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| Diabetes Self-Management |
| Some manufacturers list sugar alcohols and their gram weight under Total Carbohydrate on the Nutrition Facts panel of food labels. You can also look for sugar alcohols in the list of ingredients. |
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Sweet Substitutes
Marie Spano, M.S., R.D.
With the field of food science rapidly advancing, consumers are faced with ever longer and more confusing ingredients lists on packaged products. Foods that years ago were made of butter, sugar, and flour may today contain partially hydrogenated vegetable oil, fractionated palm kernel oil, monoglycerides, sucralose and maltodextrin. |
Many Americans are concerned about how these new food ingredients will affect their health. People with diabetes have the added concern of needing to know how these new ingredients may affect their blood glucose levels. In many cases, the answer is "less."
Surging consumer demand for low-carbohydrates and low-sugar foods in recent year has led to the development of several new sugar substitutes, as well as some new, nonsweet forms of carbohydrate that may improve the texture or flavor of foods when sugar is replaced with artificial sweeteners. Sugar substitutes may have no effect on blood glucose levels, or they may raise blood glucose somewhat but less than the sugar or other caloric sweeteners they are replacing. However, foods containing sugar substitutes may still contain carbohydrate and provide calories, so it still pays to read labels and pay attention to what you are eating.
While real sugar isn’t as dreadful as some make it out to be, over consumption of it can lead to weight gain and high blood glucose levels. Sugar substitutes may allow consumers to “indulge” in tasty foods without consuming excessive calories or developing dramatically high blood glucose level. Though some claim that sugar substitutes can increase a person’s craving for sweets, there is no scientific evidence to support this notion. Food scientists now have more than a few sugar substitutes to choose from, and they have also learned to combine these substitutes to create a pleasing taste and mouth-feel in many foods.
Sugar substitutes are typically grouped into two categories: nonnutritive sweeteners, which provide no calories when consumed in typical amounts, and nutritive sweeteners, which provide some calories. All sugar substitutes on the market are either considered Generally Recognized as Safe (GRAS) or are approved as food additives by the 1958 Food Additives Amendment to the Federal Food, Drug and Cosmetic Act. Additionally, all sugar substitutes are given an Acceptable Daily Intake (ADI), which is the amount a person can safely consume every day over a lifetime without appreciable risk. The ADI is determined by a review of all available safety and toxicological data on a given food additive. It is usually given as milligrams of sweetener per kilogram of body weight (mg/kg). (To determine your weight in kilograms, divide your weight in pounds by 2.2.)
Nonnutrive sweeteners
Also known as intense sweeteners, nonnutritive sweeteners are calorie-free (or contain negligible calories) sweeteners are so intense that only very small quantities are needed to sweeten food.
Acesulfame-k. Ace-k, as it is often called, was discovered in 1967 and initially gained food and Drug administration (FDA) approval in 1998 for use as a tabletop sweetener and in several food categories.
Over the years, it was approved for use in more food categories, and in 2003, it was approved as a general Purpose sweetener.Ace-K is a high stable, crystalline sweetener composed of carbon, nitrogen, oxygen, hydrogen, sulfur, and potassium. It is 200 times sweeter than sugar, can withstand high cooking or baking temperatures, and is not metabolized by the human body but is instead excreted in the urine, unchanged.With over 90 studies backing the safety of this sweetener, Ace-K has been given an ADI of 15 mg/kg body weight.Not only does Ace-K exhibit good stability, it also has a great shelf life, does not promote tooth decay, and has no effect on blood glucose, cholesterol, or triglyceride levels. In addition, Ace-k works well when combined with other sweeteners, providing synergistic sweetening effect. Ace-K can be found in over 4.000 different foods, including chewing gum, desserts, yogurt, sauces, cold beverages, candy, baked goods and dairy products. It is also marketed as a tabletop sweetener under the brand names sweetOne, sweet-n-safe, and sunette, and it is the main sweetening ingredient in the baking product DiabeSweet. Ace-K is considered safe for pregnant and nursing women, children, and people with diabetes.
