Home ยป Q&A: Stevia, Crohn’s, diabetes, and nut butters

Q&A: Stevia, Crohn’s, diabetes, and nut butters

THANK YOU for your well wishes for Miss Lily. She is our baby and it was a scary event, to say the least! Thanks for all the sweet comments! 🙂

I wasn’t planning on another Q&A so soon, but I was BLOWN AWAY by the questions I received since Tuesday’s Q&A…I just couldn’t resist. Plus, I’m not concise in my answers and there may be a 1 million word limit? 😉

Marla of Family Fresh Cooking: I love the flavor of Stevia and that it is an all natural sweetener that ranks 0 on the glycemic index. Everything I have read says it’s healthy to use (unlike artificial sweeteners.) Do you know of anything that would suggest otherwise?

Prevention RD: Stevia – hot topic! Stevia use and advertising has spread like wild fire! Like you said, Stevia offers a “natural” non-nutritive (calorie-free) sweetener. Like most everything we eat, safety of use will come back to labeling and marketing. The FDA has administered GRAS status (Generally Recognized as Safe) for 95% of higher purified Rebaudioside A (Reb A or rebiana) Extract. Other steviol glycosides will also submit FDA petitions for GRAS status shortly. Reb A is one of two main steviol glycosides (the other is stevioside) and are all 200-300x sweeter than sugar. Reb A has been tested through peer-reviewed research, including metabolic and carcinogenicity testing. All have shown no adverse effects with Reb A doses of approximately 4-15 mg/kg body weight per day. The World Health Organization’s Joint Expert Committee on Food Additives concluded that high purity stevia compounds are safe for use as general purpose sweeteners set at a daily intake of 0-4 milligrams per kilogram of body weight as steviol glycosides. Take home message: Yes, they are safe at moderate intake levels. Source: American Dietetic Association, June 2009. Hot Topics: Stevia.

Courtney of Pink Cow Girl: I have Crohn’s disease….or at least that’s what one GI doctor said, except I don’t have ANY of the regular issues. I can eat nuts, popcorn, onions, etc. But I’m on medication for Crohn’s. I’m also starting to think that I may be slightly lactose intolerant? What is your opinion on managing these issues with diet? Do you think going vegan could help my stomach troubles???

Prevention RD: Crohn’s disease – not fun 🙁 For those that aren’t familiar with Crohn’s, it is a condition of lesions that develop throughout the GI tract. Lesions can begin in the mouth and develop anywhere and everywhere, between the mouth to the anus. I brushed up on Crohn’s and found some interesting information (I learn from these Q&A’s, too!). Crohn’s may be correlated with cola beverage intake, chewing gum, chocolate, and increased sugar consumption. Other research shows that high animal protein and polyunsaturated fat intake along with low intake of omega-3 fatty acids may contribute to the development of Crohn’s. It is also more common in people of Jewish decent and the majority of cases peak between the ages of 15 and 30. Symptoms of Crohn’s disease include abdominal pain, diarrhea, fever, anorexia (low appetite secondary to disease process), and weight loss. When Crohn’s is in remission, a high-fiber diet, as tolerated, is recommended to stimulate peristalsis (the rhythmic movement of the intestines) and to improve the tone of the intestinal muscles. Unnecessary restrictions should be avoided to maximize nutrient intake. During acute (active) Crohn’s outbreaks, a low-fiber diet and/or bowel rest is recommended to minimize symptoms and decrease the risk of bowel obstruction. Lactose intolerance is common in those suffering from Crohn’s disease. The restrictions you are describing, however, would align more so with a diverticulitis diet – avoidance of small food particles that can get stuck in small out-pouches of the intestine causing infection – nothing related to Crohn’s. If you were properly diagnosed with Crohn’s (typically you are scoped to look for lesions throughout the GI tract), I would advise against a vegan diet. Malnutrition is very common in Crohn’s patients and putting strict restrictions on the diet could further exacerbate any malnutrition. If you suspect you have lactose sensitivity, I would omit lactose and switch to lactose-free milk, cheese, yogurt, ice creams, etc. If your symptoms improve, you have your answer! Excellent question! I wish you all the luck in managing such a complicated, uncomfortable disease.

