How do artificial sweeteners affect insulin resistance in type 2 diabetes patients. What are the potential benefits and risks of using artificial sweeteners for diabetics. Are artificial sweeteners a safe and effective alternative to sugar for managing diabetes.

Understanding Artificial Sweeteners and Their Role in Diabetes Management

Artificial sweeteners have emerged as popular sugar substitutes, particularly for individuals managing diabetes. These non-nutritive sweeteners provide sweetness without the caloric content of sugar, making them an attractive option for those seeking to control blood glucose levels. However, recent research has raised questions about their efficacy and potential long-term health impacts.

The most common artificial sweeteners include:

• Sucralose
• Acesulfame K (ACE K)
• Aspartame
• Saccharin

Initially, these sweeteners were believed to be beneficial for obesity and diabetes management. However, ongoing studies have revealed a more complex relationship between artificial sweeteners and metabolic health.

The Impact of Artificial Sweeteners on Glucose Metabolism

Recent research has shed light on how artificial sweeteners interact with the body’s glucose metabolism processes. Contrary to earlier assumptions, these sweeteners are not metabolically inert. They can influence various aspects of glucose regulation, including:

1. Intestinal glucose absorption
2. Insulin secretion
3. Incretin hormone release

These effects suggest that artificial sweeteners may play a more significant role in glucose homeostasis than previously thought. But how exactly do they impact insulin resistance in type 2 diabetes patients?

Insulin Resistance and Artificial Sweeteners

Insulin resistance is a hallmark of type 2 diabetes, characterized by reduced cellular responsiveness to insulin. Some studies have indicated that regular consumption of artificial sweeteners might contribute to insulin resistance, potentially exacerbating the condition in diabetic patients.

For instance, research has shown that certain artificial sweeteners can alter the gut microbiome composition, which in turn may affect glucose tolerance and insulin sensitivity. This gut microbiota alteration could potentially lead to worsened glycemic control in individuals with diabetes.

Evaluating the Efficacy of Artificial Sweeteners in Diabetes Management

Despite their widespread use, the effectiveness of artificial sweeteners in managing diabetes remains a subject of debate. Meta-analyses of human studies have yielded mixed results, with some key findings including:

• No significant effect on body weight
• Limited impact on overall glycemic control
• Potential for improved short-term blood glucose management

These findings challenge the notion that artificial sweeteners are universally beneficial for diabetes management. It’s crucial for healthcare providers and patients to consider the individual responses to these sweeteners when developing treatment plans.

Potential Risks Associated with Artificial Sweetener Consumption

While artificial sweeteners may offer some benefits in diabetes management, recent studies have highlighted potential risks associated with their long-term consumption. A large cohort study revealed concerning associations between high artificial sweetener intake and various health outcomes, including:

• Increased all-cause mortality
• Elevated cardiovascular risk
• Higher risk of coronary artery disease
• Increased cerebrovascular risk
• Potential cancer risk

These findings underscore the need for caution when recommending artificial sweeteners as a long-term strategy for diabetes management. Healthcare providers should weigh the potential benefits against these risks when advising patients on their use.

The Gut Microbiome: A Key Player in Artificial Sweetener Effects

One of the most significant revelations in recent research is the impact of artificial sweeteners on the gut microbiome. The gut microbiota plays a crucial role in various metabolic processes, including glucose metabolism and insulin sensitivity.

Studies have shown that artificial sweeteners can alter the composition and function of gut bacteria, potentially leading to:

• Changes in glucose tolerance
• Alterations in insulin sensitivity
• Disruptions in metabolic signaling pathways

These microbiome-mediated effects may explain some of the observed inconsistencies in individual responses to artificial sweeteners. As our understanding of the gut-brain axis grows, it becomes increasingly clear that the impact of these sweeteners extends beyond their direct effects on taste and calorie intake.

Artificial Sweeteners and Taste Perception: Implications for Diabetes Management

An often-overlooked aspect of artificial sweetener use is its potential impact on taste perception. Research has shown that early and regular exposure to intense sweeteners like ACE K can alter an individual’s taste response to sugar.

This altered taste perception may have several implications for diabetes management:

1. Increased cravings for sweet foods
2. Difficulty in adhering to low-sugar diets
3. Potential overconsumption of calories from other sources

Understanding these effects is crucial for developing comprehensive dietary strategies for individuals with diabetes. Healthcare providers should consider the potential long-term impacts on taste preferences when recommending artificial sweeteners as part of a diabetes management plan.

