Current Diabetes Reports

, 19:142 | Cite as

Natural Alternative Sweeteners and Diabetes Management

  • Emily Mejia
  • Michelle PearlmanEmail author
Lifestyle Management to Reduce Diabetes/Cardiovascular Risk (B Conway and H Keenan, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Lifestyle Management to Reduce Diabetes/Cardiovascular Risk


Purpose of Review

The goal of this review is to discuss the data on natural alternative sweeteners and their effects on glucose homeostasis and other metabolic parameters within the past five years. We sought to answer whether common natural alternative sweeteners have a positive or negative effect on glucose control in both human and animal models, and whether the data supports their widespread use as a tool to help reduce the prevalence of diabetes and associated comorbid conditions.

Recent Findings

Recent studies suggest that natural alternative sweeteners may reduce hyperglycemia, improve lipid metabolism, and have antioxidant effects particularly in those that have baseline diabetes.


Diabetes and metabolic syndrome have become a global healthcare crisis and the sugar overconsumption plays a major role. The use of artificial sweeteners has become more prevalent to improve insulin resistance in those with diabetes, obesity, and metabolic syndrome, although the evidence does not support this result. There are however some promising data to suggest that natural alternative sweeteners may be a better alternative to sugar and artificial sweeteners.


Natural alternative sweeteners Diabetes Stevia Sugar alcohols Rare sugars 


Compliance with Ethical Standards

Conflict of Interest

Emily Mejia and Dr. Michelle Pearlman declare that they have no conflict of interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Toews I, Kuellenberg de Gaudry D, Sommer H, Meerpohl JJ, Lohner S. Non-nutritive sweeteners for diabetes mellitus. The Cochrane Database of Systematic Reviews. 2017;2017(11):CD012885. Scholar
  2. 2.
    Baynes JW, Thorpe SR. Role of oxidative stress in diabetic complications: a new perspective on an old paradigm. Diabetes. 1999;48(1):1–9. Scholar
  3. 3.
    Prata C, Zambonin L, Rizzo B, Maraldi T, Angeloni C, Vieceli Dalla Sega F, et al. Glycosides from Stevia rebaudiana bertoni possess insulin-mimetic and antioxidant activities in rat cardiac fibroblasts. Oxid Med Cell Longev. 2017;2017:3724545. Scholar
  4. 4.
    Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes care. 2014;37(Supplement 1):S120–S43.CrossRefGoogle Scholar
  5. 5.
    Adult obesity facts. Center for Disease Control and Prevention. 2018. Accessed 6/23/19.
  6. 6.
    Organization WH. Global report on diabetes. 2016. 2017.Google Scholar
  7. 7.
    Bender C, Graziano S, Zimmermann BF. Study of Stevia rebaudiana Bertoni antioxidant activities and cellular properties. Int J Food Sci Nutr. 2015;66(5):553–8.CrossRefGoogle Scholar
  8. 8.
    Carrera-Lanestosa A, Moguel-Ordonez Y, Segura-Campos M. Stevia rebaudiana Bertoni: a natural alternative for treating diseases associated with metabolic syndrome. J Med Food. 2017;20(10):933–43. Scholar
  9. 9.
    Tey SL, Salleh NB, Henry CJ, Forde CG. Effects of non-nutritive (artificial vs natural) sweeteners on 24-h glucose profiles. Eur J Clin Nutr. 2017;71(9):1129–32. Scholar
  10. 10.
    Tey S, Salleh N, Henry J, Forde C. Effects of aspartame-, monk fruit-, stevia-and sucrose-sweetened beverages on postprandial glucose, insulin and energy intake. Int J Obes. 2017;41(3):450.CrossRefGoogle Scholar
  11. 11.
    Ritu M, Nandini J. Nutritional composition of Stevia rebaudiana, a sweet herb, and its hypoglycaemic and hypolipidaemic effect on patients with non-insulin dependent diabetes mellitus. J Sci Food Agric. 2016;96(12):4231–4.CrossRefGoogle Scholar
  12. 12.
    Onakpoya IJ, Heneghan CJ. Effect of the natural sweetener, steviol glycoside, on cardiovascular risk factors: a systematic review and meta-analysis of randomised clinical trials. Eur J Prev Cardiol. 2015;22(12):1575–87.CrossRefGoogle Scholar
  13. 13.