Courtney of Pink Cow Girl: My favorite employee at my school (the secretary) has diabetes (sugar diabetes…but I don’t know if that means type 1 or 2 or if it matters). She also will eat ANY and EVERY kind of candy she can get her hands on. I love to bake cookies, and I want to give her something HEALTHY but…not let her know it. Do you have any delicious diabetic recipes??? I’d love to hear what you suggest as far as the best sweet treat to trick a diabetic!!!

Prevention RD: Can I just say that I think it’s adorable when people refer to diabetes as “sugar diabetes”? 🙂 It makes me smile every time! The majority of diabetics in the US are type 2, meaning they are non-insulin dependent diabetics (don’t have to take shots, or at least not initially…for most). Type 2 diabetes used to be referred to as “adult onset diabetes” but that is no longer true – type 2 diabetes is being diagnosed in kids under the ago of 10 — compliments of the obesity epidemic here in America. Scary, isn’t it? Regardless, type 1 or 2, a diabetic diet is a carbohydrate-controlled diet. Carbohydrates break down to glucose (sugar) in the body, so the words “carbohydrate” and “sugar” are many times used interchangeably. A diabetic can control through the diet how much carbohydrate they intake, and thus controlling how high their blood sugars go. What’s important to understand is that a diabetic can eat “normal” foods, in moderation. Further, a diabetic diet is just like any other diet – the calories from carbohydrate should comprise 50% or more of the diet – not “low carb”. While there are lower-carbohydrate and sugar-free options available, one must remember that portion control is still crucial for blood sugar control (and sugar-free does NOT mean carb-free!). I’ve made several recipes as of late that would qualify as “low-to-moderate” in carbohydrate – Oatmeal Cranberry While Chocolate Chip Cookies (16.2 grams of carbohydrate = 1 carb choice), Oatmeal, Chocolate Chip, and Pecan Cookies (15.5 grams of carbohydrate = 1 carb choice), Chocolate Peanut Butter Cookies (13.2 grams of carbohydrate = 1 carb choice), and Chocolate Chip Chickpea Cookies (13.6 grams of carbohydrate = 1 carb choice). P.S. 1 carb choice = approximately 15 grams of carbohydrate. I hope this helps! Thank you for 1) being an awesome, caring co-worker and 2) asking a great, diabetes-related question! Let me know how she likes them!

Ambre: I’m recently (thanks to watching Food, Inc.) pretty much not eating meat. On occasion I do eat fish (because I cannot give up sushi). I’m wondering if you can give me some ideas on how many grams of protein I need a day, and if I need to take any other supplements besides a multivitamin? I take a multivitamin supplement. I am also dieting, trying to lose 25 more lbs. I am currently 154lbs, 5’5″.

Prevention RD: Great movie, isn’t it? But, I couldn’t give up sushi either! Life just wouldn’t be worth living (half kidding!)! The average adult requires 0.8 grams of protein per kilogram of body weight (2.2 pounds = 1 kilogram). Therefore, 56 grams of protein a day should meet your protein needs. I would advise seeing a medical provider to under-go simple blood testing to determine whether or not your iron or hemoglobin is low. If so, an iron supplement may be advisable. In the mean time, pair high-iron non-heme sources such as leafy greens with vitamin C-containing fruits and vegetables such as tomatoes, citrus fruit, red bell peppers, and melon. For non-heme iron to be absorbed, vitamin C is required in the meal. As long as you are free of chronic disease and other co-morbidities, following a diet meeting the DRI’s + your multivitamin, you are likely meeting your nutritional needs. Thanks for the question, good luck in your weight loss!

Melanie: When I compared the nutrition facts for peanut butter and all-natural peanut better, the information was EXACTLY the same. The only difference that I could see was more sodium in my regular peanut butter, but I’m not really concerned about that. I chose to look next at the ingredients to see how they compared. The regular peanut butter ingredients are: Select Roasted Peanuts, Soy bean oil, Corn dextrin, Sugar, Hydrogenated vegetable oil, and salt. I know how bad hydrogenated oils are for us, but if these extra ingredients don’t make any difference in the nutritional information, are there really enough of them in the peanut butter to do any harm?

Prevention RD: Such a wonderful question and one that many people have concerns about. Hydrogenated oils and trans fats simply have NO place in the diet — they raise LDL-cholesterol (the “bad” kind) and lower HDL-cholesterol (the “good” kind) – double whammy! The US (I assume Canada is the same) does not require “trans fat” to be on the label unless the products contains more than 0.5 grams per serving. While this amount seems negligible, it is not. Trans fat should be eliminated from the diet whenever possible and purchasing all-natural peanut butter is a great way to decrease intake of hydrogenated oil. Shop around for brands that you enjoy, or consider using a 50/50 blend of your preferred peanut butter and an all-natural brand – it all adds up to make a positive change. Thanks for the great question!

