A variety of different carbohydrates are commonly used to sweeten foods, such as sucrose, fructose, glucose, maltose, isomaltulose, and fructooligosaccharide (FOS). Some of these sweeteners are naturally occurring (such as honey and molasses), whereas others are available in highly processed formulations (high fructose corn syrup.) In addition to the nutritive sweeteners, there are also noncaloric (artificial) sweeteners, sugar alcohols, and stevia. It is difficult for patients to discern which sweetener is best for their health, and this is particularly important for those with diabetes, who are encouraged to decrease their carbohydrate intake.  This Integrative Health tool will help clinicians offer evidence-informed advice regarding choosing the best sweetener for a given patient.

Sweeteners and Glycemic Index

Like all other foods, the glycemic index (GI) of sweeteners is a function of the type and quantity of their carbohydrate content as well as the presence of other substances (such as soluble fiber) which can slow absorption. Glucose has a GI of 100, fructose has a GI of 25 and sucrose— which is a blend of the previous two—has a GI of 65. Most natural sweeteners are a combination of these three carbohydrates.

Sweeteners containing higher levels of fructose tend to have a lower GI. Research has shown fructose (versus glucose or sucrose) leads to lower two-hour postprandial serum glucose concentrations in diabetic and nondiabetic subjects.¹ Another study showed substitution of dietary fructose for other carbohydrates produced a 13% reduction in mean plasma glucose in a study of type 1 and type 2 diabetic subjects.² GI of common sweeteners are listed in Table 1. More information on GI is available in the “Glycemic Index” tool.

Table 1. Glycemic Index of Common Sweeteners