Aspartame. The FDA first approved aspartame for use as a tabletop sweetener in 1981.after years of intense scientific review and over 200 studies indicating that it is a safe food additive, aspartame was approved for use in all foods and beverages in 1996.for the past several years, aspartame has been probably the most popular artificial sweetener (only to be trumped recently by sucralose, better known by its brand name, Splenda). Composed of two amino acids, phenylalanine and aspartic acid, and a methyl ester group, aspartame is approximately 200 times sweeter than sugar, does not cause tooth decay, products are very limited rise in blood glucose level, and has an ADI of 50mg/kg body weight. Despite consumer allegations of headaches, dizziness, seizures, and a host of other complaints supposedly caused by aspartame consumption, aspartame is considered safe for the general public, including people with diabetes, pregnant and nursing women, and children. However, people with phenylketonuria (PKU), a rare hereditary metabolic disease usually diagnosed at birth, must carefully limit their consumption of the amino acid phenylalanine, and methanol, which are absorbed into the bloodstream and used in normal body processes. Aspartame does not accumulate in the body. In addition, all three of these by-products are found naturally in the food supply. Aspartame is sold under the brand names Equal, Natra Taste, NutraSweet, and Insta-Sweet and is used in hot and cold beverages, breakfast cereals, gelatins, puddings, ice cream, regular and frozen yogurt, candy, chewing gum, and pharmaceuticals, as well as being sold in individual sweetener packets.
Though aspartame can be used in some recipes, it loses sweetness if cooked for long periods or at high temperatures. Equal sugar light, however, which is a combination of sugar and equal, can be used in most recipes and yields a lower-calorie, lower-carbohydrate product than one made with straight sugar.
Neotame. Neotame was approved for use as a general-purpose sweetener in 2002.Neotame is made by the NutraSweet Company and composed of the same three ingredients that make up aspartame phenylalanine, aspartic acid, and a methyl ester. However, it is much sweeter than NutraSweet and approximately 7,000-13,000 times sweeter than sugar. Neotame is partially absorbed in the small intestine and rapidly metabolized, with less than 20% of its phenylalanine content absorbed into the bloodstream. In fact, so little phenylalanine is absorbed that products containing neotame do not need to alert consumers that they contain phenylalanine (and those with PKU need not worry).
Both animal and human studies indicate that neotame is safe, even for children, pregnant or breast-feeding women, and people with diabetes, and it does not accumulate in the body. In addition, neotame does not significantly affect fasting plasma glucose or insulin levels in those with type 2 diabetes. The ADI for neotame is 2 mg/kg body weight. Neotane can be used for baking although it can’t be substituted cup-for-sugar (most artificial sweeteners can’t due to the intensity of their sweetness in such a small volume). Instead, neotame is often blended with sugar for use in commercially prepared goods.
Saccharin. Saccharin was the original intense sweetener. It is 200-700 times sweeter than sugar, is not metabolized by the body, does not cause cavities, can be used in baking, does not raise blood glucose level, and has an ADI of 5 mg/kg body weight. The safety of saccharin has been controversial over the years. In 1977, the FDA recommended that saccharin be banned based on research showing it caused cancer in lab animals. Instead of it being banned, however, Congress stepped in with the Saccharin Study and Labeling Act, requiring that any product containing saccharin also be given the warning label: “Use of this product may be hazardous to your health. This product contains saccharin which has been determined to cause cancer in laboratory animals.”
In 2000, after reexamining the data on saccharin, scientists at the National Toxicology Program determined that the evidence of saccharin’s potential to cause cancer in humans was not strong enough to merit a warning. And by 2001, the warning label was dropped. Saccharin can be found in cosmetics, pharmaceuticals, chewing gum, candy, beverage, baked goods, cake mixes, and as a table-top sweetener in the familiar pink packets. Though considered safe, specific maximum amounts are allowed when saccharin in used as sweetener in beverages and foods. Saccharin is sold under the brand names Sweet’N Low, Sweet Twin, Sweet’N Low Brown, Sugar Twin, and Necta Sweet.
