Ketogenic Diet is a high fat low carbohydrate normal protein diet that was first introduced for uncontrolled epilepsy. One of the important absolute restriction is that ‘NO SUGAR’ is allowed.

This is because natural sugar is an obstacle to the production of Ketones. Ketosis or formation of Ketones in body is the main ingredient in its therapeutic use which is expanding from uncontrolled epilepsy to other medical conditions like cancers, Alzheimer’s disease, autism, progressive MS amongst others. (For more information on these indications for KD please refer to our website).

So when we say ‘NO SUGAR’ does that means no sweet recipes/ desserts in Ketogenic Diet?- NO. So, we can give sweets in Ketogenic Diet(KD) but by using SUGAR SUBSTITUTE OR NON NUTRITIVE SWEETNERS in the recipes. These are also known as artificial sweeteners which makes KD more acceptable especially for children.

We use Sucralose/ Stevia which is believed to be safe and best sweeteners in India.

First let us understand which sugar substitutes are easily available in India:-

In India there are four major types of artificial sweeteners available.

These are Saccharine, Aspartame Sucralose and Stevia.

Type of Sugar Substitute	Sold under Brand name in India	Sweetness compared to natural Sugar	Termed as
Saccharine	Sweet n Low or Sugar Free	300 times	Most popular sweeteners
Aspartame	Equal and Sugar Free Gold	180 times	It is one of the pocket friendly sweeteners
Stevia	Herb Veda, Sunova and Steviocal etc.	250 to 300 times	It is a herb and is an organic sweetener so it cannot be termed as an ‘artificial’ sweetener.
Sucralose	Splenda and Sugar Free Natura	600 times	Best and Safe

Let us see what are the pros and cons of Sugar substitute on our body in general and later how its different form / type affect ketogenic diet.

Pros of Sugar substitute as follows:-

• Sweetness without sugar: Most important factor from Ketogenic diet point of view.
• Calorie control as the above mentioned 4 types of Sugar substitute are all non- nutritive ( zero calorie)
• Managing weight-loss program.
• Managing Diabetics/pre-diabetics by not affecting blood sugar, the way it is affected after consuming natural sugar.
• B. A. Magnuson et al. (2017) – Most recently human clinical trials in healthy and diabetic subjects by numerous researchers provide a clear demonstration of safety of use of sucralose as a non-caloric sweetener in foods and beverages.

Cons of Sugar substitute as follows:-

• Possible link of few sweeteners to diseases: Numerous studies have examined the link to artificial sweeteners to various cancers and diseases. Eg:-Saccharine was reported to be a potential ‘carcinogen’. Lots of studies conducted on male lab rats confirmed that saccharine does increase chances of bladder cancer.
• Susan S. Schiffman et al. (2013) reported that sucralose is not entirely safe and could be a possible carcinogen.
• The FDA currently recognizes artificial sweeteners as GRAS (Generally Regarded as Safe).
• It m lead to more sugar cravings:Because artificial sweeteners aren’t real sugar, they may not satisfy your sugar cravings. This can lead to overeating.
• Yanina Pepino observed Three potential mechanisms, which are not mutually exclusive, are presented:

1) Non Nutritive Sweeteners (NNS) interfere with learned responses that contribute to control glucose and energy homeostasis

2) NNS interfere with gut microbiota and induce glucose intolerance

3) NNS interact with sweet-taste receptors expressed throughout the digestive system that play a role in glucose absorption and trigger insulin secretion.

 We use Stevia for ketogenic diet which is relatively safer as compared to other sweeteners used in KD.

 Which is better we need to research this more today.

References:-‘

1. B. A. Magnuson et al. Critical review of the current literature on the safety of sucralose Food and Chemical Toxicology 106 (2017) 324e355.
2. Yanina Pepino. Metabolic effects of non-nutritive sweeteners. Physiol Behav. 2015 December 1; 152(0 0): 450–455.
3. Susan S. Schiffman et al. Sucralose, A Synthetic Organochlorine Sweetener: Overview of Biological Issues. J Toxicol Environ Health B Crit Rev. 2013 Sep; 16(7): 399–451.