Rethinking the Role of Artificial Sweeteners in Diabetes Treatment

Given the complex and sometimes contradictory findings regarding artificial sweeteners, it’s essential to reevaluate their role in diabetes treatment. While they may offer short-term benefits in glycemic control, the potential long-term risks and metabolic effects warrant careful consideration.

A more nuanced approach to artificial sweetener use in diabetes management might include:

• Individualized recommendations based on patient response
• Regular monitoring of blood glucose levels and weight
• Consideration of gut microbiome health
• Education on potential long-term health implications

Healthcare providers should work closely with patients to develop personalized strategies that balance the potential benefits and risks of artificial sweetener consumption.

The Need for Long-Term Studies

To fully understand the impact of artificial sweeteners on insulin resistance and overall health in diabetic patients, more extensive long-term studies are needed. These studies should focus on:

1. Long-term glycemic control
2. Changes in insulin sensitivity over time
3. Alterations in gut microbiome composition
4. Cardiovascular and metabolic health outcomes

By gathering more comprehensive data, researchers and healthcare providers can develop more informed guidelines for the use of artificial sweeteners in diabetes management.

Practical Considerations for Artificial Sweetener Use in Diabetes Management

While the debate on the overall impact of artificial sweeteners continues, there are several practical considerations for their use in diabetes management:

Moderation is Key

As with many dietary components, moderation in artificial sweetener consumption is crucial. Excessive intake may lead to adverse effects, while moderate use might offer some benefits in glycemic control.

Individual Variability

Responses to artificial sweeteners can vary significantly between individuals. Some people may experience improved glycemic control, while others might see no benefit or even negative effects. Personalized approaches are essential.

Combining with Other Dietary Strategies

Artificial sweeteners should not be viewed as a standalone solution for diabetes management. They should be part of a comprehensive dietary approach that includes balanced nutrition, portion control, and regular physical activity.

Regular Monitoring

Patients using artificial sweeteners should undergo regular monitoring of blood glucose levels, insulin sensitivity, and overall metabolic health to assess their individual response and adjust their treatment plan accordingly.

Future Directions in Artificial Sweetener Research and Diabetes Management

As our understanding of artificial sweeteners and their impact on metabolism evolves, several areas warrant further investigation:

• Mechanisms of action: Deeper exploration of how different artificial sweeteners interact with metabolic pathways and gut microbiota.
• Personalized medicine approaches: Developing methods to predict individual responses to artificial sweeteners based on genetic, metabolic, and microbiome profiles.
• Alternative sweeteners: Investigating natural non-nutritive sweeteners and their potential advantages over artificial options.
• Long-term health outcomes: Conducting extensive longitudinal studies to assess the long-term impacts of artificial sweetener consumption on diabetes progression and overall health.

These research directions could provide valuable insights for developing more effective and personalized diabetes management strategies.

Balancing the Benefits and Risks of Artificial Sweeteners in Diabetes Care

The use of artificial sweeteners in diabetes management presents a complex balance of potential benefits and risks. While these sweeteners may offer short-term advantages in glycemic control and weight management, emerging research highlights potential long-term health concerns and metabolic effects that cannot be ignored.

Healthcare providers and patients must approach the use of artificial sweeteners with a nuanced understanding of their effects. This includes:

• Recognizing individual variability in responses
• Considering the potential impact on gut health and metabolism
• Monitoring long-term health outcomes
• Integrating artificial sweetener use into a comprehensive diabetes management plan

As research in this field continues to evolve, it’s crucial to remain open to new findings and adjust recommendations accordingly. The goal should be to harness the potential benefits of artificial sweeteners while minimizing any associated risks, ultimately improving the quality of life and health outcomes for individuals living with diabetes.

The Importance of Patient Education

Educating patients about the current understanding of artificial sweeteners is crucial. This includes:

1. Explaining the potential benefits and risks
2. Discussing the importance of moderation
3. Encouraging self-monitoring and reporting of any observed effects
4. Promoting a holistic approach to diabetes management that goes beyond sweetener use

By empowering patients with knowledge, healthcare providers can help them make informed decisions about incorporating artificial sweeteners into their diabetes management strategies.