    Ahmad U, Ahmad RS. Anti diabetic property of aqueous extract of Stevia rebaudiana bertoni leaves in streptozotocin-induced diabetes in albino rats. BMC Complement Altern Med. 2018;18(1):179–11. Scholar
  14. 14.
    Elnaga NA, Massoud MI, Yousef M, Mohamed HH. Effect of stevia sweetener consumption as non-caloric sweetening on body weight gain and biochemical’s parameters in overweight female rats. Annals of Agricultural Sciences. 2016;61(1):155–63.CrossRefGoogle Scholar
  15. 15.
    Assaei R, Mokarram P, Dastghaib S, Darbandi S, Darbandi M, Zal F, et al. Hypoglycemic effect of aquatic extract of Stevia in pancreas of diabetic rats: PPARγ-dependent regulation or antioxidant potential. Avicenna journal of medical biotechnology. 2016;8(2):65.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Aranda-González I, Moguel-Ordóñez Y, Chel-Guerrero L, Segura-Campos M, Betancur-Ancona D. Evaluation of the antihyperglycemic effect of minor steviol glycosides in normoglycemic and induced-diabetic Wistar rats. J Med Food. 2016;19(9):844–52. Scholar
  17. 17.
    • Akbarzadeh S, Eskandari F, Tangestani H, Bagherinejad ST, Bargahi A, Bazzi P et al. The effect of Stevia rebaudiana on serum omentin and visfatin level in STZ-induced diabetic rats. Journal of dietary supplements. 2015;12(1):11-22. Proposed molecular mechanism for stevia’s insulin-mimetic properties. Google Scholar
  18. 18.
    Mooradian AD, Smith M, Tokuda M. The role of artificial and natural sweeteners in reducing the consumption of table sugar: a narrative review. Clinical nutrition eSPen. 2017;18:1–8.CrossRefGoogle Scholar
  19. 19.
    Noronha JC, Braunstein CR, Glenn AJ, Khan TA, Viguiliouk E, Noseworthy R, et al. The effect of small doses of fructose and allulose on postprandial glucose metabolism in type 2 diabetes: a double-blind, randomized, controlled, acute feeding, equivalence trial. Diabetes Obes Metab. 2018;20(10):2361–70. Scholar
  20. 20.
    Han Y, Kwon E-Y, Yu M, Lee S, Kim H-J, Kim S-B, et al. A preliminary study for evaluating the dose-dependent effect of d-allulose for fat mass reduction in adult humans: a randomized, double-blind. Placebo-Controlled Trial Nutrients. 2018;10(2):160. Scholar
  21. 21.
    Hayashi N, Yamada T, Takamine S, Iida T, Okuma K, Tokuda M. Weight reducing effect and safety evaluation of rare sugar syrup by a randomized double-blind, parallel-group study in human. J Funct Foods. 2014;11:152–9. Scholar
  22. 22.
    • Ensor M, Williams J, Smith R, Banfield A, Lodder RA. Effects of three low-doses of D-tagatose on glycemic control over six months in subjects with mild type 2 diabetes mellitus under control with diet and exercise. Journal of endocrinology, diabetes & obesity. 2014;2(4):1057. Identifies minimum dosage required to see positive effects on blood glucose after six months of treatment. Google Scholar
  23. 23.
    •• Ensor M, Banfield AB, Smith RR, Williams J, Lodder RA. Safety and efficacy of D-tagatose in glycemic control in subjects with type 2 diabetes. Journal of endocrinology, diabetes & obesity. 2015;3(1). Results were reproducible with a longer treatment period with a larger and more diverse participant population. Google Scholar
  24. 24.
    Nagata Y, Mizuta N, Kanasaki A, Tanaka K. Rare sugars, d -allulose, d -tagatose and d -sorbose, differently modulate lipid metabolism in rats. J Sci Food Agric. 2018;98(5):2020–6. Scholar
  25. 25.
    • Shintani T, Yamada T, Hayashi N, Iida T, Nagata Y, Ozaki N et al. Rare sugar syrup containing D-allulose but not high-fructose corn syrup maintains glucose tolerance and insulin sensitivity partly via hepatic glucokinase translocation in Wistar rats. Journal of agricultural and food chemistry. 2017;65(13):2888-94. Evaluates the mechanism of action of rare sugars and suggests that RSS affects glucose metabolism through GK and increased glycogen levels. CrossRefGoogle Scholar
  26. 26.
    Iwasaki Y, Sendo M, Dezaki K, Hira T, Sato T, Nakata M, et al. GLP-1 release and vagal afferent activation mediate the beneficial metabolic and chronotherapeutic effects of D-allulose. Nature Communications. 2018;9(1).
