Building Competency in Diabetes Education THE ESSENTIALS

5-12 | CHAPTER 5

Diabetes Canada recommends that carbohydrate intake be more than 45% (in part to prevent high intakes of fat) and up to 60% of total energy intake if carbohydrate is derived from low glycemic index and high fibre foods (35).

Sugars Traditionally, avoidance of sugar had been a major focus of nutritional advice for people with diabetes. However, scientific evidence clearly shows that sugars are an acceptable part of a healthy diet, especially sugars obtained from fruits, vegetables and dairy products. Naturally occurring sugars should be included as part of the daily carbohydrate allowance and a healthy eating plan (5). Food sources of sugars may be more important than type of sugar. Many studies in people with and without diabetes have shown increased risk of hypertension and coronary heart disease with intake of sugar-sweetened beverages (SSBs). The adverse effects are most apparent when intake of SSBs account for more than 10% of energy intake and are likely due to excess calories (36). This effect has not been shown for other sources of added or natural sugars (37-39). Sucrose Sucrose does not increase glycemia to a greater extent than isocaloric amounts of starch (40). Added sucrose intake of up to 10% of total daily energy requirements is acceptable, since there is no evidence that sucrose intake up to this level has any adverse effect on glycemic control or lipids in people with diabetes (41-43). Intake of sucrose >10% of total daily energy may increase BG and triglyceride levels in some patients (44,45). Intake of other nutrients ingested along with sucrose (such as fat) should be considered, and care must be taken to avoid excess energy intake. Fructose Systematic review and meta-analyses have shown that, for most people with type 2 diabetes, consumption of added fructose in place of equal amounts of other sources of carbohydrate is unlikely to have any harmful effect on body weight (46,47), blood pressure (48), or uric acid (47,49) and may even lower A1C (48,50,51). However, at amounts of >60 g/day or >10% total daily energy intake, fructose may have a small triglyceride raising effect in those with type 2 diabetes (52). Consuming naturally occurring fructose from fruit does not show evidence of harm .