A Sweeter Life For People With Diabetes Reprinted from Food Insight November/December 1993 There was a time when ice cream, cookies and other sweets were considered off-limits to people with diabetes. But advances in food technology and in understanding the effects of different foods on blood sugar, have made sweet foods an acceptable part of the diabetes meal plan. "People with diabetes were once confined to a very limited range of sweet and artificially-sweetened foods, which made managing the condition extremely difficult," said Hope Warshaw, M.M.Sc., R.D., former chairperson of the American Dietetic Association's (ADA) practice group on diabetes. "Today there are many more acceptable options to make life sweeter for people with diabetes." In diabetes, the body does not produce sufficient amounts of the hormone insulin or cannot use the amount that is produced properly. Insulin helps the body use sugar or glucose in the blood that results from digestion of food, by allowing it to enter cells Consistently high blood glucose levels can lead to heart disease, blindness, kidney failure and other health problems. Intense Sweeteners Until the approval of aspartame in 1981, persons with diabetes primarily shopped for "dietetic" foods in a secluded section of the supermarket. Aspartame vastly expanded the range of acceptable foods for persons with diabetes by providing a clean- tasting sweetener that does not affect blood glucose levels. Although technically considered a nutritive sweetener contributing four calories per gram, aspartame is 200 times sweeter than sugar and very little is needed to achieve a sweet taste. Thus its caloric contribution is negligible. Today, the sweetener is approved for use in more than 150 product categories. Other intense sweeteners such as saccharin and acesulfame K, which was approved by the Food and Drug Administration (FDA) in 1991, also provide a sweet taste without significantly affecting blood glucose levels. Sugar Alcohols Other sweeteners that have expanded the food options for people with diabetes are known as sugar alcohols. Included in this category are sorbitol, mannitol, xylitol, maltitol, maltitol syrup, lactitol, isomalt and hydrogenated starch hydrolysates. Most sugar alcohols are approximately half as sweet as sucrose; maltitol and xylitol are about as sweet as sucrose. As a group, sugar alcohols are incompletely absorbed and metabolized and consequently contribute fewer calories than other carbohydrates. Sugar alcohols are found naturally in berries, apples, plums and other foods. They also are produced commercially from carbohydrates such as sucrose, glucose and starch for use in sugar-free candies, cookies and chewing gum. "Sugar alcohols are modified carbohydrates that have a sweet taste," said Joseph Borzelleca, Ph.D., professor of pharmacology and toxicology at the Medical College of Virginia in Rich-mond. "The 'alcohol' designation refers to their chemical structure, but they are in no way related to ethyl or drinking alcohol. Sugar alcohols are very safe." Along with adding a sweet taste, sugar alcohols perform a variety of functions such as adding bulk and texture, providing a cooling effect on taste, preventing browning that occurs during heating and retaining moisture in foods. According to the FDA, foods that contain sugar alcohols but no sugar can be labeled "sugar free." But if the food is not also low in calories, it must bear a statement such as "Not a reduced-calorie food." Products containing sugar alcohols also may be labeled "Does not promote tooth decay," as these sweeteners are non-cariogenic. When consumed in excess, sugar alcohols may produce abdominal gas and discomfort in individuals. As a result, foods containing certain sugar alcohols that are likely to be eaten in amounts that could produce such an effect must be labeled with a statement to this effect. Sugar and Diabetes Modern nutritional management of diabetes recommends up to 55 to 60 percent of calories from carbohydrates. While complex carbohydrates should comprise the majority of carbohydrates, most endocrinologists and other health experts now agree that sugar can be part of a well-balanced diabetes meal plan. New research indicates that sugars and starches affect blood glucose levels similarly. The amount of carbohydrate, not the source, is the most important consideration for people with diabetes. According to the 1992 ADA position statement on nutritive and non-nutritive sweeteners, "When the grams of carbohydrate are equal, the source of the carbohydrate does not appear to be the major factor in determining the effect of the food on blood glucose levels." The American Diabetes Association also approves the enjoyment of small amounts of foods containing sucrose and other refined sugars by people whose diabetes is well-controlled. The organization is currently revising its nutritional recommendations for people with diabetes, with an expected publication date in 1994. Reprinted from the International Food Information Council Foundation, 1993

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