The Sweet Life for Diabetics

Not long ago, diabetics were told to avoid sugar like the plague and depend on sugar substitutes to sweeten up their foods. The diabetic sugar ban was imposed because it was once thought that sugar was more rapidly absorbed into the bloodstream than starchy foods. But now we know differently. Many carbohydrate sources can affect blood sugar in a similar way as sucrose does. It’s the total amount of carbohydrates people consume, as well as their quality, that affect blood glucose levels.

The new era of diabetic dietary recommendations does not embrace blanket restrictions of simple sugars. But you won’t find anyone advising the 20.8 million Americans (7% of the population) with diabetes to fill up on sugary stuff, either. Today’s diabetic is counseled to balance carbohydrate intake for the entire day with a focus on unprocessed, fiber-rich carbohydrates that tend to produce lower, slower increases in the blood sugar compared to refined carbohydrates.

Controlling glucose 

The overriding goal for diabetics is to manage their disease in order to prevent serious complications down the road. Within this framework, tight glycemic control (as close to normal fasting and postprandial glucose levels as possible) is a biggie, since it reduces complications like retinopathy, nephropathy, neuropathy and, possibly, coronary vascular disease.

The recently updated position statement for standards of medical care in diabetes issued by The American Diabetes Association (ADA), Alexandria, VA, and published in Diabetes Care in 2006 (29:S4-S42), reported that monitoring total grams of carbohydrates through tools like exchanges or carbohydrate counting is key in achieving good glycemic control. Lowcarbohydrate diets (less than 130 grams per day) are not recommended for diabetes management; instead 45% to 65% of total calories should come from carbohydrates.

Putting sugar in its place 

If a diabetic wants a sugar fix, they can fit it in. Foods containing simple sugars, such as white sugar, brown sugar, honey and molasses, can be substituted for starchy carb sources, like tortillas and potatoes. One could skip a slice of bread in order to have two small cookies, since both contain roughly 15 grams of carbohydrates.

But many sugar-containing foods are high in carbs and calories and may often be low in important nutrients. Since the amount and type of carbohydrate influences blood glucose levels, choosing foods that keep hyperglycemia at a minimum following a meal is recommended. Thus, attention to the glycemic index or load can be helpful.

How artificially sweet it is 

Artificial sweeteners have had a long, sweet history with diabetics, starting with saccharin, the first artificial sweetener, dating back to 1879. Diabetics have grown to count on an expanding number of high-intensity sugar substitutes to satisfy their sweet cravings. These provide sweetness without the calories or carbohydrates, because they are many times sweeter than sucrose and their caloric contribution is negligible or zero.

But as the number of artificial sweeteners has swollen, so has the controversy surrounding their safety. In reality, sugar substitutes are some of the most rigorously studied food ingredients on the planet. According to the ADA, nonnutritive and reduced-calorie sweeteners are safe when consumed within the acceptable daily intake levels established by FDA. Five nonnutritive sweeteners have been approved by FDA in the United States:

Reduced-calorie sweeteners approved by FDA include the sugar alcohols (polyols) erythritol, hydrogenated starch hydrolysates, isomalt, lactitol, maltitol, mannitol, sorbitol, xylitol and tagatose. Unlike nonnutritive sweeteners, which sweeten in very small amounts, polyols are carbohydrates used in the same quantity as sucrose, although their sweetness varies. Polyols provide fewer calories, because they are absorbed slowly and incompletely from the intestine.

“As a class, polyols have reduced calories and reduced glycemic response when compared to most sugars and, therefore, help in maintaining a stable blood glucose level,” says Tom Parady, associate program coordinator of food applications, Roquette America, Keokuk, IA. Maltitol syrup (regular) has a GI of 52, hydrogenated starch hydrolysate has a GI of 39, xylitol has a GI of 13, sorbitol and isomalt have a GI of 9, lactitol has a GI of 6, and erythritol and mannitol have a GI of 0. In some people, excessive consumption of sugar alcohols may cause gastrointestinal symptoms, such as gas or laxative effects.

Sugar subs in food 

“The ADA recommendations for diabetics have been moving away from banning simple sugars for a long time. Nevertheless, many diabetics continue to seek out reduced-sugar foods,” says Parady.

The sweetness profile created by sugar substitutes is sometimes different from sucrose, so blends are often used in mixtures to create a natural sweet sensation or better mouthfeel. Artificial sweeteners may be used in many products, including instant or ready-to-drink coffees, teas and other drinks; cold cereals; chewing gum; breath mints; gelatins; puddings; frozen desserts; yogurt; baked goods; candies; and pharmaceuticals.

With current diabetes rates exceeding the 60% global increase projected by the Geneva-based World Health Organization between 1995 and 2030, the sugar-free food industry may be tasting sweet success in the years to come. 

Sharon Palmer is a registered dietitian with 16 years of experience in health-care and foodservice management. She writes on food and nutrition for newspapers, magazines, websites and books. Palmer makes her home in Southern California and can be reached at [email protected].