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Ask the Dietitian: Are sugar substitutes okay for someone with kidney disease?

Question:

I have been reading a lot about sugar substitutes online and I am concerned about how they may affect my kidneys. Are sugar substitutes ok or not ok for someone with kidney disease?


Answer:

What are sugar substitutes?

Sugar substitutes, also known as artificial sweeteners or nonnutritive sweeteners, are created in a lab and are much sweeter than regular sugar. They do not contain calories or sugars, vitamins, minerals, fiber, or antioxidants so they are not considered healthy food. Their purpose is to replace sugar in foods and beverages. In general, we consume more sugar than recommended and artificial sweeteners can help to reduce the amount of sugar that we eat. However, replacing only sugary foods and beverages with artificial sweeteners and making no other changes to our plates does very little to improve the overall quality of our diets. Artificial sweeteners can be helpful for people working on controlling their blood sugar, like those with diabetes, since they contain no carbohydrates or sugars that can cause increases in blood sugar levels.

Are sugar substitutes safe?

Artificial sweeteners have been extensively studied for safety and have been found to be safe in human studies. This is important because most studies that showed health risks with artificial sweeteners were conducted in animals and not in humans so results may differ in humans. One risk that has been reported is that the increased sweetness may change our taste buds causing us to eat more which can then contribute to weight gain.


What about sugar substitutes and kidney disease?

For kidney disease, the results are mixed with no clear recommendations. One reason for this is that there is a lack of research, particularly randomized controlled trials, looking at the relationship between sugar and artificial sweeteners and kidney disease. A review article from 2013 reported that there is some support for a relationship between high sugar intake and risk of kidney disease, but better designed studies are needed to conclude that high sugar intake is a risk factor for kidney disease. The authors reported that there were only two studies that showed an association between diet soft drinks and risk of kidney disease. A 2021 systematic review of sugar and artificially-sweetened beverages and the risk of kidney disease reported that there is a non-significant association between sugar or artificially-sweetened beverages and risk of kidney disease. A significant, increased risk of kidney disease was observed when more than 7 sugar or artificially sweetened beverages were consumed in a week.


Should I consume artificial sweeteners with kidney disease?

Like sugar, it is a good idea to moderate how many artificial sweeteners you’re consuming. While both are ok to consume with kidney disease less is best. Think of swapping out sugar or artificially sweetened foods and beverages with whole food like fruits, vegetables, unsweetened cereals and yogurt, whole grains, and legumes.


Got a question for Dr. Melissa Prest?

Send it to her at mprest@nkfi.org and she may answer it on the blog!

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