As the list of artificial sweeteners used in our food continues to grow, the list of questions we have about them does, too.

Sweet like regular sugar (maybe even sweeter) but without the calories, they can seem like an effective tool for keeping blood sugar under control if you have diabetes — or even helping to prevent the condition altogether.

But are artificial sweeteners really any better for managing blood sugar?

Which is worse: sugar or artificial sweeteners?

"Anything that has calories in it, whether those calories are from carbohydrates, proteins or fats, is going to raise your blood sugar — the difference is just by how much," says Mag Ayyad, a dietitian specializing in weight management at Houston Methodist. "The fastest way to raise blood sugar is to eat a sugary or starchy food."

And when sugar is added to an already starchy food or one containing natural sugars — combining flour and sugar to make cookies, fruit and sugar to make a fruit juice or flour, sugar and fruit to make a pie — blood sugar can rise even higher.

"But if an artificial sweetener is used instead of regular sugar, it reduces the amount that blood sugar is raised," says Ayyad. "For instance, if tea is sweetened artificially, blood sugar only rises a small amount."

A quick note here: a rise in blood sugar isn't always a bad thing.

"People often think of a blood sugar spike as a negative thing, but it's a normal part of the process to create energy for your body," explains Ayyad. "It becomes a problem when your body isn't able to bring your blood sugar back down in a timely manner and becomes more resistant to your natural insulin, as is the case with type 2 diabetes."

If you have diabetes, you likely already know the importance of managing blood sugar spikes. It's why Ayyad says that, when we want added sweetness, the preference is to use an artificial sweetener rather than regular sugar.

"Especially when we're trying to bring blood sugar down, they're definitely the lesser of two evils," says Ayyad. "Switching to artificial sweeteners can be a step toward getting a better health profile, and then we can start working on reducing how often we're eating sweet foods."

And even if you don't have a reason to worry about your blood sugar right now, know that frequent blood sugar spikes can, over time, lead to diabetes and make it tougher to lose weight.

Do artificial sweeteners raise blood sugar?

The fastest way to spike blood sugar is to eat something sugary or starchy, but how do artificial sweeteners affect blood sugar levels?

"The simple answer is that they don't affect it," says Ayyad. "If we were to open a packet of artificial sweetener and eat it, it wouldn't raise our blood sugar at all."

He notes that no one does this of course. We're adding these artificial sweeteners to food or drink — our coffees, our teas, our baked goods. And that's where things get more complex.

"Your sugar-free piece of cake still contains fat — probably a lot of fat, in fact" says Ayyad. "So while the artificial sweetener won't affect your blood sugar, the fat content and calories of the cake is still going to raise it."

Ayyad points out that keto-friendly products are another example, often using sugar substitutes as a way to keep the food item on the low-sugar side. But since the food still has to taste good, these products often contain a lot of fat.

In other words, just because something is sweetened artificially doesn't mean it can't still spike your blood sugar.

Artificial sweeteners and diabetes: Common questions, answered

Artificial sweeteners are especially important for people with prediabetes and type 2 diabetes, and Ayyad is a proponent of using them to help get blood sugar under control.

"If you have diabetes and you're drinking three sodas a day, I'm going to ask if we can switch that to three diet sodas instead," says Ayyad. "We can have a significant impact on blood sugar with a change as simple as this, even if we don't change any other dietary habits initially."

But Ayyad knows that many people have concerns about artificial sweeteners. He's frequently asked: Are artificial sweeteners bad for you? It's a question stemming from claims these sugar substitutes are linked to everything from digestive problems to cancer.

"Artificial sweeteners have been extensively studied and found to be 100% safe," says Ayyad. "What studies have found, though, is that they can affect gut bacteria and, in some people, cause digestive symptoms — but that's often related to dosage, when someone is consuming the equivalent of seven or eight diet cokes a day."

Artificial sweetener side effects can include bloating or excessive gas, as well as other irritable bowl syndrome symptoms like diarrhea. Some initial steps can be taken to try to work around these sensitivities, though.

"I usually start by asking to try a different type of artificial sweetener," says Ayyad. "If there are still issues, next we think about consuming less. One of the two works for the majority of people."

Switching to diet soda is a straightforward swap. But given that some artificially sweetened items can still spike your blood sugar, you may be confused about which foods and products you can trust.

"Anything that contains a lot of calories, regardless of whether it's sweetened artificially, can spike your blood sugar," reminds Ayyad.

This means we can't always rely on marketing labels that say, 'No Sugar' or 'Keto Friendly.'

"Look at the nutrition label," says Ayyad. "Does it have a lot of calories? If it does, it's going to spike your blood sugar. Not because of sugar in this case, but because there's a lot of fat or other nutrients that need to be broken down into energy."

Take that sugar-free cake, for instance. Perhaps you can indulge more than you could if the cake contained regular sugar but, depending on the size of your slice and its total calorie content, you may still need to consider doing some portion sizing to avoid a blood sugar spike.

And one last tip when trying to control blood sugar: there's one type of food you never need to worry about portion sizing — non-starchy vegetables.

"You can eat as many non-starchy vegetables as you want," says Ayyad. "They are going to raise your blood sugar a little, yes — but they don't spike it. Plus, you get fiber and other beneficial nutrients we need for a fraction of the calories you get from other food options."