Thinking Artificial Sweeteners Are Safe for Diabetes? Here's What Doctors Want You to Know

If you've been diagnosed with Type 2 diabetes, you've probably heard the advice: cut back on sugar. It makes sense—after all, when you have Type 2 diabetes, your body doesn't use insulin properly, which causes blood sugar to rise and can lead to serious health problems. So naturally, many people think the solution is simple: replace sugar with artificial sweeteners. But according to endocrinologists, that's not quite the right answer.

Why Your Body Struggles With Blood Sugar in Type 2 Diabetes

To understand why artificial sweeteners aren't the magic fix, it helps to know what's happening in your body. "With Type 2 diabetes, your body does not correctly use the insulin created by your pancreas," explains Dr. Manikya Kuriti, an endocrinologist with the Wendy Novak Diabetes Institute. "Instead of the insulin being used by cells as energy, your cells don't respond. When the body produces more insulin to overcome this issue, your blood sugar rises—which can turn into serious health issues."

This is why managing blood sugar through diet, exercise, and sometimes medication becomes so important. But here's where artificial sweeteners complicate things.

The Hidden Problem With Artificial Sweeteners

You might assume that because artificial sweeteners don't contain sugar, they're automatically better for your blood sugar control. The reality is messier. Research has found that artificial sweeteners can affect your body in ways that go beyond just sweetness.

"There are studies that have found links between higher intake of artificial sweeteners and cognitive decline," Dr. Kuriti says. "The thought is these sweeteners can change the gut microbiome, which then causes inflammation. They also may change metabolic signals and disrupt how the body responds to insulin."

It's important to note that current research does not show artificial sweeteners directly cause dementia. However, for people who already have a risk of dementia—particularly those older than 65 with a history of stroke, high blood pressure, or vascular disease—there's a greater need to limit artificial sweetener use for long-term health.

Not All Artificial Sweeteners Are Created Equal

The sweetener aisle can feel overwhelming, and different options affect your body differently. Here's what the research shows:

• Aspartame: Studies suggest it can result in cognitive complaints and mood fluctuations.
• Sucralose, saccharin, and acesulfame potassium: These have been shown to change the gut microbiome and interfere with normal metabolic processes, potentially leading to inflammation.
• Stevia: This plant-derived sweetener seems to have minimal effect on insulin and glucose levels and causes limited microbiome disruption compared with others. Because much of it is fermented by gut bacteria rather than absorbed in the small intestine, its impact on blood glucose and insulin is much less than conventional sugar.
• Tagatose: A newly discovered sweetener still undergoing research, tagatose shows very low increases in plasma glucose or insulin after ingestion. Unlike regular sugar, it may even reduce the growth of cavity-causing bacteria in the mouth.

What Should You Do Instead?

The good news is that you don't have to feel stuck between sugar and artificial sweeteners. Dr. Kuriti recommends starting with small, manageable changes rather than overhauling your diet overnight.

"The best answer is to start with small changes that can improve your diet, your diabetes and your risks for other diseases," she says. "The goal is to make smarter substitutions to retrain your tastes."

Here are practical steps you can take:

• Start with one meal a day, decreasing how much sweetener you use.
• Each day, reduce the amount of sweetener you consume.
• Decrease processed foods and increase natural items such as berries, nuts, and vegetables.
• Replace sweetened drinks with sparkling water, plain water, or unsweetened tea.
• When you crave something sweet, reach for fruit instead of processed sweets.
• Increase your fiber intake throughout the day.

A Lifelong Approach

The key takeaway? "Diabetes in most cases is a lifelong condition and requires changes to lifestyle and diet to reduce further risks," Dr. Kuriti emphasizes. Rather than looking for a quick fix with artificial sweeteners, working with your healthcare provider on a personalized plan is your best bet. The goal isn't perfection—it's progress, one small change at a time.