Ask Dana: Explaining the science behind artificial sweeteners vs. real sugar and how it affects children with Type 1 Diabetes
IDS Director of Technology and Applied Research, Dana Roseman
QUESTION:
Dear Dana,
My 11-year-old son was recently diagnosed with Type 1 diabetes. There has been so much to learn about dosing for insulin, along with nutrition. On top of all of that, I can't get a good answer about giving him artificial sweeteners – some sources say they are safe, while others say they could be dangerous for kids.
I have seen all too well how high his blood sugars spike with real sugar, so I really want to know what is best for keeping my son healthy. I'm feeling overwhelmed with all the conflicting advice.
Pauline Clark Silverthorne, Colorado
ANSWER:
Pauline,
You are not alone in this! Managing Type 1 diabetes in children comes with a steep learning curve, and food choices—especially sweeteners—can feel like a big decision. Let's explore the to help you make the best choice for your son.
How do Artificial Sweeteners Affect Children's Bodies?
It is compelling to use artificial sweeteners such as aspartame, sucralose, saccharin, and stevia as they do not raise blood glucose levels as quickly or as drastically as regular sugar. This makes them a helpful tool in managing T1D. Artificial sweeteners allow kids to enjoy sweet flavors without the challenge of dosing insulin as strategically to manage high blood sugars. Regulatory agencies like the FDA and the European Food Safety Authority consider most artificial sweeteners safe in moderate amounts, even for children.
However, concerns remain.
Some research suggests artificial sweeteners may alter gut bacteria, which can potentially impact glucose metabolism. Additionally, since children's bodies and brains are still developing, the long-term effects of frequent artificial sweetener consumption are not fully understood. Some studies indicate that kids who regularly consume artificial sweeteners may develop a stronger preference for sweet foods, which could impact eating habits later in life.
More recent research has also raised concerns about the potential impact of artificial sweeteners on cognitive development and behavior in young children. Some studies suggest that artificial sweeteners, particularly aspartame, may influence neurotransmitter function and could be linked to mood changes, hyperactivity, and attention deficits in some children. While more human studies are needed, these concerns suggest that parents should be mindful of the amount of artificial sweeteners their children consume.
How does Sugar Affect Children's Bodies?
Real sugar does cause blood glucose to rise, but that doesn't mean it has to be completely avoided. With the right diabetes management strategies—such as proper insulin dosing, carb counting, and pre-bolusing – children with T1D can enjoy real sugar in moderation without extreme blood sugar swings.
As with many things involving T1D management, developing strategies along with establishing a balanced approach can be the key to success. Aim to use artificial sweeteners in moderation so as to limit the concerns about cognitive, neurological and behavioral impacts.
Real sugar can be tricky with diabetes management, but also should not be eliminated completely. Help your son learn strategies on insulin timing and consider pairing high sugar treats with increased activity to help reduce the rise of a blood sugar.
Ideally, try to prioritize real, whole foods and limit overly processed food for best long-term health. We also want to strive to teach your son about how to enjoy treats and tricky foods for blood sugar management rather than complete restriction. This can lead to disordered eating habits or incorrect beliefs about what can and cannot be eaten for people living with T1D.
At Integrated Diabetes Services, we help guide you to make informed choices, keep blood sugars well monitored, and learn to time and dose insulin appropriately to allow your child to enjoy food while staying healthy. Let us help you and your son develop strategies to keep the burden of living with T1D to a minimum – especially around mealtimes!
Artificial Sweeteners and Natural Alternatives: Safety by Age Group
**American Academy of Pediatrics (AAP)
| Sweeteners | Category | Notes | Suggested Age Guidance |
|---|---|---|---|
| Stevia | Generally Considered Safe (In Moderation) | Considered safe by FDA & AAP, no known metabolic or cognitive concerns. | Ages 2+ (AAP suggests minimal use in young children) |
| Monk Fruit Extract | Naturally derived, no known harmful effects. | Ages 2+ (Minimal studies in infants/toddlers) | |
| Aspartame (Equal, NutraSweet) | Needs More Research | Concerns about cognition, mood, and potential behavioral effects in children. | Ages 6+ (Use caution in younger children; avoid in those with PKU) |
| Sucralose (Splenda) | May alter gut microbiota, needs more research. | Ages 6+ (AAP suggests limited use in young children) | |
| Acesulfame Potassium (Ace-K) | Some studies suggest possible neurological effects. | Ages 6+ (Use in moderation) | |
| Saccharin (Sweet'N Low) | Older cancer concerns, but not proven in humans. | Ages 6+ (Limited long-term studies in young children) | |
| Sugar Alcohols (Sorbitol, Xylitol, Maltitol, Erythritol) | Can cause digestive distress, especially in young children. | Ages 3+ (Avoid large amounts in young kids due to GI upset) | |
| Glycerol (Glycerin, found in sugar-free slushes & processed foods) | Should Be Used With Caution in Young Children | Recent BMJ study suggests risk of intoxication in young children. | Ages 6+ (Avoid in high amounts in younger children) |
| Artificial Blends (Sweeteners mixed with dextrose, maltodextrin) | Can still impact blood sugar despite being labeled "sugar-free." | Ages 6+ (Monitor for blood sugar spikes) | |
| Allulose | Natural Options That Have Minimal Impact on Blood Sugar | Minimal impact on blood glucose, some GI effects in high doses. | Ages 3+ (Monitor for bloating or GI issues) |