Integrating Artificial Sweeteners into Comprehensive Diabetes Care

While artificial sweeteners may play a role in diabetes management, they should be viewed as one component of a multifaceted approach. A comprehensive diabetes care plan should include:

• Balanced nutrition focusing on whole foods
• Regular physical activity
• Stress management techniques
• Medication management as prescribed
• Regular monitoring of blood glucose levels and other health markers
• Ongoing education and support

By integrating artificial sweeteners into this broader context, healthcare providers can help patients maximize the potential benefits while mitigating risks.

Collaborative Decision-Making

The decision to use artificial sweeteners should be made collaboratively between healthcare providers and patients. This process should involve:

1. Discussing the current scientific evidence
2. Considering the patient’s individual health status and preferences
3. Setting clear goals and expectations
4. Establishing a plan for monitoring and follow-up

This collaborative approach ensures that the use of artificial sweeteners aligns with the patient’s overall health goals and personal values.

Is the Use of Artificial Sweeteners Beneficial for Patients with Diabetes Mellitus? The Advantages and Disadvantages of Artificial Sweeteners

Review

. 2022 Oct 22;14(21):4446.

doi: 10.3390/nu14214446.

Katsumi Iizuka 
¹

Affiliations

Affiliation

• ¹ Department of Clinical Nutrition, Fujita Health University, Toyoake 470-1192, Japan.

• PMID:

  36364710

• PMCID:

  PMC9655943

• DOI:

  10.3390/nu14214446

Free PMC article

Review

Katsumi Iizuka.

Nutrients.

2022.

Free PMC article

. 2022 Oct 22;14(21):4446.

doi: 10.3390/nu14214446.

Author

Katsumi Iizuka 
¹

Affiliation

• ¹ Department of Clinical Nutrition, Fujita Health University, Toyoake 470-1192, Japan.

• PMID:

  36364710

• PMCID:

  PMC9655943

• DOI:

  10.3390/nu14214446

Abstract

Artificial sweeteners have been developed as substitutes for sugar. Sucralose, acesulfame K (ACE K), aspartame, and saccharin are artificial sweeteners. Previously, artificial sweeteners were thought to be effective in treating obesity and diabetes. Human meta-analyses have reported that artificial sweeteners have no effect on body weight or glycemic control. However, recent studies have shown that artificial sweeteners affect glucose absorption in the intestinal tract as well as insulin and incretin secretion in humans and animals. Moreover, artificial sweeteners alter the composition of the microbiota and worsen the glycemic control owing to changes in the gut microbiota. The early intake of ACE K was also shown to suppress the taste response to sugar. Furthermore, a large cohort study showed that high artificial sweetener intake was associated with all-cause mortality, cardiovascular risk, coronary artery disease risk, cerebrovascular risk, and cancer risk. The role of artificial sweeteners in the treatment of diabetes and obesity should be reconsidered, and the replacement of sugar with artificial sweeteners in patients will require the long-term tracking of not only intake but also changes in blood glucose and weight as well as future guidance based on gut bacteria data. To utilize the beneficial properties of artificial sweeteners in treatment, further studies are needed.

Keywords:

acesulfame K; aspartame; microbiota; saccharin; sucralose.

Conflict of interest statement

The author declares no conflict of interest.

Figures

Figure 1

The sweet taste receptors T1R2/T1R3,…

Figure 1

The sweet taste receptors T1R2/T1R3, artificial sweeteners, and metabolism.

Figure 1

The sweet taste receptors T1R2/T1R3, artificial sweeteners, and metabolism.

Figure 2

Artificial sweeteners have advantages and…

Figure 2

Artificial sweeteners have advantages and disadvantages. Artificial sweeteners (sucralose, saccharin, aspartame, and acesulfam…

Figure 2

Artificial sweeteners have advantages and disadvantages. Artificial sweeteners (sucralose, saccharin, aspartame, and acesulfam K) present advantages (non-caloric; a flavor enhancer; a GLP-2 stimulant) and disadvantages (increased mortality, cerebrovascular risk, cardiovascular risk, hyperglycemia, increased plasma HDL levels with impaired antioxidant functions, impaired FGF21 secretion).

Figure 3

Questioning the intake of artificial…

Figure 3

Questioning the intake of artificial sweeteners may be an important issue in nutritional…

Figure 3

Questioning the intake of artificial sweeteners may be an important issue in nutritional guidance in the near future.

