Keeping Your Sweet Tooth

The days when people with diabetes were forbidden sugar are now behind us. Today the medical view is that a little bit of sugar, as part of a balanced diet, does no harm. But what if you have a really sweet tooth? In this article you will find out more about the way our food is sweetened so you can make some choices about the sweet food you eat. Remember before you decide, there are more issues to consider than just your blood sugar. Don't forget to think about:

• Your weight - increasing weight can make diabetes more difficult to manage, and losing weight if you are overweight can make things easier.
• Your teeth - we all know eating too many sugary sweets can lead to fillings, but what about the other types of sweetener?
• And of course your blood sugar - not just which sweeteners put it up too high but also which you can use to increase it quickly if a hypo strikes.

Below are some details of what makes our food sweet and how it may, or may not, affect your weight, your teeth and your blood glucose. At the end of the article is a summary table for you to print out and keep.

A spoonful of sugar

Conventional white or brown sugar which people use in tea and coffee and also use in baking is called sucrose. Sucrose is quickly digested into glucose and moves into your blood stream. This happens even quicker when it is dissolved in water, which is why when you are feeling really hypo a sugary drink is often the best thing for you.

A good tip to prevent food sweetened with sucrose sending your blood glucose too high is to eat it at the end of a meal because digestion will take longer and your insulin will cope better. So, for example, if your sweet tooth needs a bit of a treat, ice cream at the end of your main meal would be a good way to pacify it! Food and drink with sucrose in which you still should try to avoid are things like non-diet fizzy drinks, because the sugar is so quickly absorbed and really intensely sugary things such as frosted cakes. The hit of sugar you get from these very sweet things can be difficult for your insulin to cope with, even after a meal. For some people with diabetes, fructose - the sugar found in fruit and honey - is a useful alternative to sucrose. It can be bought in powdered form from the pharmacy and supermarkets.

Fructose is only slowly turned into glucose by your body, so although it will eventually produce an increase in your blood levels, this tends to be a smaller rise than with sucrose. Another advantage of fructose is that it can be used instead of sucrose for baking. But be careful. Fructose tastes sweeter than sucrose so you will need to experiment and use rather less than the recipe suggests. If you are watching your weight then both sucrose and fructose contain plenty of calories and nothing else - no vitamins for example. That's why sugar is sometimes called 'empty calories' - it goes straight to your hips without doing much good on the way there!

Sugar alcohols (polyols)

Nowadays on the shelf of your local supermarkets you will find plenty of products labeled 'Low sugar' or 'Sugar free'. Sounds very tempting! But hiding in amongst the ingredients in many of these foods you will find one or more of the following:

• Sorbitol
• Mannitol
• Xilitol
• Lactitol
• Hydrogenated starch hydrolysate

All of these are known either as polyols or 'sugar alcohols', which is a bit misleading, as they don't contain sugar or alcohol! They are, however, sweet. Weight for weight they contain fewer calories than sucrose. And they don't cause tooth decay. So what is the catch? Well actually there are several:

1. Polyols (which can be found in specific diabetic foods) are still carbohydrates and eventually your body will turn them, a least in part, into glucose. It may take longer and your blood glucose may not go quite so high, but it will rise nevertheless.
2. Even though the polyols themselves may give you fewer calories than sucrose, most products that contain them have just as much total carbohydrate, fat and calories as those containing sucrose. Check the labels and you will see! So, if you are watching your weight, polyol based products will not be much help.
3. Polyols can behave like a laxative, making you feel gassy, bloated and giving you diarrhea. So, when a well-meaning friend or relative presents you with a box of diabetic chocolates made with sorbitol, or a polyol stuffed product which says it is 'sugar free' on the label, remember:
   • they can still affect your blood glucose
   • they are probably just as fattening as conventional chocolates
   • they may upset your stomach

Intense sweeteners

Artificial sweeteners include things like saccharin, aspartame and acesulfame K. They do not contain carbohydrate or any other form of calories, so they won't affect your blood glucose, your weight or your teeth.

Over the years much has been written on the safety of artificial sweeteners and in response the government has set an acceptable daily intake (ADI) for each type. You can find out more in the Ask the Expert section of this site.

 

Summary of Sweeteners

Type	On packaging as:	Cause tooth decay?	Effect on blood glucose	Effect on weight	Useful for treating hypos?
Sugars	Sucrose	Yes	Increases, particularly quickly if dissolved in water	'Empty calories' will increase weight if eaten to excess	Yes, particularly when dissolved in water
	Fructose	Yes	Slow increase	'Empty calories' will increase weight if eaten to excess	No
Polyols	Sorbitol Mannitol Xilitol Lactitol Hydrogenated   starch   hydrolysate	No	Slow increase	Fewer calories than sugar but often in high calorie, high fat foods which will increase weight if eaten to excess.	No
Intense sweeteners	Saccharin Aspartame Acesulfame K	No	None	None	No

Important Notice: Information provided is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any health care questions you may have, especially before trying a new medication, diet, fitness program, or approach to health care issues.

DOC11718-Rev-A 04/08