  27. 27.
    Ochiai M, Misaki K, Yamada T, Iida T, Okuma K, Matsuo T. Comparison of anti-obesity effect between two types of syrup containing rare sugars in Wistar rats. J Nutr Sci Vitaminol. 2017;63(3):208–13. Scholar
  28. 28.
    • Nagata Y, Kanasaki A, Tamaru S, Tanaka K. D-psicose, an epimer of D-fructose, favorably alters lipid metabolism in Sprague–Dawley rats. Journal of agricultural and food chemistry. 2015;63(12):3168–76. First study to show that allulose may modulate lipid absorption in the small intestine, explaining its hypolipidemic actions. CrossRefGoogle Scholar
  29. 29.
    • Hossain A, Yamaguchi F, Hirose K, Matsunaga T, Sui L, Hirata Y et al. Rare sugar D-psicose prevents progression and development of diabetes in T2DM model Otsuka Long-Evans Tokushima Fatty rats. Drug Design, Development and Therapy. 2015:525. doi: Long term (greater than 1 year) provides evidence supporting rare sugars’ role in decreasing inflammation.
  30. 30.
    Yamada T, Hayashi N, Iida T, Takamine S, Okuma K, Matsuo T. Dietary D-sorbose decreases serum insulin levels in growing Sprague-Dawley rats 2014;60(4):297–9. doi: Scholar
  31. 31.
    Gray A. Nutritional recommendations for individuals with diabetes. Endotext [Internet]. MDText. com, Inc.; 2015.Google Scholar
  32. 32.
    Jain T, Grover K. Sweeteners in human nutrition. International Journal of Health Sciences and Research. 2015;5(5):439–51.Google Scholar
  33. 33.
    Wölnerhanssen BK, Cajacob L, Keller N, Doody A, Rehfeld JF, Drewe J, et al. Gut hormone secretion, gastric emptying, and glycemic responses to erythritol and xylitol in lean and obese subjects. American Journal of Physiology-Endocrinology and Metabolism. 2016;310(11):E1053–E61. Scholar
  34. 34.
    Overduin J, Collet T-H, Medic N, Henning E, Keogh JM, Forsyth F, et al. Failure of sucrose replacement with the non-nutritive sweetener erythritol to alter GLP-1 or PYY release or test meal size in lean or obese people. Appetite. 2016;107:596–603. Scholar
  35. 35.
    Mohsenpour MA, Kaseb F, Nazemian R, Mozaffari-Khosravi H, Fallahzadeh H, Salehi-Abargouei A. The effect of a new mixture of sugar and sugar-alcohols compared to sucrose and glucose on blood glucose increase and the possible adverse reactions: a phase I double-blind, three-way randomized cross-over clinical trial. Endocrinologia, diabetes y nutricion. 2019.Google Scholar
  36. 36.
    Wen H, Tang B, Stewart AJ, Tao Y, Shao Y, Cui Y, et al. Erythritol attenuates postprandial blood glucose by inhibiting α-glucosidase. J Agric Food Chem. 2018;66(6):1401–7. Scholar
  37. 37.
    Chukwuma CI, Islam S. Xylitol improves anti-oxidative defense system in serum, liver, heart, kidney and pancreas of normal and type 2 diabetes model of rats. Acta Pol Pharm. 2017;74(3):817–26.PubMedGoogle Scholar
  38. 38.
    Rahman MA, Islam MS. Xylitol improves pancreatic islets morphology to ameliorate type 2 diabetes in rats: a dose response study. J Food Sci. 2014;79(7):H1436–42. Scholar
  39. 39.
    Lee YJ, Jeong J, Kim MO, Nam J-O. The positive effect of luohanguo as sugar substitute on blood glucose and metabolism in streptozotocin-induced diabetic mice. Applied Microscopy. 2016;46(3):140–9.CrossRefGoogle Scholar
  40. 40.
    Gangoso A, Robben DM, Wesley MC, Rodriguez PRR, editors. Comparison of the glycemic response of white sugar and monk fruit sweetener among normoglycemic subjects. 7th International Scholars Conference Proceeding; 2018.Google Scholar
  41. 41.
    Liu H, Qi X, Yu K, Lu A, Lin K, Zhu J, et al. AMPK activation is involved in hypoglycemic and hypolipidemic activities of mogroside-rich extract from Siraitia grosvenorii (Swingle) fruits on high-fat diet/streptozotocin-induced diabetic mice. Food Funct. 2019. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.University of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of Medicine, Division of Gastroenterology & HepatologyUniversity of Miami Health Systems, Miller School of MedicineMiamiUSA

Personalised recommendations