See this image and copyright information in PMC

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References

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Publication types

MeSH terms

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Grant support

• 20K11645/Japan Society for the Promotion of Science

Artificial Sweeteners :: Diabetes Education Online

Home » Living With Diabetes » Diet And Nutrition » Understanding Carbohydrates » Demystifying Sugar » Artificial Sweeteners

• Understanding Fats & Oils »
• «
  Demystifying Sugar

Artificial sweeteners do not raise blood sugar levels.

When used instead of sugar, artificial sweeteners help you keep within your carbohydrate goals when planning meals.

Artificial sweeteners, or non-nutritive sweeteners offer the sweet taste of sugar, but have no carbohydrates or calories. Artificial sweeteners do not raise blood sugar levels. So when used instead of sugar, artificial sweeteners can help you keep within your carbohydrate goals when planning meals. And because artificial sweeteners have no calories, choosing foods made with artificial sweeteners may lower your calorie intake.

Look for manufactured foods and sweeteners for the table that contain one of these 5 sugar substitutes approved by the United States Food and Drug Administration:

• Aspartame (Brand Name: Equal)
• Sucralose (Brand Name: Splenda)
• Acesulfame-K (Brand Name: Sweet One)
• Saccharin (Brand Name: Sweet and Low, Sugar Twin)
• Neotame

A note to household chefs

Aspartame loses sweetness when cooked. Sucralose, acesulfame-K and saccharin can be used for baking. Look for special baking recipes for artificial sweeteners, as direct substitution for sugar might not give you the result you want. Or, try a combination of artificial sweetener and sugar in recipes to get your desired result while lowering the overall carbohydrate amount. Keep in mind that some artificial sweeteners can be sweeter than equal amounts of natural sugar. A little bit goes a long way.

What is Stevia?

This naturally sweet herb has been used in other countries for centuries. It is not FDA approved for use as a sweetener, but it can be purchased as a “dietary supplement” in many health food stores. Stevia comes in powder, liquid and tablet form. It doesn’t provide calories or impact blood glucose.

Are Artificial Sweeteners Safe?

The FDA has completed careful testing of all the artificial sweeteners. Artificial sweeteners have been shown to be safe to eat. Despite rumors of cancer causing effects of artificial sweeteners, research does not support that risk. All artificial sweeteners may be used by people with diabetes.

Food For Thought

Some foods made with artificial sweeteners may have more calories or fat than the original sugar-sweetened product. This may be the case with desserts and baked goods. Read food labels to compare products for serving sizes, calories and fat. Choosing a smaller portion of a sugar-sweetened product may be lower in calories than the artificially sweetened version!

View a printer-friendly Guide to Sweeteners.

Self-assessment Quiz

Self assessment quizzes are available for topics covered in this website. To find out how much you have learned about  Understanding Carbohydrates, take our self assessment quiz when you have completed this section.  The quiz is multiple choice. Please choose the single best answer to each question. At the end of the quiz, your score will display. If your score is over 70% correct, you are doing very well. If your score is less than 70%, you can return to this section and review the information.

• Understanding Fats & Oils »
• «
  Demystifying Sugar

Artificial sweeteners increase risk of type 2 diabetes | Article

22nd of May 2017

Kotikovich Yu.S.

Keywords:

glucose,

artificial sweeteners,

type 2 diabetes,

sucralose

Specialties:

E ndocrinology

Summary

By changing the body’s susceptibility to glucose

In a new small study, scientists from the University of Adelaide, Australia, have shown that the use of artificial sweeteners alters the body’s sensitivity to glucose and increases the risk of developing type 2 diabetes. The results of this work were presented by experts at the annual meeting of the European Association for the Study of Diabetes (EASD), held in Lisbon, Portugal.

Previous studies have shown that high artificial sweetener habits can significantly increase the risk of type 2 diabetes. However, the biological mechanisms underlying the identified relationship remained unknown. In this study, led by Dr. Richard Young, researchers assessed the effect of sweeteners on the body’s response to glucose intake. To do this, they analyzed the condition of 27 healthy participants who received daily placebo or artificial sweeteners (sucralose or acesulfame-K) in an amount equivalent to their content in 1.5 liters of diet soft drink. Participants took the drugs in the form of capsules 3 times a day for 2 weeks. At the end of the study, they assessed the body’s response to glucose, analyzing the degree of its absorption and concentration in the blood plasma, as well as measuring the level of insulin and peptides.