Melanie: I noticed that comparing raw peanuts to raw almonds – they have roughly the same amount of calories but raw almonds have less saturated fats. Does that mean almond butter would be a healthier choice than peanut butter?

Prevention RD: You’re very label savvy! Yes, almonds have less saturated fat than peanuts; almonds are rich in mono and polyunsaturated fatty acids making them a very heart-healthy nut despite their relatively high caloric density. In comparing almond butter to peanut butter (all-natural brands of each), almond butter contains 0.5 grams of saturated fat while peanut butter contains 2.5 grams of saturated fat. I think this is one of the main reasons almond butter has been gaining spotlight attention in recent years. I would never deem all-natural peanut butter a poor source of nutrition but if you’re comparing it to almond butter…almond butter does take the cake! Great question!

Question: How many people do you know with diabetes (type 1 or 2)?

Any exciting weekend plans? 🙂

And on a completely unrelated topic (for Jersey Shore fans) — who would you date if you HAD to choose one? The Situation? Pauly D? Vinny? Ronnie?

Happy Friday! Cheers to a wonderful weekend!!!!

Share With Your Friends!


  1. suzicate
    January 22, 2010 / 7:52 pm

    I’ve been flipping through your blog…quite impressive, lots of useful information. You have really gotten a handle on your own weight, eating, nutrition etc…

  2. Morgan @ Healthy Happy Place
    January 22, 2010 / 8:48 pm

    You are an encyclopedia of nutrition knowledge! I’m so glad I am an avid reader!

    This is probably not the norm, but I only know 2 people with diabetes, and they are both type 1. It’s very scary that so many people are being diagnosed with type 2 simply due to their lifestyle. Proof that so many illnesses can be avoided with proper nutrition and exercise.

  3. inmytummy
    January 22, 2010 / 9:14 pm

    I think Vinny. He seems the most laid back.

    My dad has type 2 diabetes. It’s kind of weird because he’s not overweight nor did he ever eat that badly. Both of his parents had it too.

  4. Lena
    January 22, 2010 / 9:44 pm

    I know 4 people – girl from high school, grade-school teacher, cousin’s husband and my h.s. best friend’s little boy. The little boy got really sick, he was only about 2 I think, and had to go into Chicago’s Children’s Memorial Hospital and stay for a few days – maybe a week. Very scary ordeal and now they’re counting carbs and doing regular shots.

    Any tips I could share with her about dealing with little kids and diabetes? (He’s maybe 3 now.)

    I’d choose Vinny as well. This weekend = work and chores at home.

  5. Anna
    January 22, 2010 / 9:58 pm

    Yay! Thanks for the information about Stevia– I’ve been reading hearing more and more about this sweetener, so it’s nice to get some of the facts!

  6. sophia
    January 22, 2010 / 10:01 pm

    Oh wow. That was some GOOD questions. OMG. I learned SO much, thank you, thank you!!! xD

    I don’t know much ppl with severe diabetes, but I always get confused. I thought you aren’t supposed to have too much sugar when you have diabetes, but the people I know who DO have them still eat junk and refined products. Also, isn’t diabetic diabetic? Or are there degrees to that?

    • Nicole
      January 22, 2010 / 11:06 pm

      Great question. There aren’t “degrees” of diabetics but diabetics are considered controlled or uncontrolled based off a simple blood test which measures average blood sugar over a 6-8 week period of time. Diabetes is a manageable disease so long as the diabetic is compliant with diet, medications, and proper health care. Typically, once type 2 diabetes is diagnosed, oral pills are used to help control blood sugars. Once these medications are maxed out or no longer sufficient to control blood sugars (diabetes is a progressive disease — it gets worse with time, but can progress very slowly and controlled with good glucose control), insulin shots may be necessary. Hope this helps!

