The diabetic diet has in the past been referred to as the sugar-free diet but many studies have shown that consuming iso-caloric amounts of other carbohydrates can raise blood glucose levels and aggravate hyperglycaemia more than sucrose itself. The consensus view is that sucrose may be consumed in the diet of people with diabetes at the same level, 10% of total calories, as that recommended for the general population.
Fructose has been shown to invoke a lower glucose and insulin response compared to other carbohydrates. However, dietary fructose in amounts comparable to those of sugars in Western diets (7.5 – 20% daily energy) can result in raised fasting triglycerides and LDL concentrations. There may also be a greater risk of gastrointestinal disturbances with large doses. There is no reason to believe that fructose either confers special benefits for people with diabetes or that it is detrimental to health in the amounts found in everyday foods.
Polyols or sugar alcohols like sorbitol, xylitol, mannitol and isomalt are bulk or nutritive sweeteners which contain calories and raise blood glucose levels.
They must still be accounted for in meal planning. They have a slightly lower glycaemic response than sucrose and a slightly lower calorie value (2.4 kcal/g) because they are not completely digested and absorbed. Polyols may therefore cause diarrhoea, particularly if consumed in large amounts (<25 g). Although they have a lower cardiogenic effect compared to sucrose, polyols offer no special benefit to people with diabetes.
Intense or non-nutritive sweeteners are sugar-free and calorie-free. Permitted sweeteners in the UK and Europe include aspartame, saccharin, acesulfame potassium, cyclamate, sucralose and alitame. These substances are very often used in combination as table-top sweeteners or in food products in order to produce a better flavour synergy or heat stability. There has been ongoing public debate about the safety of these substances, but there is no conclusive evidence to suggest that particular health problems are implicated by their use.
In the UK the government Food Standards Agency (FSA) (formerly the Ministry of Agriculture, Foods and Fisheries (MAFF)) monitors consumption of sweeteners and provides guidelines to the food industry regarding levels of intense sweeteners permitted in foods. In this way there is deemed to be control over intake.