It turned out that the use of artificial sweeteners significantly changed the indicators of the body’s response to the introduction of glucose. The researchers evaluated the results using a method known as area under curve (AUC) analysis. This indicator increased for the level of glucose absorption and decreased for the concentration of the GLP-1 peptide, which inhibits the increase in glucose concentration after a meal. In participants who took placebo, the researchers did not notice any changes in carbohydrate metabolism.

As emphasized by the authors of the work, the data obtained indicate that the use of artificial sweeteners after 2 weeks leads to an increase in the level of glucose absorption, manifested by an increase in the concentration of glucose in the blood plasma. This supports the concept that artificial sweeteners may impair glycemic control, which may contribute to the development of type 2 diabetes.

• Diabetologia (2017) Small study suggests consuming large amounts of artificial sweeteners may increase the risk of developing type 2 diabetes. ScienceDaily, Sep. 13 (http://www.sciencedaily.com/releases/2017/09/170913193141.htm).

Julia Kotikovich

Artificial sweeteners and diabetes

By Dr. Mercola

According to the latest According to statistics, almost 40% of American adults, more than 18% of teenagers and almost 14% of children are now not only overweight, but obese, and processed foods and sweetened drinks are clearly driving factors.

Unfortunately, many people make the mistake of thinking that artificially sweetened foods are a healthy choice that cuts down on calories. This is not true at all.

Over the years, a growing body of research has shown that artificial sweeteners increase the risk of obesity and type 2 diabetes, perhaps even more so than sugar. A recent example is an animal study presented at the 2018 San Diego Experimental Biology Conference.

It examines how various sweeteners affect the use and storage of food in the body, and how they affect vascular function. Sugar and artificial sweeteners have been found to cause disturbances, albeit in different ways.

After a diet high in artificial sweeteners (aspartame or acesulfame potassium) or sugars (glucose or fructose) for three weeks, adverse effects were noted in all groups. All had increased blood lipids (fats), but the artificial sweeteners also accumulated in the animals’ blood, further damaging the lining of the blood vessels.

Newest Fad: Nutrient-Fortified Artificial Sweeteners

Despite evidence like this, the artificial sweetener market continues to thrive. Merisant launched a new calorie-free sweetener called Sugarly Sweet exclusively on Amazon at the end of January 2019, as well as a brand new line of vitamin and mineral fortified artificial sweeteners, according to Food Navigator.

Fortified sweeteners are sold under the Equal Plus brand and are available in three varieties: vitamin C and zinc, vitamins B3, B5 and B12, or vitamins C and E. The products are advertised as a “good source” of these nutrients, one sachet of which provides 10 percent of the recommended daily allowance for added vitamins and minerals.

Metabolic Effects of Zero Calorie Sweeteners

It is important to understand that while artificial sweeteners have no (or very few) calories, they are still metabolically active. As explained in the 2016 paper, Metabolic Effects of Non-Caloric Sweeteners, many studies have linked them to an increased risk of obesity, insulin resistance, type 2 diabetes, and metabolic syndrome. The article presents three mechanisms by which artificial sweeteners contribute to metabolic dysfunction:

1. They disrupt the conditioning that promotes glucose control and energy homeostasis.
2. They disrupt the gut microbiota and cause glucose intolerance
3. They interact with the sweet taste receptors expressed in the digestive system that are involved in glucose absorption and trigger insulin secretion.

In addition to the sweet taste buds on your tongue, there are also those in your gut that release signaling molecules into your bloodstream in response to sweet tastes, thereby forcing your pancreas to release insulin in preparation for the spike in glucose (that would happen if you ate sugar).

Artificial sweeteners are toxic to gut bacteria

Artificial sweeteners also have significantly different effects on the gut microbiome than sugar. While sugar is bad because it feeds health-damaging microbes, artificial sweeteners are even worse because they are toxic to gut bacteria in principle.

In a 2008 study, sucralose (Splenda) reduced gut bacteria by as much as 50 percent, specifically targeting those with important health benefits. Just seven small sachets of Splenda may be enough to negatively impact the gut microbiome.

In addition to the myriad side effects associated with disruptions to the gut microbiome, sucralose has also been associated with a wide range of other health effects. A selection of studies is provided in the article “Studies Reveal Shocking Side Effects of Splenda”, where you will also find a long list of studies demonstrating that artificial sweeteners cause weight gain and metabolic disturbances.

