With sugar-free and “diabetes-friendly” sweets increasingly available during festivals, are they really a healthier alternative to traditional mithai? Dr Ambrish Mithal, renowned endocrinologist and Chairman of Endocrinology and Diabetes at Max Healthcare, explains why sugar-free doesn't necessarily mean calorie-free, why portion control matters, and what people with diabetes should know before indulging in festive treats.
Excerpts from an interview
Q. Indian festivals and celebrations are incomplete without mithai. Yet, there is a growing market for sugar-free and “diabetes-friendly” sweets. What is driving this trend, and are these products genuinely healthier than traditional sweets?
Dr Ambrish Mithal: People are increasingly conscious of their health, and those with diabetes want to enjoy sweets without raising their blood sugar. This has created a market for sugar-free products. However, several difficulties remain, particularly with traditional Indian sweets.
Packaged products may list the sweeteners used and their nutritional content, but consumers still have to rely on the accuracy of that information. With traditional mithai, especially sweets sold loose during festivals, we often have no reliable information about the ingredients, the type and quantity of sweeteners used, or the calorie content.
Even if a sweet is genuinely sugar-free, it doesn't mean it is low in calories or will not affect blood glucose. Flour, milk solids, fat, and other ingredients remain. People should therefore be cautious about assuming that a product labelled “sugar-free” or “diabetes-friendly” can be consumed without restriction.
Q. What ingredients are commonly used to replace sugar? Are jaggery, stevia and monk fruit healthier alternatives?
Dr Mithal: Jaggery is essentially similar to sugar in terms of its calorie content and its effect on blood glucose. It may contain small amounts of minerals, including iron, but that doesn't make it a suitable substitute for sugar if the goal is to control blood glucose.
Honey and date-based sweeteners also contain sugars and can raise blood glucose. Calling them natural does not mean they are harmless for someone with diabetes.
Non-sugar sweeteners include substances such as aspartame, sucralose, and saccharin, as well as stevia and monk-fruit sweeteners. Depending on the product, they can offer sweetness with little or no energy. They are permitted for use within applicable safety limits, but that does not mean people should consume them indiscriminately.
Sugar alcohols, such as erythritol and other polyols, are also used in some products. Their calorie content and effects vary. Manufacturers may combine several sweeteners to achieve the desired taste and texture, so check the full ingredient list rather than assume a product contains only one substitute.
Q. If stevia and monk fruit are marketed as natural sweeteners, are they necessarily better than synthetic sweeteners such as aspartame and sucralose?
Dr Mithal: A sweetener being called natural does not automatically make it healthier. We need to assess these products based on their composition, quantity, and safety, not their marketing claims.
Non-sugar sweeteners can help reduce added sugar in a product. However, they do not necessarily address the underlying preference for very sweet foods. Sweetness may temporarily satisfy a craving, but it does not necessarily reduce people's overall desire for sweet foods. Very sweet products may also make less-sweet foods seem less appealing.
Concerns remain about the long-term use of some sweeteners, and research continues into their possible metabolic effects. Consumers should not interpret the availability of these products as a recommendation to use them routinely or in large quantities.
Q. The World Health Organization has advised against relying on non-sugar sweeteners for long-term weight control. What should consumers make of this?
Dr Mithal: The important point is that non-sugar sweeteners have not established themselves as a reliable long-term strategy for weight management. Although they can reduce sugar and calories in particular products, that doesn't automatically translate into sustained weight loss or better metabolic health.
Some studies have reported associations between long-term sweetener consumption and adverse metabolic outcomes, including insulin resistance. However, associations do not necessarily establish that the sweeteners themselves caused these outcomes, and the evidence varies by sweetener and study design.
The practical message is that people should not depend on sugar substitutes as a long-term solution for weight control. More useful goals are reducing the overall preference for sweetness and following a balanced diet.
Q. Can sugar-free sweets still cause blood sugar spikes in people with diabetes?
Dr Mithal: Yes, they can. Sugar-free does not mean carbohydrate-free or calorie-free.
The sweetener itself may contribute little or no energy, but the other ingredients in the sweet can still affect blood glucose. For example, refined flour is a carbohydrate that the body can digest quickly. Milk solids and other ingredients also shape the overall nutritional profile.
