Editing Sugar substitute (section)

===== Glucose metabolism =====
*[[Diabetes mellitus]] – People with diabetes limit [[refined sugar]] intake to regulate their blood sugar levels. Many artificial sweeteners allow sweet-tasting food without increasing blood glucose. Others do release energy but are metabolized more slowly, preventing spikes in blood glucose. A concern, however, is that [[overconsumption]] of foods and beverages made more appealing with sugar substitutes may increase risk of developing diabetes.<ref name="bmj">{{cite journal | vauthors = Imamura F, O'Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathiraju SN, Forouhi NG | title = Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction | journal = BMJ | volume = 351 | pages = h3576 | date = July 2015 | pmid = 26199070 | pmc = 4510779 | doi = 10.1136/bmj.h3576 }}</ref> A 2014 systematic review showed that a 330ml/day (an amount little less than the standard U.S can size) consumption of artificially sweetened beverages lead to increased risks of type 2 diabetes.<ref name="Lohner-2017">{{cite journal | vauthors = Lohner S, Toews I, Meerpohl JJ | title = Health outcomes of non-nutritive sweeteners: analysis of the research landscape | journal = Nutrition Journal | volume = 16 | issue = 1 | pages = 55 | date = September 2017 | pmid = 28886707 | pmc = 5591507 | doi = 10.1186/s12937-017-0278-x | doi-access = free }}</ref> A 2015 [[meta-analysis]] of numerous [[clinical research|clinical studies]] showed that habitual consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice increased the risk of developing diabetes, although with inconsistent results and generally low quality of evidence.<ref name=bmj/> A 2016 review described the relationship between non-nutritive sweeteners as inconclusive.<ref name="Lohner-2017"/> A 2020 Cochrane systematic review compared several non-nutritive sweeteners to sugar, placebo and a nutritive low-calorie sweetener ([[tagatose]]), but the results were unclear for effects on HbA1c, body weight and adverse events.<ref name="Lohner-2020">{{Cite journal |last1=Lohner |first1=Szimonetta |last2=Kuellenberg de Gaudry |first2=Daniela |last3=Toews |first3=Ingrid |last4=Ferenci |first4=Tamas |last5=Meerpohl |first5=Joerg J |date=2020-05-25 |editor-last=Cochrane Metabolic and Endocrine Disorders Group |title=Non-nutritive sweeteners for diabetes mellitus |journal=Cochrane Database of Systematic Reviews |language=en |volume=2020 |issue=5 |pages=CD012885 |doi=10.1002/14651858.CD012885.pub2 |pmc=7387865 |pmid=32449201}}</ref> The studies included were mainly of very low certainty and did not report on health-related quality of life, diabetes complications, all-cause mortality or socioeconomic effects.<ref name="Lohner-2020"/>
*[[Reactive hypoglycemia]] – Individuals with reactive hypoglycemia will produce an excess of insulin after quickly absorbing glucose into the bloodstream. This causes their blood glucose levels to fall below the amount needed for proper body and brain function. As a result, like diabetics, they must avoid intake of [[Glycemic|high-glycemic]] foods like white bread, and often use artificial sweeteners for sweetness without blood glucose.