Sugar-Free Sugar Replacers and Diabetes

Suddenly it seems that sugar-free products are everywhere.

Many of the sweets and goodies that people with diabetes have been reluctant to eat or have been advised to steer clear of are now available in sugar-free versions.

Although this fast-moving sugar-free trend is not primarily driven by the needs of people who have diabetes, there are potential benefits for Diabetes Health readers.

Did You Say ‘Sugar Replacers’? Don’t You Mean ‘Sugar Alcohols’?

Sugar not only makes candies, cookies and many other foods taste good, it also serves as a filler in some foods. That filler must be replaced in sugar-free products when the sugar is removed.

That’s why sugar-free versions of many products contain a second type of sugar-free sweetener: sugar replacers!

Sugar replacers aren’t really new-only the name is new. Sugar replacers are what most people with diabetes know as “sugar alcohols.”

The term “sugar replacer” was invented because it better describes the function of these sweeteners; scientists use the chemical names of these “polyols” (for example, xylitol and sorbitol). Two that are commonly seen now are isomalt and lactitol. Like sugar substitutes or intense sweeteners, sugar replacers have little or no effect on blood glucose and insulin levels. And unlike sugar, neither sugar substitutes nor sugar replacers promote tooth decay.

But the biggest difference is calories.

It’s common knowledge that sugar substitutes are calorie-free because they are used in such tiny amounts. The caloric values of the most frequently used sugar replacers range from 1.6 to 3 calories per gram. Sugar and most other carbohydrates provide 4 calories per gram.

Extremely important for people with diabetes, however, is the fact that sugar replacers, while not being sugars, are carbohydrates.

The body treats sugar-replacer carbohydrate much as it does fiber. Like fiber, sugar replacers are only partially digested in the intestines. Therefore, nutritionists categorize both fiber and sugar replacers as “low-digestible carbohydrates.”

As most people know from experience with high-fiber foods, low-digestible carbohydrates promote gastrointestinal function and can help prevent constipation. Research is still being done on the intestinal benefits of sugar replacers, but some seem to have effects similar to the health-promoting properties of fiber.

However, eating a lot of a low-digestible carbohydrate can sometimes cause loose stools and more gas than usual. This can be avoided by gradually adding the low-digestible carbohydrate (or new sugar-free product) to the diet, allowing the digestive system time to get accustomed to it.

How Do You Count Carbs and Calories?

The Food and Drug Administration (FDA) makes the rules about what food manufacturers must, and may, say in the Nutrition Facts box that appears on the labels of packaged foods.

The FDA, however, hasn’t yet started to use the term “sugar replacers,” so food labels still identify these ingredients as sugar alcohols. The number of grams per serving is given under Total Carbohydrate.

FDA rules take care of the lower-caloric values of sugar replacers.

The number shown on the food label is correct for the calories that are absorbed by your body and can be used for energy.

Read the food label and use it.

When it comes to the grams of carbohydrate shown on the food label, keep in mind that the purpose of counting carbohydrates is to keep track of the amount of carbohydrate that gets digested and turned into glucose in the blood. Since sugar replacers are digested only partially or not at all, only a small amount of what goes into a person’s mouth shows up as glucose in the blood.

The FDA is still trying to decide how best to show grams of low-digestible carbohydrates, such as fiber, in the Nutrition Facts box. Until that decision is made, the grams shown for sugar replacers in the Nutrition Facts box is the grams-in-your-mouth number rather than the grams-to-your-blood-glucose number.

Although digestibility varies somewhat among different sugar replacers, diabetes educators recommend that when counting carbs of all sugar replacers, count only half of the grams shown as sugar alcohol in the Nutrition Facts box. On the other hand, people who use “net effective carbohydrate” for low-carb diet weight loss do not count any of the carbohydrate grams from sugar replacers. It is important to note that this concept has not yet been endorsed by organizations such as the American Diabetes Association or the American Association of Diabetes Educators.

Choose Wisely, My Friend

It’s nice to have the option of eating sugar-free products now and then, and not worrying about breaking the old no-sugar rule may have value for some people. But choosing sugar-free is no license to pig out on any one type of food, especially if that causes you to miss out on fruits, vegetables and other healthful foods needed for good nutrition.

As is true for most food and health choices, common sense and what makes you feel your best, now and in the future, are often the most reliable guidelines.

Kristen Mcnutt, Phd, JD, is president of Consumer Choices Inc., a nutrition communications company, in Santa Cruz, California. Dr. Mcnutt served on the NIH National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) Advisory Council and is the nutrition communications consultant to Palatinit of America, the company that makes the sugar replacer isomalt.

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