Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: LIFESTYLE| 5-13

Encouraging low-glycemic index fruit over high-glycemic index fruit may provide glycemic benefit (53).

Sugar alcohols Sugar alcohols produce a lower postprandial BG response than glucose, fructose or sucrose and have lower available energy values (54). The conversion rate is slow, variable, usually minimal, and may have no significant effect on BG (35). Matching rapid-acting insulin to the sugar alcohol content of food is not recommended (55). When calculating the carbohydrate content of foods containing sugar alcohols, it is appropriate to subtract all of the sugar alcohol content from the total carbohydrate. There is no evidence that the amounts likely to be consumed in a meal or day result in a significant reduction in total daily energy intake or improvements in long-term BG control. Although the exact energy values of sugar alcohols vary, they average approximately 8 kJ (2 kcal) per gram, compared with 17 kJ (4 kcal) per gram from other carbohydrates. There are no long-term, randomized controlled trials of consumption of sugar alcohols by people with diabetes, but intake of up to 10 g/day does not appear to result in adverse effects (56). Excess amounts of sugar alcohols (>10 g per day) may have a laxative effect (56). There is no Acceptable Daily Intake (ADI) for the sugar alcohols, with the exception of erythritol (see Table 4). Non-nutritive sweeteners Acesulfame potassium, aspartame, cyclamates, neotame, saccharin, steviol glycosides, sucralose, tagatose, thaumatin and Monk fruit extract (57) have been approved by Health Canada and most have been shown to be safe when used by people with diabetes (58). There are limited data on the newer sweeteners, such as neotame and thaumatin. Some prospective cohort studies have shown an adverse association of non-nutritive sweetened beverages with weight gain, CVD and stroke, but evidence from systematic reviews and meta-analyses of randomized controlled trials have actually shown a weight loss benefit when non-nutritive sweeteners displace excess calories from added sugars. In Canada, sweeteners are regulated as food additives, and Health Canada sets standards regulating the amounts permitted for use in foods. ADI is defined as the amount of sweetener that can be safely consumed on a daily basis over a person’s lifetime without any adverse effects. ADI amounts are much higher than a person would typically consume, and the amounts are rarely achieved (e.g. the ADI of aspartame for a 75 kg male is 3,000 mg per day, and a 355 mL can of diet iced tea contains approximately 200 mg of aspartame; if this man’s only intake of aspartame was from the iced tea, then he could consume 15 cans per day).