More recent studies have confirmed and expanded on these findings, showing that all currently approved artificial sweeteners disrupt the gut microbiome. An animal study published in the journal Molecules in October 2018 found that aspartame, sucralose, saccharin, neotame, advantame, and acesulfame potassium-K cause DNA damage and interfere with the normal and healthy activity of gut bacteria.

While all six types of artificial sweeteners have been found to have toxic effects on intestinal bacteria , there are individual differences in the type and amount of damage they produce:

• and genotoxic effects, meaning it is toxic to cells and damages the genetic information in the cell (which can cause mutations).
• Neotame caused a metabolic disorder in mice and also increased several fatty acids, lipids and cholesterol. Some gut genes are also decreased in number with this sweetener.
• Aspartame and Acesulfame Potassium-K – the latter commonly found in sports supplements cause DNA damage

Artificial sweeteners can cause muscle breakdown

that in addition to harming blood vessels and increasing the risk of obesity and type 2 diabetes, artificial sweeteners also cause muscle breakdown.

As lead author and Ph.D. Brian Gofman, assistant professor of biomedical engineering at Marquette University and the Medical College of Wisconsin, explained, “[Artificial] sweeteners trick the body.

And when your body isn’t getting the energy it needs because it needs some sugar to function properly, it potentially finds a source elsewhere.” Muscle is one such alternative source.

The neuroscience of food awards and how artificial sweeteners trick your body into eating more

An article published in the Yale Journal of Biology and Medicine in 2010 focused specifically on the neurobiology of sugar cravings and the effects of artificial sweeteners in the context of the neurobiology of reward food. As explained in this article:

“Food reward consists of two branches: sensory and post-ingestion… with mechanical satiety.

For moderately concentrated nutrients, rats have learned to prefer food associated with regular feeding, rather than “sham feeding”, in which incoming food flows out of the body through the gastric fistula.

However, the rats showed no preference if highly concentrated nutrients were used. The hypothalamus mediated reward after food ingestion. The hypothalamus secretes a variety of neuropeptides to regulate energy, osmotic balance, and feeding behavior…A growing body of evidence suggests that artificial sweeteners do not activate food reward pathways in the way that natural sweeteners do.”

“Diet” drinks are associated with an increased risk of stroke and heart attack

In related news, a recent observational study from the American Heart Association (AHA) found that, compared to drinking one or fewer “diet” drinks per week , two or more artificially sweetened drinks a day increase the risk of stroke, heart attack and early death in women over 50 by 23, 29 and 16 percent, respectively.

The risk is especially high for women with no history of heart disease, those who are obese and/or African American women. The study included more than 81,700 women from the Women’s Health Initiative Observational Study, a longitudinal health study of nearly 93,680 postmenopausal women aged 50 to 79.

The median follow-up was close to 12 years. According to the authors:

“Most of the participants (64.1 percent) were infrequent users (never or

In a multivariate analysis, those who consumed more PPIs compared to those who never or rarely … had a significantly higher probability of all endpoints (except hemorrhagic stroke), after multiple tests were performed.

Adjusted models showed that hazard ratios … were 1.23 for all strokes; 1.31 for ischemic stroke; 1.29 for coronary heart disease; and 1.16 for all causes of death.

In women with no history of cardiovascular disease or diabetes, high PPI intake was associated with a more than twofold increased risk of ischemic stroke with small artery occlusion… High PPI intake was associated with a significant increase in risk development of ischemic stroke in women with a body mass index ≥30 …”

In the accompanying editorial article, “Artificial sweeteners. Real Risks,” Hannah Gardener, Assistant Scientist in the Department of Neurology at the University of Miami, and Dr. Mitchell Elkind suggest drinking pure water instead of non-caloric sweetened drinks as the safest and healthiest low-calorie drink.

If you want a taste, just squeeze a fresh lemon or lime into mineral water. In cases where a little sweetener is needed in cooking, baking or drinks, choose consciously.

Healthy Sugar Substitutes

Two of the best sugar substitutes are Stevia and Lo Han Guo (also spelled Lo Han Guo). Stevia, a very sweet herb derived from the leaves of the stevia plant in South America, is sold as a supplement. It is completely safe in its natural form and can be used to sweeten most foods and drinks.

Lo Han Guo is similar to stevia, but this is my personal favorite. I use Lakanto brand vanilla flavor and it is a real delicacy. The Li Han fruit has been used as a sweetener for centuries and is about 200 times sweeter than sugar.