Sucralose. Since its initial FDA approval in 1998, sucralose, sold under the brand name Splenda, has soared in popularity, possibly because of its brilliant yet misleading marketing logo, “made from sugar.” Sucralose may be made from sugar, but it is nothing like sugar. It is produced by combining sugar with chlorine to create a substance that is both calorie-free (because it is not metabolized by the body) and 600 times sweeter that sugar. Sucralose also does not cause cavities, does not raise blood glucose levels, can be used in baking (though it isn’t ideal for all baking uses), and has a ADI of 15 mg/kg of body weight. It is found in many consumer products from yogurt and ice cream to Cadbury Schweppes 7UP Plus ( a variety of 7UP that contains calcium).
Splenda brand sucralose comes in two baking-friendly varieties, Splenda Brown Sugar Blend. Both blends combine Splenda and sugar (white sugar or brown sugar), provide half the calories and carbohydrate when substituted for sugar, and are better for baking than pure Splenda alone. When baking with Splenda blends, replace the sugar called for in the recipe with half the amount of Splenda Blend.
Nutritive sweeteners
Reduced-calorie, or nutritive, sweeteners are primarily used by food manufacturers to create lower-calorie or lower-carbohydrate package products. Only recently have two such sweeteners come on the market that are sold directly to consumers for cooking, baking, or sweetening beverages at home.
Polyols (sugar alcohols). In spite of their name, sugar alcohols, or polyols, do not contain either sugar or alcohol. They are carbohydrates that are incompletely absorbed from the gut. (they are called sugar alcohols because part of their chemical structure resembles sugar and part resembles alcohols.) While some polyols are found naturally in plants, those used in packaged foods are commercially produced. They are typically less sweet than sugar and provide bulk in foods the way sugar does, so they are often combined with nonnutritive sweeteners in food products. The polyols currently used in the United States include erythritol, hydrogenated starch hydrolysates, isomalt, lactitol, maltitol, mannitol, sorbitol, and xylitol.
Because polyols are not fully absorbed, they provide on average approximately 2 calories per gram, compared to 4 calories per gram for table sugar, and they raise blood glucose levels less than table sugar. However, incomplete absorption does not come without a drawback, namely gastrointestinal distress. Excessive consumption of certain polyols – in particular, sorbitol and mannitol – can cause flatulence, bloating, cramping, and diarrhea. In fact, products containing sorbitol and/or mannitol must carry the following warning on their label, “Excess consumption may have a laxative effect,” if consumers could reasonably be expected to ingest either 50 grams of sorbitol or 20 grams of mannitol when eating the product. However, the amount of polyols that may cause gastrointestinal symptoms is different for each individual, so be aware of your consumption of polyols and how they affect you. The last thing you want is to be doubled over in pain just because you had the hankering for something sweet.
Polyols do not promote dental cavities, and one polyol, xylitol, may reduce the risk of dental cavities. Some polyols may also exert prebiotic effects, or selectively stimulate the growth or activity of certain “good” bacteria in the gut.
Some manufacturers list sugar alcohols and their gram weight under Total Carbohydrate on the Nutrition Facts panel of food labels. You can also look for sugar alcohols in the list of ingredients. Sugar alcohols can be found in candies, chewing gum, jams and jellies, various diet products, energy bars, baked goods, frozen confections, pharmaceuticals, and hygiene products such as toothpaste and mouthwash.
