Not All Net Carbs and Artificial Sweeteners are Alike
Presentation: The Top 5 Nutrition Controversies
Speakers at this ADA Scientific Sessions presentation included: Maureen Chomko, RD,CDCES (Neighborcare Health); Alison Evert, MS, RDN, CDCES, (UW Medicine – Primary Care Clinics), Gretchen Youssef, MS, RDN, CDCES (Medstar Health)
Net carbs and artificial sweeteners are popular within the diabetes community or among people who follow a very low-carb and ketogenic diet.
Here, experts discussed why determining how much a product’s “net carbs” or artificial sweeteners will impact your blood sugar doesn’t have a one-size-fits-all answer.
Net carbs: don’t be so sure about that number
“People think products are more healthy if it lists net carbs—to the point where people are asking what the net carbs on things like apples, raspberries, and avocados,” said Maureen Chomko, an RD and CDCES from Neighborcare Health.
An oversimplified definition of net carbs is the total amount of carbs = carbs that are digested – carbs that are not digested (fiber) or aren’t converted into glucose. Many types of dietary fiber are not broken down into glucose, which leads you to subtract them from the total carbohydrate content.
For example, pulling details from a nutrition panel, you might calculate the following:
- Total carbohydrates: 30 grams
- Dietary fiber: 8 grams
- Net carbs: 22 grams
It’s important to know that the ADA or the Academy of Nutrition and Dietetics doesn’t endorse the concept of net carbs. More importantly, every food product company can decide how they define net carbs, said Chomko.
This means no one is regulating the net carb claims on those food products, and there is no guarantee that your net carbs calculation truly determines how many carbohydrates might impact your blood sugar.
Remember the Atkins diet? It was an immensely popular diet in the 90s and 2000s that used net carbs to guide which sources of carbs to eat. Over the years, companies have started using the term in a way that will best market their product to low-carb consumers or those trying to “eat healthily” not what’s actually healthiest (or true) for the consumer.
What those food labels don’t tell you is that not all fiber is digested the same way.
Insoluble fiber doesn’t provide calories or carbs. When it comes to soluble fiber, we don’t know how much fiber we consume from certain foods.
Labels also don’t tell you how much insoluble fiber is in certain products—it’s simply all grouped together as “fiber.”
Additionally, many “keto” foods these days add huge amounts of fiber to products for bulk and claim all of that fiber will not affect blood sugar levels. The more fiber there is added to a product, the more potential it can affect your blood sugar—especially if you don’t know what type of fiber it is.
Sugar Alcohols: They’re Also Not All The Same
Chomko emphasized that when it comes to sugar alcohols,—which are also used in some net carbs calculations—they aren’t created equal. In fact, sugar alcohols do produce a post-meal glucose response. In other words: some of the sugar in sugar alcohols does raise your blood sugar!
Even though sugar alcohols are labeled, there can be different sugar alcohols in a product (they all end in “-ol”), and you’d have to identify them and then look at a chart to see how many calories and sugar your body actually derives from them.
This is why “net carbs” can’t be simplified as it currently is. It assumes that all those factors act in an identical fashion and have the same glucose response effect on everyone. In reality, it depends on:
- Type of fiber and how it’s processed
- Amount of fiber, especially when added in as filler
- How long food is cooked
- Amount of carbs consumed
- Levels of insulin resistance
- Physical activity
- Solubility of fibers
- Type and amount of sugar alcohol
And so much more.
Chomko mentioned that the practice of subtracting fiber to determine net carbs is no longer standard, why?
- Because math is challenging. Numeracy and literacy skills are a barrier to management, especially for people on insulin.
- There’s no evidence to support continuing the practice—even for people on insulin. Instead, as Chomko put it, “We just want you to look at the labels for opportunities to eat more fiber —good God, please eat more fiber.”
- Just because a product has sugar alcohols does not mean a product is sugar-free or that it will not raise your blood sugar.
Instead, use the total grams of carbohydrates, even when consuming foods high in fiber and sugar alcohols. Take good notes on how your blood sugar reacted, how much insulin you took for that meal or product, and what changes you might make next time you eat it.
Artificial Sweeteners: Good for Diabetes, Bad for Diabetes, or Does it Matter?
Chomko noted that there are many fear-based articles on artificial sweeteners (AS), so it makes sense that the information surrounding it is confusing. However, it’s not as simple to say they’re all “bad for diabetes management” or make general blanket statements about them.
- They’re each digested, metabolized, and excreted differently.
- They aren’t consumed in isolation. You may have more than one AS in one beverage or other food product. They’re also in other non-food products like toothpaste.
- You can’t isolate the individual effects of AS within the complex eating patterns, backgrounds, and environments of individuals.
According to Chomko, the data on AS isn’t strong. Here are a few findings from research about the impact of regularly consuming artificial sweeteners:
- Decreases glucose tolerance
- Increases risk of developing obesity, metabolic syndrome, and type 2 diabetes but for most studies, these links become insignificant once adjusted for BMI
- Increases BMI by a small but significant amount over a period of years.
- Contributes to an overall higher calorie consumption because food containing AS is often lower in quality and highly processed.
The ADA and AHA have said, respectively, that there isn’t enough evidence to determine if using AS leads to a long-term reduction in cardiometabolic risk factors. Additionally, they said AS don’t necessarily make an unhealthy choice “healthy” but rather less unhealthy.
The AHA has stated the use of AS beverages can help control energy intake and promote weight loss, but there’s a lack of evidence of potential adverse effects.
Why not just drink more water?
Naturally, the next question after wondering if a person with diabetes should have products with artificial sweeteners, particularly beverages, is: why can’t we just drink more water?
Because access to safe drinking water isn’t available to everyone, especially low-income communities and people of color.
Chomko referenced National Health and Nutrition Examination Survey (NHANES) Data from 2009-2012 that surveyed nearly 8,300 people and their beverage choices. Here’s what the data said:
- Black and Hispanic individuals were less likely than whites to drink tap water and drank more bottled water and sugar-sweetened beverages.
- Many communities of color and lower-income communities have unsafe drinking tap water due to alack of access; therefore, they face the economic burden of drinking bottled water.
When it comes to accessing the food, drinks, and other tools needed to manage diabetes, we know historical context in regards to systemic racism and other economic barriers matters.
If your doctor assumes you can drink more water (or access anything else necessary to improve your care), tell your doctor about your situation and work together to determine ways and resources to make the healthiest options possible.