The effect on blood glucose depends on the ingredients, the quantity consumed, and the individual’s response. Therefore, people with diabetes should not assume that a sugar-free sweet will leave their blood glucose unchanged.
The other concern is that people often feel they can eat unlimited quantities once they see the words “sugar-free” on a label. That defeats the purpose of choosing the product in the first place.
Q. Does removing sugar make a substantial difference to the calorie content of sweets?
Dr Mithal: It can make a difference, but the product does not become calorie-free. For example, a conventional chocolate bar containing around 500 calories might have around 300 calories in a sugar-free version, depending on its formulation. The reduction comes from replacing sugar, but the fat and other ingredients still contribute calories.
The same principle applies to Indian sweets. Gulab jamun, for instance, is made from milk solids and often refined flour, is deep-fried, and is traditionally soaked in sugar syrup. Removing added sugar doesn't remove the fat or calories from the other ingredients.
Consumers need to look at the whole product, not just the sugar content.
Q. Are some traditional Indian sweets better choices than others?
Dr Mithal: The ingredients and preparation methods make a difference. A typical gulab jamun may contain around 150–200 calories, while a rasgulla may provide approximately 100–150 calories, depending on its size and preparation. Rasgulla generally contains less fat than gulab jamun, making it the better choice.
Milk-based sweets can sometimes be preferable to deep-fried alternatives. Sweets made with besan, nuts, and seeds may provide some protein, while coconut barfi made with fresh coconut and less sugar is another option. However, these foods can still be calorie-dense, and their nutritional value depends on the recipe and portion size.
You don't need to treat one sweet as entirely healthy and another as entirely unhealthy. The amount consumed matters considerably.
Q. What about sugar alcohols such as erythritol? Some products use them because they have fewer calories than sugar.
Dr Mithal:Sugar alcohols generally provide fewer calories than sugar, although their energy content varies considerably. Erythritol, for example, provides virtually no calories, whereas xylitol and maltitol contribute some calories. They are also frequently combined with other sweeteners to achieve the desired sweetness, texture and taste.
Consumers should check the ingredients and nutritional information rather than assume that a product containing sugar alcohols is calorie-free or necessarily healthy. Some sugar alcohols can also cause bloating, flatulence and diarrhoea, particularly when consumed in large quantities. Erythritol is generally better tolerated than some other sugar alcohols.
There has also been considerable interest in emerging research on erythritol and cardiovascular health. Some observational studies have reported an association between higher circulating erythritol levels and cardiovascular events. Experimental studies have raised concerns about possible effects on platelet activation and thrombosis. However, these findings need careful interpretation. The body also produces erythritol naturally, and we still lack convincing long-term clinical evidence that consuming erythritol increases cardiovascular events.
The important message is that sugar-free does not automatically mean healthy. These products may serve as alternatives to sugar, but they should not encourage greater consumption of sweet foods. Ultimately, reducing our preference for excessive sweetness is a better long-term strategy.
Q. How should people with diabetes approach sugar-free sweets during Diwali and other festivals?
Dr Mithal: Moderation is the most practical approach. Festivals are occasions when people want to enjoy traditional foods, and it is unrealistic to expect everyone to avoid sweets completely.
The important thing is to choose carefully and control portion sizes. Instead of eating several pieces because a sweet is labeled sugar-free, have a small portion and savor it. People should be particularly cautious about unlabelled, loosely sold sugar-free sweets because they may not know which sweeteners or other ingredients are used.
Where possible, packaged products with clear ingredient lists and nutritional information provide more information than products with unknown compositions. However, even labelled products should be consumed in moderation.
People with diabetes should also follow their healthcare professional's dietary advice and monitor their blood glucose as recommended.
Q. Should manufacturers be required to provide clearer labels for traditional mithai, especially products marketed as sugar-free or diabetes-friendly?
Dr Mithal: Ideally, yes. Consumers should know what a product contains, including the sweeteners used and its nutritional composition. This is particularly important when a product is being marketed to people with diabetes or those trying to manage their weight.
Without clear information, consumers struggle to judge how much they can safely eat. Transparent labelling would help people make more informed choices and reduce the risk of misleading health claims.