  7. Stef @ moretolifethanlettuce
    January 22, 2010 / 10:29 pm

    i love when you slip on your RD hat and teach us all some really cool things! actually you pretty much always have your RD hat on in every post, but you know what i mean. haha “sugar diabetes” is cute. so sad that type II is so common in kids now though ๐Ÿ™

  8. eatmovelove
    January 22, 2010 / 11:35 pm

    I know a couple of people with diabetes. Y’know – I haven’t caught on to this “Jersey Shore” kick…seems annoying…but laughable…so perhaps I should check it out haha :). Great Q & A! So is there a “limit” to the use of Stevia? I use it in most things ;)…along with maple syrup (yum…I literally drank from the bottle today oh my God no wonder I feel so sick…or could be the box of chocolates I inhaled from feeling like crap….:(…which didn’t help – oye – ..also have turbinado sugar but haven’t used it yet – think it’s like regular?

  9. Melinda
    January 23, 2010 / 6:14 am

    I would say I know tons of people with diabetes, but hey, I specialized in diabetes counseling, so I don’t think that counts! Great questions your readers have asked and great responses from you. I think it is always nice when we RDs can give people truthful information, especially when they are actually asking for it in the right place.

  10. Susan
    January 23, 2010 / 6:22 am

    I did not know about the saturated fat difference between peanut and almond butter!! Two of my best friends growing up were Type 1 diabetics. I remember as a child them always poking their fingers to check their blood, and them taking this giant sugar pills sometimes. Would be hard to deal with as a child!

  11. Katie @ Health for the Whole Self
    January 23, 2010 / 6:28 am

    Thanks for the information on nuts and nut butters! Very informative and useful ๐Ÿ™‚

  12. Shannon
    January 23, 2010 / 6:46 am

    I love these! You can do Q&A’s any time you want and I will happily read.

    I had a student I counseled with uncontrolled (Type I)diabetes. It was really tough for her. Her blood sugar would jump all over the map over the course of a day. A tough thing for a teenager to deal with. Thankfully, I don’t know anyone else right now, which is kind of amazing given how prevalent it (Type II) has become.

  13. Heather
    January 23, 2010 / 7:00 am

    I love the Q & A! It’s nice to learn more about Stevia and crohn’s disease. I add Sun Crystals to my coffee in the morning and it’s a mix of Stevia and Sugar Cane… good to know that you think it’s safe for moderate use… which 1 pack a day is moderate right??

  14. Karla
    January 23, 2010 / 7:47 am

    I love your Q&As! I read every word!

    I’ve recently started using agave nectar/syrup instead of splenda or sugar. I know it has calories still (I’m okay with that, I can fit it into my calorie budget for the day) but I’ve read that it has a low glycemic index so it doesn’t raise your blood sugar level as much. Is that right?

    Thanks for the protein question. I’ve always wondered how much I really need. I usually shoot for about 60g per day so I was just about right!

  15. Andrea@WellnessNotes
    January 23, 2010 / 8:14 am

    I love your Q & A’s!!! Great info!

    We don’t have any exciting weekend plans but will probably play as much in the rain and puddles as we can… ๐Ÿ™‚

    Happy Weekend!

  16. Kasey
    January 23, 2010 / 8:15 am

    Great Q&A! Thanks for stopping by my blog. I too get excited to meet fellow RDs in the blogosphere. Have a fabulous weekend!

  17. Food-Fitness-FreshAir
    January 23, 2010 / 8:47 am

    Good to know about Stevia, but I guess I’m still a little skeptical about it, although not as skeptical as sweeteners containing aspartame. Definitely go natural on peanut butter! I wish the FDA had stricter regulations. You can’t go wrong with pure peanuts and salt…although there are studies about the mold that grows on peanut butter…but I don’t think I could ever give up PB!

  18. The Candid RD
    January 23, 2010 / 9:03 am

    Great Q and A!! I think it’s funny when people call diabetes “The Sugar” haha. When I first heard that I was like, what?! So confused. I know many people with diabetes (type 2) but only 1 person with type 1!

    I never understood why they make all protein and carb recommendations according to your weight in kg. I hate that. I mean I know it’s easy to convert, but I hate having to convert it for other people. Why not just pounds?! I’m just in a complaining mood.

    This weekend is the weekend to find a house! Super exciting.

  19. eaternotarunner
    January 23, 2010 / 9:18 am

    Great Q&A! My mom has type 2 diabetes…

  20. homecookedem
    January 23, 2010 / 9:36 am

    Great Q & A! Interesting comparison of PB and AB. Thanks!!

    Vinny, for sure! He’s a cutie!