Zsweet. Zsweet is a new sweetener on the market made from a blend of erythritol and natural fruit extracts as flavor enhancers. It has zero calories and does not raise blood glucose. Erythritol can be found naturally in low levels in some foods, particularly fruits and fermented foods such as soy sauce, cheese, wine, beer, and cake. Unlike some other polyols, erythritol is highly digestable and does not cause a laxative effect. In addition, unlike some other sweeteners on the market, Zsweet closely resembles the texture, flow, and mouth-feel of real sugar.
If used for baking, it is recommended that Zsweet be substituted for approximately half of the sugar in the recipe (keep half of the called for, and substitute Zsweet for the other half). The company that manufactures this product is currently developing a Zsweet product intended solely for baking. Currently, Zsweet is available online, through www.zsweet.com, and on a limited basis throughout the United States.
Shugr. Swiss Diet’s Shugr is made from erythritol, maltodextrin (a carbohydrate from cornstarch), tagatose (an FDA-approved sugar replacer made from lactose that is incompletely absorbed by the body), and sucralose. Shugr is calorie-free, doesn’t cause cavities, raises blood glucose only a small amount, and, according to its manufactures, cooks just like real sugar. New to the market and currently available only via the Internet, more information on Shugr can be found at www.shugr.com.
Stevia. Stevia rebaudiana is a South Ameriacan shrub with sweet-tasting leaves. Powders and extracts derived from these leaves are gaining popularity in the United States, but unlike the aforementioned sweeteners that have FDA approval as GRAS or food additives, stevia is considered a supplement. What’s the difference? Foods given GRAS or food additive status are deemed safe for consumption daily. Supplements, however, are intended to “supplement” the diet and be used only in certain doses. The FDA has yet to change the status of stevia because its safety has been questioned by research studies. Therefore, under the FDA’s regulations, stevia cannot be marketed as a sweetener.
Everything in moderation
Foods with labels that say "low in sugar", "no added sugar", "low glycemic response", or "sugar free" most likely contain one or more sugar subtitutes. In fact, some products, such as sugarless gum, often contain four or five different sugar substitutes.
When consumed as part of a healthy diet, foods made with sugar substitutes or packets of sugar substitutes added to drinks such as coffee and tea can help a person with diabetes manage his carbohydrate intake and still enjoy a sweet or two. However, sugar-free foods are not necessarily carbohydrate-free, and they may not provide much in the way of nutrients. When choosing foods, therefore, consider what they do provide as well as what they don’t. processed foods made with sugar substitutes can fit into a diet of nutrient-rich foods such as fruits, vegetables, low-fat dairy products, whole grains, fish, and low-fat poultry and meat, but they shouldn’t be consumed in place of these foods.
Marie Spano is a registered dietitian and exercise physiologist. She is a freelance writer, consultant, and speaker in the nutrition, fitness, and health industries. In addition, she is a spokeperson for the International Society of Sports Nutrition.
FOR MORE INFORMATION
Recipes and more information about many sweeteners can be found on the Internet.
To learn more about all types of low-and reduced-calorie sweeteners (as well as fat replacers), visit the Web site of the Calorie Control Council, www.caloriecontrol.org
To learn more about food additives, visit the FDA’s Web site, www.cfsan.fda.gov/-lrd/foodadd.html
For recipes that use Equal (aspartame) and Equal Sugar Lite, go to www.equal.com/Recipes or call (800) 323-5316.
For recipes using NatraTaste (aspartame), go to www.natrataste.com.
For more information on neotame, visit the Web site www.neotame.com.
For recipes using SugarTwin (saccharin), go to www.sugartwin.com.
To learn more about or purchase Shugr (erythritol, maltodextrin, tagatose, and sucralose), go to www.shugr.com or call (877) 794-7734.
For recipes using Splenda (sucralose) or one of the Splenda Sugar Blends, go to www.splenda.com
For recipes using Sweet’N Low (saccharin), visit the Web site www.sweetlow.com.
To learn more about or purchase Zsweet (erythritol), go to www.Zsweet.com or call (866) 22-SWEET (227-9338). |
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