitol
  • Isomalt
  • Polyols
  • Palatinit
  • Sorbitol
  • Polyol syrups
  • Hydrogenated starch hydrolysates  (HSH)
  • Used to sweeten foods labelled “sugar free” or “no added sugar”
  • May be found in cough and cold syrups and other liquid medications (e.g. antacids)
  • Sugar alcohols are neither sugars nor alcohols. Small amounts are found naturally in fruits and vegetables. They can also be manufactured.
  • They are only partly absorbed by your body, have fewer calories than sugar and have no major effect on blood glucose (sugar).
  • Check product labels for the number of grams of sugar alcohols per serving. If you eat more than 10 grams of sugar alcohols a day, you may experience side effects such as gas, bloating or diarrhea.
  • Talk to your dietician if you are carbohydrate counting and want to use foods sweetened with sugar alcohols.

Commonly used sugar substitutes

The U.S. Food and Drug Administration regulates artificial sweeteners as food additives.  Food additives must be approved by the FDA, which publishes a Generally Recognized as Safe (GRAS) list of additives.

Sweetener Forms & uses Other things you should know
Acesulfame Potassium (Ace-K)
  • Added to packaged foods and beverages only by food manufacturers
  • ADI = 15 mg/kg body weight per day.
  • For example, a 50 kg person could have 750 mg of Ace-K per day. One can of diet colddrink contains about 42 mg of Ace-K.
  • Available in packets, tablets or granulated form
  • Added to drinks, yogurts, cereals, low-calorie desserts, chewing gum and many other foods
  • Flavour may change when heated
  • ADI = 40 mg/kg body weight per day.
  • For example, a 50 kg person could safely have 2000 mg of aspartame per day. One can of diet colddrink may contain up to 200 mg of aspartame.
  • Individuals with a predisposition for phenylketonuria should avoid aspartame.
  • Available in packets, tablets, liquid and granulated form
  • Not allowed to be added to packaged foods and beverages
  • Flavour may change when heated
  • ADI = 11 mg/kg body weight per day.
  • For example, a 50 kg person could have 550 mg of cyclamate per day.
  • Available as tablets
  • Not allowed to be added to packaged foods and beverages
  • ADI = 5 mg/kg body weight per day.
  • For example, a 50 kg person could have 250 mg of saccharin per day.
  • Available in packets or granulated form
  • Added to packaged foods and beverages
  • Can be used for cooking and baking
  • ADI = 9 mg/kg body weight per day.
  • For example, a 50 kg person could have 450 mg of sucralose per day. One packet contains 12 mg of sucralose; one cup (250 ml) contains about 250 mg of sucralose.
Steviol glycosides
  • Table top sweeteners
  • Added to drinks, breakfast cereals, yogurt, fillings, gum, spreads, baked products, snack foods
  • ADI = 4 mg/kg body weight per day. For example, a 50 kg person could have 200 mg of stevia per day. A 30 g portion of breakfast cereal may contain 11 mg of steviol glycosides.

As long as you comply with the Acceptable Daily Intake (ADI) of these sugar substitutes there is no reason to avoid GRAS-list approved sweeteners. However, it does keep the sweet cravings alive and therefore it is recommended to gradually decrease the intake of both sugar and alternative sweeteners.