  21. Sybil
    January 23, 2010 / 9:49 am

    Wow- such great information, Nicole! You’re going to need to charge us for reading your blog soon! ๐Ÿ™‚
    In Canada, trans fats only have to appear on labels if there’s 0.2g /serving, or more (compared to 0.5g in the States).
    Have a great weekend!

    • Nicole
      January 23, 2010 / 10:01 am

      You’re sweet! THANK YOU for that piece of information — 0.2 grams is a lot better than 0.5 grams! Go Canada!!

  22. Joanne
    January 23, 2010 / 11:54 am

    Great information. I’m a stevia user as well but have to carry around Splenda because my husband won’t make the switch. I wonder how long it will take establishments to offer Stevia? We STILL come across places that don’t have Spenda.

    By the way… re- your post on pet emergencies..I mistakenly shared some raisins with Shane this morning during our morning run. Bad pet owner! App. they are toxic for dogs. Good thing readers offer the info. or I would be sharing my dried fruits with him on every run.

    • Nicole
      January 23, 2010 / 11:58 am

      I didn’t know that either, eek! No more granola for baby!

  23. thebalancebroad
    January 23, 2010 / 1:38 pm

    I am learning so much from your Q&A’s! I have a couple of friends with Crohn’s. When they have “flare ups,” they are just miserable. I really wish they could find a cure.

    That is interesting about AB, too. I LIKE it more than PB (though my wallet doesn’t!), but it’s actually better for you? Bonus!

    Hmmm….I can tell you it would NOT be The Situation. Seriously?! When he made that comment to Snookie re: the roll at dinner, I wanted to punch him through the TV.

    My mom, aunt, and uncle all have Type 2. ๐Ÿ™

  24. Faith
    January 23, 2010 / 3:22 pm

    Great Q&A! I had actually been wondering about Stevia too, so I’m glad for your info! My friend’s mom has type 2 diabetes, but she’s the only person I know with diabetes.

  25. cupcakesinparis
    January 23, 2010 / 4:04 pm

    Great post! Thanks for all this info!

  26. whydeprive
    January 23, 2010 / 5:05 pm

    I LOVE that you post these. I find it so helpful.
    Both my boyfriends brother and his father have diabetes, as does a friend of ours. It really irritates me because our friend does NOT take care of himself. We’ve actually stopped hanging around him because I dont want to be a part of it. Hes always drinking and smoking weed, and is actually proud of the fact that he’s at the highest weight he’s ever been in his life. Hes dating a friend of mine, and my fear is that they’ll get married, have kids, and then he’ll die at 40 and she’ll be alone to do it all herself.

  27. Jessica @ How Sweet
    January 23, 2010 / 5:06 pm

    Loving your answers regarding nut butters. My family thinks is doesn’t matter!

  28. Alyson
    January 24, 2010 / 1:28 am

    Great post, so informative! Now if only I could eat just 1 tbsp of nut butter :p

  29. Simply Life
    January 24, 2010 / 6:26 am

    WOW you are so good to answer all the questions and you’re SO informed! Thanks for all the great info – I loved learning about different nut butters! I’d actually love to know more about how almond butter/almonds compares to other nuts/nut butters (cashew, walnut, etc). Thanks again for sharing!

  30. Joanne
    January 24, 2010 / 7:54 am

    This is an awesome Q+A! It’s so great that you can use your knowledge to help others figure out how to live healthier lives. THIS is why I want to be a doctor ๐Ÿ˜€

    My grandfather has Type II diabetes, but he developed it in his late 80’s. Personally, I believe my father, who is definitely close to being categorized as obese, is likely pre-diabetic. But refuses to listen to a word I say about the situation. Sigh.

  31. marla {Family Fresh Cooking}
    January 24, 2010 / 6:44 pm

    Nicole, thanks so much for answering my question about stevia. It was very helpful. I am not sure how to convert the mg/kg equation…my bottles are all in ml or mg (not sure how to relate that to weight in pounds.) I still think I use too much, but I would rather the stevia than other sugars. Most sugar makes me feel awful! xo

  32. CaSaundra
    January 25, 2010 / 5:55 am

    I have yet to sit down and watch Food Inc. I have a feeling I would really like it because I enjoy documentaries about things I am interested in–however, I heard it is PRETTY intense, so we’ll see.

  33. Pingback: Diabetes Articles» Q&A: Stevia, Crohn's, diabetes, and nut butters | Prevention RD

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