About Aspartame for Diabetics - Diabetes and Aspartame

About Aspartame for Diabetics

Gougeon R, M Spidel, K Lee, C Field.

Canadian Diabetes Association National Nutrition Committee Technical Review: Non-nutritive Intense Sweeteners in Diabetes Management.
Canadian Journal Of Diabetes. 2004; 28(4):385-399.

The current Canadian Diabetes Association Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada state that up to 10% of daily calories can be derived from sugars. However, individuals with diabetes may also be relying on alternative, low-calorie sweetening agents (providing little or no calories along with sweet taste) to control carbohydrate intake, blood glucose, weight and dental health. Most low-calorie sweeteners, sometimes called intense or artificial sweeteners, are classified and regulated as food additives with set acceptable daily intake (ADI) levels. The Health Canada Health Products and Food Branch approved intense sweeteners for table-top use and as additives in products such as soft drinks, chewing gum, fruit and fruit spreads, dairy products and desserts. This technical review summarizes the literature on the potential health benefits and risk associated with the consumption of non-nutritive intense sweeteners (excluding polyols) and the evidence for the safety of intense sweetener use among individuals with diabetes and their effects on glycemia, appetite, weight, blood lipids, blood pressure and renal function. Research investigating the potential metabolic effects, benefits and risk of intense sweetener use among individuals with diabetes, children and adolescents, and pregnant and lactating women was reviewed to draft evidence-based recommendations for their use by people with diabetes. Current evidence does not support an earlier belief, reported in the medical literature, that low-calorie sweeteners stimulate appetite or affect mechanisms that regulate hunger and satiety. Evidence indicates that daily consumption (up to ADI levels) of aspartame, sucralose, saccharin, cyclamate and D-tagatose has no significant effect on glycemic control or blood lipids in persons with diabetes. Current evidence indicates that intense sweeteners, used as an adjunct to multidisciplinary programs, may improve weight loss and weight control in obese persons. Consumption of intense sweeteners by older children and adolescents is unlikely to exceed ADI levels. Aspartame consumption below ADI levels has no effect on behavior in children. In pregnancy, saccharin and cyclamate are not recommended, while other intense sweeteners have not been shown to be unsafe during this time. Intense sweeteners are most beneficial when they are used to replace energy-dense and nutrient-diluted foods including sucrose, and are least beneficial when used to displace nutrient-dense foods such as milk, fruits and fruit juices.

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Filer LJ Jr, Stegink LD.

Aspartame metabolism in normal adults, phenylketonuric heterozygotes, and diabetic subjects. Diabetes Care. 1989 Jan;12(1):67-74.

This study reviews clinical studies testing the effects of various doses of aspartame on blood levels of phenylalanine, aspartate, and methanol in normal subjects and known phenylketonuric heterozygotes. The effect of aspartame on the phenylalanine-to-large neutral amino acid ratio under various feeding situations is shown. The clinical studies of aspartame in diabetic subjects are limited to observations of its effects on blood levels of glucose, lipids, insulin, and glucagon. These studies clearly demonstrate the safety of this high-intensity sweetener for use by humans.

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Nehrling JK, Kobe P, McLane MP, Olson RE, Kamath S, Horwitz DL.

Aspartame use by persons with diabetes. Diabetes Care. 1985 Sep-Oct;8(5):415-7.

Sixty-two subjects having either insulin-dependent or non-insulin-dependent diabetes completed a randomized, double-blind study comparing effects of aspartame or a placebo on blood glucose control. Twenty-nine subjects consumed 2.7 g aspartame per day for 18 wk, given as aspartame-containing capsules with meals, while 33 subjects took identical appearing placebo capsules. After 18 wk, no changes were seen in fasting or 2-h postprandial blood glucose levels or glycohemoglobin levels in either the aspartame- or placebo-treated groups. Adverse reactions were no more common in the group taking aspartame. We conclude that use of aspartame as a low-calorie sweetener does not adversely affect glycemic control of persons with diabetes.

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Okuno G, Kawakami F, Tako H, Kashihara T, Shibamoto S, Yamazaki T, Yamamoto K, Saeki M.

Glucose tolerance, blood lipid, insulin and glucagon concentration after single or continuous administration of aspartame in diabetics. Diabetes Res Clin Pract. 1986 Apr;2(1):23-7.

A nutritive sweetener, aspartame (L-aspartyl-L-phenylalanine methylester) was administered orally to normal controls and diabetic patients in order to evaluate effects on blood glucose, lipids and pancreatic hormone secretion. An oral glucose tolerance test was also performed in the same subjects as a control study of aspartame administration. In 7 normal controls and 22 untreated diabetics, a single dose of 500 mg aspartame, equivalent to 100 g glucose in sweetness, induced no increase in blood glucose concentration. Rather, a small but significant decrease in blood glucose was noticed 2 or 3 h after administration. The decrease in blood glucose was found to be smallest in the control and became greater as the diabetes increased in severity. No significant change in blood insulin or glucagon concentration during a 3-h period was observed in either the controls or the diabetics. The second study was designed to determine the effects of 2 weeks' continuous administration of 125 mg aspartame, equal in sweetness to the mean daily consumption of sugar (20-30 g) in Japan, to 9 hospitalized diabetics with steady-state glycemic control. The glucose tolerance showed no significant change after 2 weeks' administration. Fasting, 1 h and 2 h postprandial blood glucose, blood cholesterol, triglyceride and HDL-cholesterol were also unaffected. From these and other published results, aspartame would seem to be a useful alternative nutrient sweetener for patients with diabetes mellitus.

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